Family Medicine - Jaundice In Adults

Front 1

What is the definition of jaundice?

Back 1

"Yellow Skin" related to Hyperbilirubinemia

Front 2

What is the pathogenesis of jaundice?

Back 2

A.Heme product degradation yields Hemoglobin
B.Hemoglobin transported to reticuloendothelial system, a.Heme is oxidized to bilverdin
C.Bilverdin converted to Unconjugated Bilirubin
D.Unconjugated Bilirubin circulates
1.Tightly bound to albumin and fat soluble
2.Unconjugated Bilirubin is insoluble in water
3.Concentrates in high albumin containing tissues skin and sclera jaundice
Unconjugated bilirubin converts to conjugated bilirubin by glucuronosyltransferase enzyme - only conjuagted bilirubin can be excreted

Front 3

What is the nl production of bilirubin?

Back 3

4 mg/kg/day

Front 4

How does unconjugated bilirubin circulate?

Back 4

1.Tightly bound to albumin and fat solublea.Displaced Bilirubin causesi.Albumin saturated with Bilirubin or
ii.Medications (e.g. Sulfisoxazole, Streptomycin, Vitamin K)

b.Displaced Unconjugated Bilirubin crosses blood-brain barrier and placentai.Results in toxicity (e.g. Hepatic Encephalopathy, Kernicterus)


2.Unconjugated Bilirubin is insoluble in watera.Not found in tears or Saliva
b.Unconjugated Bilirubin can not be excreted

3.Concentrates in high albumin containing tissuesa.Skin (especially face and trunk): Jaundice
b.Sclera: Scleral Icterus

Front 5

What is unconjuagted bilirubin measured as?

Back 5

Indirect
A.Normal: <1.0 mg/dl

Front 6

What are causes of increased indirect levels?

Back 6

A.Hemolysis1.Hemolytic Anemia (mild Hyperbilirubinemia)

B.Large heme load (e.g. large hematoma reabsorption)
C.Liver disease1.Hepatitis
2.Cirrhosis
3.Neoplasm

D.Hepatic congestion
E.Hereditary1.Gilbert's disease
2.Crigler-Najjar syndrome

Front 7

what are nl levels for conjugated bilirubin?

Back 7

A.<0.2 mg/dl

Front 8

What are causes for increased conjugated bilirubin?

Back 8

A.Intrahepatic Causes1.Hepatocellular diseasea.Viral Hepatitis
b.Alcoholic Liver Disease

2.Biliary Tract Obstruction
3.Drug induced cholestasis
4.Prolonged Total Parenteral Nutrition
5.Sarcoidosis
6.Pregnancy
7.Primary Biliary Cirrhosis
8.Primary Sclerosing Cholangitis

B.Extrahepatic Causes1.Cholelithiasis
2.Pancreatitis
3.Cryptosporidium infection (immunocompromised patient)
4.Cytomegalovirus infection
5.Cholangiocarcinoma
6.Cancer involving liver
7.Pancreatic Cancer
8.Lymphoma

Front 9

What test looks for urobilogen?

Back 9

Ictotest

Front 10

What diseases are positive for urobilinogen?

Back 10

A.Hepatitis
B.Liver disease1.Cirrhosis
2.Liver Metastases
3.Liver infarction

C.Hemolytic Jaundice

Front 11

What is bilirubin?

Back 11

Substance formed when red blood cells are broken down. Bilirubin is part of the bile, which is made in the liver and is stored in the gallbladder. The abnormal buildup of bilirubin causes jaundice

Front 12

What is hyperbilirubinemia?

Back 12

pathologic process consisting of an abnormal increase in the amount of bilirubin in the circulating blood, which may result in jaundice.