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Patients that go yellow
Index Case
Year One Lent Term
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Jaundice
• What does the term jaundice mean?
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Bilirubin-where can things go wrong?
• excess bilirubin production (Haemolysis)
• impaired uptake by the hepatocyte (hepatocellular jaundice)
• failure of conjugation (hepatocellular jaundice)
• impaired secretion of conjugated bile into the bile canaliculi (hepatocellular jaundice)
• impairment of bile flow subsequent to secretion by the hepatocyte (obstructive or cholestatic jaundice)
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Yellow Patient 1
• 35 year old man
• Feeling tired and run down
• GP notices jaundice and splenomegaly
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Yellow Patient 2
• 30 year old lady
• Social problems
• Acute admission unwell and jaundiced
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Yellow Patient 3
• 50 year old female
• Episodes of abdominal pain over last few months
• Now acute attack, pain severe so calls ambulance
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Yellow Patient 4
• 65 year old man
• Lost weight over last 3 months, off food, no abdominal pain
• Daughter who is nurse notices jaundice
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History and Examination
• What specific questions are you going to ask?
• What are you going to look for when you examine the patient?
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Investigations
• Which?
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NN+Haemolytic
++++++Hepatocellular
+++++++Cholestatic
AlkPTransaminases
Bilirubin
Liver Function Tests
Jaundice
Bilirubin ALT ALkP
Haemolytic + N N
Hepcellular ++ +++ +
Cholestatic +++ + +++
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Ultrasound
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Abdominal Ultrasound showing multiple gallstones in gallbladder
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US shows stone in Common Bile Duct
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MRCP showing stone in Common Bile Duct
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ERCP showing stone in Common Bile Duct
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CT Abdomen
• Mass in head of pancreas
• Obstruction of common bile duct
• Liver metastasis• Peritoneal disease and
ascites
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Patients that go yellow
• Several cases of jaundice due to different causes
• Thought about history, examination and investigations