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KCP 1: Jaundice - Coggle Diagram
KCP 1: Jaundice
Pre-hepatic
Etiology
Etiology
Unconjugated Hyperbilirubinemia
- Increased production of bilirubin
- Hemolysis (inc breakdown of RBC)
- sickle cell anemia, hereditary spherocytosis
- decreased production of RBC
- Drugs
- Rifampacin (Tuberculosis)
- Ribavirin (Antiviral for Hepatitis C)
More
Neonatal Jaundice
Overview
Physiological:
- deficiency of UGT1A1 will reach normal level at 3-4 months
- exacerbated by breast milk
Pathological:
Clinical Features
- Normal urine color
- unconjugated bilirubin is binded to albumin (plasma protein) hence it cannot pass filtration in glomerulus and hence urine color will not be darker.
- Normal Stool color
Diagnosis
- normal-increased un-conjugated bilirubin
- Increased indirect bilirubin van der brugh test
- normal liver function tests
- Decreased haptoglobin in hemolysis
- increased serum LDH in hemolysis
Hepatic
Clinical Features
- Normal Stool color
- Dark Urine Color
- Abdominal Pain ???
Diagnosis
- normal/increased indirect bilirubin
- Increased liver enzymes
- AST (asparate aminotransferase), ALT (alanine transaminase),
- AST > ALT indicates alcohol-liver disease
- ALT > AST indicates viral hepatitis
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Post-Hepatic
Etiology
Etiology
obstruction of outflow of bilirubinConjugated Hyperbilirubinemia
- Large Bile Duct Obstruction most common cause in
- Adults:
- stones
- neoplasms
- pancreatic head
- billiary tree
- strictures from surgery/ischemic injury
- Children:
- cystic fibrosis
- biliary atresia
- choledochal cysts
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Cholestatic Disease
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Cholangitis
Primary Scelerosing Cholangitis
Primary Biliary Cholangitis
EtiologyClinical Features
- pale stools aka Acholic stool
- abdominal pain
- right upper quadrant
- related to galbladder --> radiates to right shoulder
- skin xanthomas
- pruritis
Diagnosis
- increased cholestatic enzymes
- increased haptoglobin level
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Common in all 3:
Clinical Features
- Yellowing of eyes (icterus) and skin
2 mg/dL bilirubin
- Pruitis (sometimes)
- Fat malabsorption: steatorrhea, weight loss
Laboratory Investigations
- Van Der Bergh's Reaction
- Urine Bilirubin
- Urine Urobilinogen
- normal --> pre-hepatic
- increased --> hepatic
- decreased --> post-hepatic
- Dye Excretion Test
- Cyanine
- BSP (Bromosulphathein) test
- positive means theres some sort of liver damage. usually checked when there is no jaundice present
- alkaline phosphatase elevation: hepatic steatosis, alcoholic hepatitis
Overview
Flowchart for DDx:
Classification for Etiology
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