Term
normal serum Br is between 3-20umol/L
when is jaundice visible i.e. above what levels ? |
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Definition
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Term
| prehepatic jaundice. would the Br be conjugated or unconjugated? |
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Definition
billirubin unconjugated in pre hepatic jaundice.
it is conjugated in hepatic and post hepatic causes. |
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Term
| how is billirubin made water soluble? |
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Definition
| by conjugation in the liver with glucoronic acid |
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Term
| conjugated br is deconjugated into colourless urobilinogen by what? |
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Definition
colonic bacteria
this can then be oxidised to form urobilin and stercobilin that colours stools. |
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Term
| if a person with jaundice reports prodromal flu like illness what are you thinking? |
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Definition
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Term
| if the person has sudden onset jaundice with pain in an otherwise healthy person what are you thinking? |
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Definition
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Term
| list some drugs associated with jaundice and CI in jaundice |
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Definition
halothane
coamoxiclav
flucoxacillin
amitriptyline
chlorpromazine, imiprimine,
MAOI
methyldopa
isoniazid
rifampicin
thiouracil |
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Term
| how can you tell the difference between jaundice and caroteneamia? |
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Definition
in carotoneamia the sclera remains white
carotenemia is prominent in palms soles and face |
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Term
| in nuchal testing with PAPPA and BHCG what happens if the baby has downs? |
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Definition
the BHCG is raised
PAPPA is low |
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Term
| in quadruple test what is high and what is low if baby has downs? |
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Definition
BHCG and INHIBIN raised
other 2 are low |
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Term
| list causes of pre hepatic jaundice. please note the BR is unconjugated in this form of jaundice |
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Definition
Gilbert's syndrome: due to under activity of the conjugating enzyme
haemolytic anemia
thallasemia
trauma
Crigler-Najjar syndrome : deficient diphosphate glycosyltransferase |
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Term
| list causes of hepatocellular caused jaundice |
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Definition
hepatitis including alcoholic hepatitis, drug induced and and AI hepatitis
leptospirosis, brucellosis
hepatoxic chemicals: phosphorus and phenol
decompensated cirrhosis |
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Term
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Definition
due to corkscrew shaped bacteria called leptospiria.
usually spread through urine of rodents
symptoms can range from mild headaches to weils disease.
Weils disease is when the infected person gets jaundice, kidney failure and bleeding.
rx is with doxycycline |
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Term
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Definition
high contagious zoonosis
from unpasteurised milk and undercooked meat from infected animals or close contact with their secretions. |
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Term
| intrahepatic cholestasis can lead to jaundice. name some conditions that are included in this category |
|
Definition
PBC
PSC
drugs e.g. phenothiazines
Dubin-Johnson syndrome: black liver and conjugated Br
Rotor's syndrome: similar to dub in-johnson but does not cause black liver. main symptoms is itch less jaundice |
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Term
| causes of extra hepatic cholestasis jaundice |
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Definition
gallstones
bile duct strictures
cancer head of pancreas
tumour of ampulla of cater
pancreatitis
cancer of gallbladder |
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Term
| in post hepatic jaundice what colour are stools? |
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Definition
pale
and urine is dark. make sure to ask about this in hx |
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Term
| in cirrhossis AST is raised more than ALT. name conditions when ALT is > than AST |
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Definition
acute hepatitis
extrahepatic obstruction |
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Term
|
Definition
AST/ALT are hepatocellular
ALP is extra hepatic and raised in obstruction
GTT is non specific but sensitive for alcohol. |
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Term
| anti mitochondrial antibodies are the hallmark of which hepatic tract disease? |
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Definition
| primary billiary cirrhosis |
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Term
| imaging ix to do in liver disease |
|
Definition
Abdominal USS
CT
MRI
MRCP
ERCP
liver biopsy
laparotomy |
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Term
| what is the name of the syndrome when a gallstone impacted in the cystic duct causes common bile duct compression? |
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Definition
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|
Term
| pale stool and dark urine = |
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Definition
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|
Term
| billirubin is absent from urine in pre hepatic causes of jaundice what is this AKA? |
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Definition
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Term
| how much must the bile ducts be dilated by on USS in order for us to think there is an obstruction? |
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Definition
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Term
| mx of someone presenting with jaundice |
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Definition
USS liver
screen and address clotting irregularities
if pt has malignancy they will need a stent: plastic or metal
if gallstones: ERCP or operative cholangiogram that leaves a T tube in situ |
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Term
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Definition
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Term
in Hep B what does HBsAg imply?
what if it is present fro > 6months? |
|
Definition
acute disease present for 1-6 months.
if present for >6 months then it implies chronic disease |
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Term
what does anti-HBs imply?
it is found in chronic disease? |
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Definition
it implies immunity.
this can be from exposure or from vaccination
it is negative in chronic disease |
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|
Term
what doe the following findings suggest?
HBsAg
anti-HBs
anti-HBc
HbeAg |
|
Definition
HBsAG - recent infection within 1-6 months. >6months = chronic disease
anti-HBs - means immunity. this can be from exposure or vaccination. it is negative in chronic disease
anti-HBc - implies previous or current infection. initially you get IgM anti-HBc. after this you will have IgG anti-HBc
HBeAg- a marker of infectivity |
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Term
| which antibody finding in hep b would imply the infection was contracted in the past 6 months? |
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Definition
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|
Term
| in hep B what finding would imply immunity from either previous exposure to Hep B or from immunisation? |
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Definition
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Term
what does anti-HBc imply
what does IgM and IgG got to do with this? |
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Definition
it implies previous or current infection.
if it is IgM anti-HBC then you think there is a current infection
if it is IgG anti-HBc you think they had it in the past |
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Term
| in Hep b what finding suggests a marker of infectivity? |
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Definition
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Term
| previous immunisation for Hep B what would serum markers reveal? |
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Definition
anti-HBs positive
all other markers negative |
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Term
| previous Hep b infection > 6 months ago. the person is not a carrier. what would be the findings? |
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Definition
anti-HBc positive
HBsAg negative |
|
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Term
| previous Hep B, now a carrier, what would antibody tests reveal? |
|
Definition
anti-HBc positive
HBsAg positive |
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Term
| rx for hepatic related pruritis |
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Definition
|
|
Term
| which medication is a bile salt and can be given to people with small gallstones as a medical management? |
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Definition
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|
Term
| what is the recommended units of alcohol that men and women should not exceed a week? |
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Definition
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Term
| one unit of alcohol is equal to how many ml of alcohol? |
|
Definition
|
|
Term
| what determines the strength of the alcohol? |
|
Definition
| the ABV = alcohol by volume |
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Term
| how to calculate the number of units in a drink?? |
|
Definition
you multiply the volume of the drink in ml by the ABV then divide by 1000.
eg. pint of 5% beer.
pint = 568ml
568 X 5% (abv) = 2840/1000 = 2.84 units |
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Term
| ways to prevent hepatitis |
|
Definition
limit alcohol men and women to no more than 14 u per week over 3 days
if travelling don't drink unsafe water
don't have unprotected sex |
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|
Term
| describe mechanism of alcohol withdrawal |
|
Definition
chronic alcohol use enhances GABA in the CNS much like BDZ. it also inhibits glutamate NMDA receptors.
withdrawal leads to the opposite effects |
|
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Term
| time line for alcohol withdrawal |
|
Definition
symptoms start at 6-12 hours
peak incidence of seizures 36hours
peak incidence of DT at 72 hours |
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|
Term
| when is the peak incidence for seizures from alcohol withdrawal? |
|
Definition
36 hours
peak incidence for DT is 72 hours. |
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Term
| mx of alcohol withdrawal? |
|
Definition
| BDZ e.g. chroldiazepoxide. |
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|
Term
mx for acute withdrawal in alcohol is BDZ
what is antabuse MOA?
CI? |
|
Definition
it is called Disulfiram
it inhibits acetaldehyde dehydrogenase causing a flushing hangover reaction.
CI in ischemic heart disease and psychosis |
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Term
| which medication is a weak antagonist of NMDA glutamate receptor in the CNS and is believed to reduce cravings in withdrawing alcoholics so long as they are motivated? |
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Definition
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