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Transcript

Pre-Hepatic

Post-Hepatic

Info

Info

Hepatic

Info

Jaundice

Jaundice is a yellow discolouration of the skin and sclera due to a raised serum Bilirubin. ​ Understanding bilirubin metabolism will help you understand Jaundice.

Excreted

Conjugated

Created

Jaundice

Build up of Bilirubin may occur due to problems with any part of this pathway and so we can break down the causes into pre-hepatic, hepatic and post hepatic. Thinking about the causes will help you understand what symptoms and signs to look for to narrow your differential diagnosis ​ ​

The skin and sclera are both discoloured yellow. Jaundice may be more difficult to recognise in Black and Brown skin. Check out 'Mind the Gap: A handbook of clinical signs in Black and Brown skin' on the CARES 2 reading list

Breakdown product of Haemoglobin metabolism

travels to liver bound to albumin (unconjugated) conjugated in the liver

soluble conjugated bilirubin excreted in bile into duodenum >> in colon deconjugated by colon bacteria >>> urobilinogen >>> stercobilin >>> excreted in faeces (gives stool the brown colour)

e.g Haemolytic anaemias, Gilbert’s syndrome

e.g Viral hepatitis, Drug-induced hepatitis

e.g common bile duct stone, malignancy

Ask about: Risk factors e.g travel, drug, alcohol hx. Abdominal painFeverFatigueLook for: signs of chronic liver disease​e.g spider naevi, gynaecomastia, palmar erythema

Ask about: Fatigue, breathlessness (anaemia)​Look for: Clinical sings of anaemia lymphadenopathysplenomegaly

Ask about: Abdominal pain Weight lossStool colour​ Look for: Abdominal tendernessMasses RUQ/Epigastrium