Virus - hepatitis, autoimmune Pregnancy related: HELLP / acute fatty liver Decreased clearance - biliary excretion problem Gallstone disease : CBD stone, ascending cholangitis Wisecracks: 1) What are clinical signs of liver disease? Abnormalities in bilirubin metabolism: Jaundice - usually not obvious until >25 mg/L seen in tissues with high albumin concentrations: skin, eyes, absent in tears, saliva Symptoms: May be asymptomatic or have: pruritus, malaise, nausea Jaundice with abdominal pain = biliary obstruction or hepatic inflammation Jaundice WITHOUT abdominal pain = pancreatic neoplasm Ask about fit of clothing (ascites) or personality changes Signs: Skin Sublingual or conjunctival jaundice Signs of liver disease: angiomas, excoriations, caput medusae, ascites, liver borders and texture, splenomegaly, neurologic examination, asterixis Stages of encephalopathy see table in Rosen’s – 2) What laboratory tests can be useful in a jaundiced patient? GGT = confirms a hepatic source of ALP if ALP is up ALP can also be elevated from bone or placental sources An elevated reticulocyte count can suggest hemolysis Acetaminophen level*** (AST is first to rise) Glucose level Ammonia - is of limited use and does NOT correlate with degrees of hepatic encephalopathy Ascitic fluid - for analysis Blood cultures - for fever
Virus - hepatitis, autoimmune Pregnancy related: HELLP / acute fatty liver Decreased clearance - biliary excretion problem Gallstone disease : CBD stone, ascending cholangitis Wisecracks: 1) What are clinical signs of liver disease? Abnormalities in bilirubin metabolism: Jaundice - usually not obvious until >25 mg/L seen in tissues with high albumin concentrations: skin, eyes, absent in tears, saliva Symptoms: May be asymptomatic or have: pruritus, malaise, nausea Jaundice with abdominal pain = biliary obstruction or hepatic inflammation Jaundice WITHOUT abdominal pain = pancreatic neoplasm Ask about fit of clothing (ascites) or personality changes Signs: Skin Sublingual or conjunctival jaundice Signs of liver disease: angiomas, excoriations, caput medusae, ascites, liver borders and texture, splenomegaly, neurologic examination, asterixis Stages of encephalopathy – see table in Rosen’s 2) What laboratory tests can be useful in a jaundiced patient? GGT = confirms a hepatic source of ALP if ALP is up ALP can also be elevated from bone or placental sources An elevated reticulocyte count can suggest hemolysis Acetaminophen level*** (AST is first to rise) Glucose level Ammonia - is of limited use and does NOT correlate with degrees of hepatic encephalopathy Ascitic fluid - for analysis Blood cultures - for fever
CrackCast-Shownotes-Episode-28-Jaundice.docx