Hepatic And Post-hepatic Jaundice Sonal Pruthi Roll Number - 82

Defective Hepatic Uptake Abnormal Conjugation Hepatocellular Damage Gilbert’s Syndrome Drugs Rifampicin Novobiocin Probenecid Viral Hepatitis Alcoholic Hepatitis Drug Induced Hepatitis Autoimmune hepatitis Toxic Hepatitis Criggler Najjar Syndrome Viral Hepatitis Drugs Primaquine Novobiocin Pregnanediol Chloramphenicol Hepatic Jaundice

Hepatitis AHepatitis BHepatitis CHepatitis D Hepatitis E EBVCMV Viral Hepatitis

Hepatitis A

HBsAg HBeAg Total Anti-HBc IgM Anti-HBc Anti-HBe Anti-HBs HBV DNA Hepatitis B

HBV DNA

HBsAg

HBeAg

Total Anti - HBc

IgM-Anti HBc

Hepatitis C

Clinical Features- Hepatic Jaundice Icterus Spider telangiectasia Asterixis Palmar erythema Fetor hepaticus Gynaecomastia Testicular atrophy Ascites

Obstructive Jaundice Intrahepatic Cholestasis Extrahepatic Cholestasis Primiary Biliary Cirrhosis Primary Sclerosing Cholangitis Dubin Johnson Syndrome Rotor’s Syndrome BRIC PFIC Drugs - phenothiazines Bile duct strictures Common duct stone. Periampullary carcinoma

Gall bladder Stone The majority of cases (approximately 80%)are asymptomatic (silent) gall stones, discovered accidentally by abdominal sonar. Obstruction of common bile duct leading to pain & jaundice

Periampullary Carcinoma CBD Duodenum Ampulla Pancreas

Clinical features - Obstructive Pain due to gallbladder disease, malignancy or stretching of the liver capsule Fever due to ascending cholangitis Palpable and / or tender gallbladder Enlarged liver usually smooth

Investigations HepaticPost-hepatic Total BilirubinIncreased Conjugated Bilirubin Increased Unconjugated Bilirubin IncreasedNormal UrobilinogenIncreasedDecreased/ absent StercobilinNormalReduced/absent

 ALT and AST – Raised ALT specific for liver injury ALT>1000 IU/L - suggestive of Hepatocellular injury AST:ALT > 2:1 Suggestive of ALD AST:ALT < 1 Suggestive of viral hepatitis Enzymes that reflect damage to hepatocytes

Enzymes that reflect Cholestasis  Alkaline Phosphatase – Raised  large bile duct obstruction  Intrahepatic cholestasis  Gamma Glutamyl transferase  more sensitive marker for cholestasis as compared to ALT

Investigations  Prothrombin Time  might be increased in cases of hepatic jaundice.  Disorders that lead to Vitamin K deficiency  Serum ANA and Anti Smooth Muscle Antibody  positive in patients with PBC

Clinical Vignette Match the clinical description with the most likely disease process. a. Primary biliary cirrhosis b. Sclerosing cholangitis c. Anaerobic liver abscess d. Hepatoma e. Hepatitis C f. Hepatitis D g. Hemochromatosis

A 40-year-old white female complains of pruritus. She has an elevated alkaline phosphatase and positive antimitochondrial antibody test. CHOOSE 1 DISEASE PROCESS

A 70-year-old male with a long history of diverticulitis has low-grade fever, elevated alkaline phosphatase, and right upper quadrant pain. CHOOSE 1 DISEASE PROCESS

A 30-year-old male with ulcerative colitis develops jaundice, pruritus,and right upper quadrant pain. Liver biopsy shows an inflammatory obliterative process affecting intrahepatic and extrahepatic bile ducts. CHOOSE 1 DISEASE PROCESS

A 40-year-old white male complains of weakness, weight loss, and abdominal pain. On examination, the patient has diffuse hyperpigmentation, icterus and a palpable liver edge. Polyarthritis of the wrists and hips is also noted. Fasting blood sugar is 185 mg/dL. The most likely diagnosis is a. Insulin-dependent diabetes mellitus b. Pancreatic carcinoma c. Addison’s disease d. Hemochromatosis

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