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57 Cards in this Set
- Front
- Back
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The focal point of bilirubin metabolism is within the __?
-duodenum -liver -large colon -gall bladder |
liver
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__ is the yellow discoloration of the skin and sclera due to deposition of the bile pigment bilirubin.
-bile -jaundice -hemolytic anemia |
jaundice
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icterus is an old fashioned name for __?
-nystagmus -jaundice -hepatitis -cirrhosis |
jaundice
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bilirubin is the breakdown product of __ and is modified in the liver (conjugated) before being excreted in the bile.
-rbc's -platelets -hemoglobin -wbc's |
hemoglobin
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Bilirubin is excreted within the __.
-stool -urine -bile |
bile
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The causes of jaundice should be classified as __. (3 ways)
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pre-hepatic
hepatic post-hepatic Another classification system divides jaundice into hepatic and cholestatic causes |
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__ causes simply mean those agents that damage the liver cells, interfering with their functions (including bilirubin metabolism).
-hepatic causes -cholestatic causes |
hepatic causes
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T/F
the distinction between hepatitic and cholestatic causes is somewhat artificial because elements of both may co-exist in the same pt. |
True, true, oh so true.
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__causes are those that obstruct the normal flow of bile into the small intestine.
-hepatic -cholestatic -biliary |
cholestatic
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Name the subdivisions of cholestatic causes of jaundice. Yuck, it's complicated.
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1) intrahepatic cholestasis-where the disturbance occurs in the intrahepatic bile ducts and canliculi and the intrahepatic ducts.
2) extrahepatic cholestasis-the disturbance is in the extraphepatic ducts, such as the common bile duct. |
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__ is a bile pigment which results from a breakdown of hemoglobin.
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bilirubin
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normally, the bilirubin is taken up by the __ cells.
-hemoglobin -rbc's -liver -cholestatic |
liver
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bilirubin gets excreted in the bile via the __ into the small intestine.
-biliary tree -gall bladder -portal vein -common bile duct |
biliary tree
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t/f
jaundice occurs as a result of unconjugated bilirubin in the blood. Conjugated bilirubin does not cause jaundice. |
false; may be of either type, conjugated or unconjugated
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when _ bilirubin increases in the blood, it may appear in the urine, resulting in 'cola colored' urine.
-conjugated -unconjugated |
conjugated
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t/f
unconjugated bilirubin is not excreted in the urine. |
true
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when excretion of bile into the intestine is obstructed the stools will turn _.
-black -watery -acholic |
acholic
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acholic stools are a frequent manifestation of _ jaundice.
-hemolytic -hepatic -obstructive |
obstructive
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__ jaundice is a result of unconjugated hyperbilirubinemia.
-pre hepatic -hepatic -post hepatic |
pre hepatic
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__ jaundice is a result of conjugated hyperbilirubinemia.
-pre hepatic -hepatic -post hepatic |
post hepatic
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Biliary obstruction malignancy, biliary strictures, stones, primary sclerosing cholangitis are all examples of __ jaundice.
-pre hepatic -hepatic -post hepatic |
pre hepatic
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Cirrhosis, hepatitis, viruses, etoh, autoimmune, drugs, malignancy, liver congestion, heart failure are examples of __ jaundice.
-pre hepatic -hepatic -post hepatic |
hepatic
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__ jaundice results in a mix of unconjugated and conjugated bilirubin.
-pre hepatic -hepatic -post hepatic |
hepatic
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Inc. bili production, hemolytic anemia, reabsorption from a hematoma, dec. ehpatic intake, dec. hepatic conjugation of bili, and an inc. in unconjugated bili production are all causes of __ jaundice.
-pre hepatic -hepatic -post hepatic |
pre hepatic
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An increase in alanine and ast are signs of _ causes of jaundice.
-pre hepatic -hepatic -post hepatic |
hepatic
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an increased level of unconjugated bilirubin is evidence of a _ cause of jaundice.
-pre hepatic -hepatic -post hepatic |
pre hepatic
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A pt's labs show elevated levels of Alk. Phos and GGT, you know that this means there jaundice is from a _ cause.
-pre hepatic -hepatic -post hepatic |
post hepatic
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within the duodenum which of following part of digestion occurs?
-emulsification & digestion of fats -micelle formation & fat absorption -active absorption of bile salts |
emulsification & digestion of fats
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within the ileum what part of digestion occurs?
-emulsification & digestion of fats -micelle formation & fat absorption -active absorption of bile salts |
active absorption of bile salts
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within the jejunum, what part of digestion occurs?
-emulsification & digestion of fats -micelle formation & fat absorption -active absorption of bile salts |
micelle formation & fat absorption
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what is the normal range of bilirubin?
-0.0 to 0.9 -0.1 to 1.1 -0.2 to 1.0 -0.2 to 1.5 |
0.2 to 1
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Jaundice becomes clinically evident when the bilirubin level reaches what point?
-1.2 -1.5 -1.8 -2.0 |
1.5
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A jaundiced sclera indicates a bilirubin level of _.
-1.5 -2.0 -2.5 -5.0 |
2.0-but this is UNreliable
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bilirubin is taken up by the liver and conjugated with __.
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glucuronic acid
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unconjugated bilirubin is transported thru the blood attached to a _ molecule to the liver.
-hemoglobin -fat -albumin -protein |
albumin
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bile is secreted from the liver into the __.
-gall bladder -pancreatic duct -intestine -liver |
intestine
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in the intestine, glucuronic acid is removed by bacteria, The resulting bilirubin is converted to __.
-bile -waste -urobilinogen |
urobilinogen
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excess amounts of urobilinogen go where?
-the gall bladder -the stool -the urine |
out in the pee, what ever the liver doesn't need, goes out...p..p..ppppp
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t/f
urobilinogen reappears in urine when obstruction begins to abate. |
true
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which of the following is soluble in plasma?
-conjugated bilirubin -unconjugated bilirubin |
conjugated bilirubin is water soluble
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conjugated bilirubin is the same as __.
-direct bili -indirect bili |
direct bili
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albumin/pre-albumin are the markers of __.
-liver disease -nutrition -degree of chonicity of illness |
nutrition
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in a neonate, an elevation of __ bilirubin usually is evident int he first 48-72 hours.
-direct bilirubin -indirect bilirubin |
indirect bilirubin
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elevated direct bilirubin should lead you to think of __.
-biliary obstruction -hemolysis -hereditary spherocytosis -hepatitis -A & D -B & C -all of the above |
A & D, biliary obstruction and hepatitis
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t/f
ALT is always higher than AST levels with hepatitis. |
true
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__ comes from the cytosol of the hepatocytes and AST.
-ALT -GGT -ALP |
ALT
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Swelling of the liver cells d/t inflammation as in hepatitis, results in __ levels being markedly elevated.
-AST -ALT -Alk. Phos |
ALT
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__ comes from the mitochondria of the hepatocytes.
-ALT -AST -GGT |
AST
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Abnormal AST + ALT = ?
-hepatocellular damage -obstructive liver disease -viral hepatitis -alcoholic hepatitis |
hepatocellular disease
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ALT > AST in ?
-obstructive liver disease -cirrhosis -viral hepatitis |
viral hepatitis
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hemolytic anemia, excessive breakdown of rbc's, reabsorption of a hematoma, spherocytosis, and sickle cell are all examples of what type of jaundice?
-pre hepatic -hepatic -post hepatic |
pre hepatic
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t/f
pre hepatic jaundice is not usually severe. |
true
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t/f
in pre hepatic jaundice you will have elevated levels of unconjugated bilirubin, + urobilinogen int he urine, and the ALP, AST, ALT will all be elevated. |
false; the ALP, ALT, AST are all NORMAL
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etoh, hepatitis, cirrhosis, drugs, and malignancy are all causes of _ jaundice.
-pre hepatic -hepatic -post hepatic |
hepatic
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there will be _% loss of hepatic function before you will see jaundice.
-50 -75 -80 -90 |
80% loss
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__ is widespread fibrosis and nodule formation within the liver.
-hepatitis -cirrhosis -etohic cirrhosis |
cirrhosis
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if you have increased red cell destruction within the reticulo-endothelial system, this is called _ that will result in increased unconjugated bilirubin levels, and eventually jaundice.
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hemolysis
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