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Questions and Answers
What is the primary cause of jaundice?
What is the primary cause of jaundice?
Jaundice occurs when bilirubin levels exceed 3 mg/dl.
Jaundice occurs when bilirubin levels exceed 3 mg/dl.
True
What is the condition called when bilirubin levels are elevated?
What is the condition called when bilirubin levels are elevated?
Hyperbilirubinemia
Excessive bilirubin formation typically occurs due to ____________ lysis.
Excessive bilirubin formation typically occurs due to ____________ lysis.
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Match the type of jaundice with its classification:
Match the type of jaundice with its classification:
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Which type of bilirubin is water soluble?
Which type of bilirubin is water soluble?
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Icterus is a term used to describe the yellow coloration of the skin and sclera associated with jaundice.
Icterus is a term used to describe the yellow coloration of the skin and sclera associated with jaundice.
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What is the main component that bilirubin binds to in the blood?
What is the main component that bilirubin binds to in the blood?
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What causes hepatocellular jaundice?
What causes hepatocellular jaundice?
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Gilbert's syndrome is a form of obstructive jaundice.
Gilbert's syndrome is a form of obstructive jaundice.
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What type of jaundice is primarily caused by bile duct obstruction?
What type of jaundice is primarily caused by bile duct obstruction?
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The accumulation of bile salts in the liver can lead to _____, which causes itching.
The accumulation of bile salts in the liver can lead to _____, which causes itching.
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Match the following conditions with their associated causes:
Match the following conditions with their associated causes:
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Which symptom indicates the presence of obstructive jaundice?
Which symptom indicates the presence of obstructive jaundice?
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Hyperbilirubinemia can be predominantly unconjugated in cases of viral hepatitis.
Hyperbilirubinemia can be predominantly unconjugated in cases of viral hepatitis.
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In cases of hypersplenism, the spleen's function can lead to increased _____ destruction.
In cases of hypersplenism, the spleen's function can lead to increased _____ destruction.
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What is a characteristic of hepatitis B carriers?
What is a characteristic of hepatitis B carriers?
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Hepatitis D can exist and infect independently without HBV.
Hepatitis D can exist and infect independently without HBV.
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What is the primary mode of transmission of Hepatitis C?
What is the primary mode of transmission of Hepatitis C?
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Hepatitis C accounts for most cases of __________ hepatitis.
Hepatitis C accounts for most cases of __________ hepatitis.
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Which population has a high incidence of hepatitis B carriers?
Which population has a high incidence of hepatitis B carriers?
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Match each type of hepatitis with its characteristic:
Match each type of hepatitis with its characteristic:
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Some HBV infected patients may show no signs of liver abnormality.
Some HBV infected patients may show no signs of liver abnormality.
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HCV is primarily responsible for __________ infections.
HCV is primarily responsible for __________ infections.
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What is a common risk factor for gallbladder carcinoma?
What is a common risk factor for gallbladder carcinoma?
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Pancreatitis can only present in a chronic form.
Pancreatitis can only present in a chronic form.
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What is the main structure in the pancreas that allows the entry of pancreatic juices into the duodenum?
What is the main structure in the pancreas that allows the entry of pancreatic juices into the duodenum?
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The pancreas predominantly contains ______ tissue.
The pancreas predominantly contains ______ tissue.
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Match the following pancreatic conditions with their descriptions:
Match the following pancreatic conditions with their descriptions:
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Which enzyme is NOT typically found in pancreatic juices?
Which enzyme is NOT typically found in pancreatic juices?
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The sphincter of Oddi controls the entry of pancreatic juices and bile into the duodenum.
The sphincter of Oddi controls the entry of pancreatic juices and bile into the duodenum.
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What do pancreatic juices contain that neutralizes incoming gastric acid?
What do pancreatic juices contain that neutralizes incoming gastric acid?
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What percentage of the pancreas does the body constitute?
What percentage of the pancreas does the body constitute?
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The prognosis for pancreatic cancer is generally favorable with a high survival rate beyond 5 years.
The prognosis for pancreatic cancer is generally favorable with a high survival rate beyond 5 years.
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What is the significance of Courvoisier's sign in clinical presentation?
What is the significance of Courvoisier's sign in clinical presentation?
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Most pancreatic tumors spread to the _____ first through hematogenous routes.
Most pancreatic tumors spread to the _____ first through hematogenous routes.
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Match the clinical presentations with their corresponding descriptions:
Match the clinical presentations with their corresponding descriptions:
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Study Notes
Jaundice
- Caused by bilirubin metabolism abnormalities.
- Bilirubin, a hemoglobin breakdown product, is produced in several steps:
- Aged or damaged RBCs are phagocytosed in the liver and spleen.
- Hemoglobin is degraded in Kupffer cells and the spleen.
- Iron is removed from heme, resulting in bilirubin.
- Bilirubin is released into the blood and binds to albumin.
- Unconjugated, non-water-soluble bilirubin is conjugated in the liver.
- Water-soluble, conjugated bilirubin becomes part of bile, aiding in fat digestion.
- Excess bilirubin is reabsorbed in the intestines and recycled to the liver.
- Bilirubin is also excreted in urine. This process is called enterohepatic circulation.
Hyperbilirubinemia
- Occurs when bilirubin levels are elevated.
- Normal level is 0.3-1 mg/dl.
- Classified biochemically:
- Conjugated
- Unconjugated
- Mixed conjugated & unconjugated
- Jaundice, the yellow coloration of the skin and sclera, occurs when:
- Bilirubin levels exceed 3 mg/dl.
- It is an observable clinical marker for liver dysfunction.
- Types of jaundice:
- Prehepatic (hemolytic) jaundice: unconjugated hyperbilirubinemia.
- Hepatic jaundice: mixed, conjugated & unconjugated hyperbilirubinemia.
- Posthepatic (obstructive) jaundice: conjugated hyperbilirubinemia.
Prehepatic (hemolytic) Jaundice
- Excessive bilirubin formation due to erythrocyte lysis (hemolysis).
- Etiology:
- Abnormal hemoglobins (sickle cell, thalassemia).
- Immune-mediated blood mismatches.
- Drug-induced hemolysis.
- Hypersplenism.
- Resolution of large bruises (especially in newborns).
- Genetic lack of conjugating enzymes (Gilbert's Syndrome):
- Autosomal dominant defect in bilirubin uptake.
- Mild jaundice, not clinically significant.
- Hemolysis overwhelms the liver's capacity to conjugate and excrete bilirubin.
- Tissue bilirubin deposition leads to jaundice.
Hepatocellular Jaundice
- Most common type of jaundice seen clinically.
- Failure of the liver to take up, conjugate, or excrete bilirubin.
- Hyperbilirubinemia can be predominantly unconjugated or conjugated depending on the pathology.
- Etiology:
- Damage to liver cells by infection, tumors, drugs or chemicals.
- Viral hepatitis is the most common cause.
- Other causes include drugs, alcoholic cirrhosis, and metabolic diseases.
- Neonatal jaundice in newborns:
- Due to liver immaturity and increased bilirubin load.
- Predominantly unconjugated.
- Damage to liver cells by infection, tumors, drugs or chemicals.
Post-hepatic (obstructive) Jaundice
- Obstruction of the bile duct system.
- Disturbance in the excretion of conjugated bile.
- Bile flow to the duodenum is reduced or blocked (cholestasis).
- Bilirubin and bile salts accumulate in the liver and spill into the blood.
- Etiology:
- Intrahepatic causes:
- Infections, drugs, and swelling causing compression of intrahepatic ducts.
- Congenital biliary atresia: deficient quantity of bile ducts.
- Extrahepatic causes:
- Obstruction of the common bile duct.
- Intrahepatic causes:
Hepatitis B Virus Carrier State
- Some patients are unable to eliminate HBV particles due to inadequate immune response.
- Infection persists, with minimal liver dysfunction or no abnormality.
- Carriers are asymptomatic but still infectious and capable of spreading the virus for prolonged periods.
- Identifying carriers can be difficult as some may have had undiagnosed mild infections.
- Does not exist for hepatitis A, but exists for hepatitis B & C.
- High among homosexuals and intravenous drug users.
Hepatitis C
- First NANB virus identified.
- Etiology:
- Responsible for most post-transfusion hepatitis before screening for HCV.
- Sporadic epidemics.
- Sexual transmission possible.
- Pathology and prognosis:
- Initial illness milder than HBV but progresses to chronic hepatitis in 50% of infected individuals.
- Risk factors:
- Development of cirrhosis.
- Higher incidence of hepatocellular carcinoma.
Hepatitis D
- Cannot infect alone, only in concert with HBV.
- HDV is a viroid, an incomplete RNA virus that requires HBV for infection.
- Infection occurs simultaneously with HBV (co-infection) or superimposed on established HBV (superinfection).
Hepatitis E
- Not common in the US.
Gallbladder Carcinoma
- Common in older patients, mostly female.
- Risk factor: gallstones.
- Grows into the liver, extrahepatic ducts, and duodenum.
- Few symptoms until late disease, with early metastases.
- Poor prognosis.
Pancreas
- Two main diseases: inflammation (pancreatitis) and neoplasia (pancreatic cancer).
- Problems uncommon but significant.
Anatomy and Physiology of the Pancreas
- Head: in the curve of the duodenum.
- Tail: against the hilum of the spleen.
- Body: centrally located.
- Predominately exocrine tissue: secretes 20 digestive enzymes.
- Duct system:
- Pancreatic duct joins the common bile duct, both entering the duodenum at the Ampulla of Vater.
- Entry is controlled by the sphincter of Oddi.
- Pancreatic juices contain:
- Bicarbonate: neutralizes gastric acid.
- Pro-enzymes: inactive forms of enzymes.
Pancreatitis
- Can be acute (life-threatening) or chronic (recurring acute episodes).
Acute Pancreatitis
- Etiology and pathogenesis:
- Potent proteolytic and lipolytic enzymes are normally inactive.
- Digestion of pancreatic tissue and blood vessels by these enzymes causes necrosis and hemorrhage.
- Commonly seen in patients with alcohol abuse.
- Histology: moderately differentiated with prominent fibrosis.
Pancreatic Cancer
- Bulk of pancreas is in the head, containing most of the ducts.
- Body – 10%.
- Tail - 5%.
- Diffuse – 25%.
- Histology: most are moderately differentiated with prominent fibrosis.
- Clinical picture:
- Early metastases, widely spread at diagnosis.
- Location of pancreas makes metastasis easy.
- Main routes:
- Local: obstructive jaundice.
- Lymphatic: regional lymph nodes.
- Hematogenous: liver first.
- Clinical presentation syndromes:
- Weight loss, anorexia, chronic epigastric pain radiating to the back.
- Obstructive jaundice with painless gallbladder enlargement (Courvoisier's sign).
- Migratory thrombophlebitis in the legs.
- Other symptoms: ascites, splenomegaly, intestinal obstruction.
- Prognosis: very poor due to aggressive growth and early metastases.
- 5-year survival rate is 5%, compared to 50% for colorectal and 70% for Hodgkin's.
- Most die within 6-12 months of diagnosis.
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Description
Explore the mechanisms behind jaundice and hyperbilirubinemia, focusing on bilirubin metabolism and its role in the body. Learn about the causes, classifications, and effects of elevated bilirubin levels, including its impact on skin coloration. This quiz provides insightful knowledge essential for understanding liver health.
