Patients that go yellow

Index Case

Year One Lent Term

Jaundice

• What does the term jaundice mean?

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)

.

Yellow Patient 1

• 35 year old man

• Feeling tired and run down

• GP notices jaundice and splenomegaly

Yellow Patient 2

• 30 year old lady

• Social problems

• Acute admission unwell and jaundiced

Yellow Patient 3

• 50 year old female

• Episodes of abdominal pain over last few months

• Now acute attack, pain severe so calls ambulance

Yellow Patient 4

• 65 year old man

• Lost weight over last 3 months, off food, no abdominal pain

• Daughter who is nurse notices jaundice

History and Examination

• What specific questions are you going to ask?

• What are you going to look for when you examine the patient?

Investigations

• Which?

NN+Haemolytic

++++++Hepatocellular

+++++++Cholestatic

AlkPTransaminases

Bilirubin

Liver Function Tests

Jaundice

Bilirubin ALT ALkP

Haemolytic + N N

Hepcellular ++ +++ +

Cholestatic +++ + +++

Ultrasound

Abdominal Ultrasound showing multiple gallstones in gallbladder

US shows stone in Common Bile Duct

MRCP showing stone in Common Bile Duct

ERCP showing stone in Common Bile Duct

CT Abdomen

• Mass in head of pancreas

• Obstruction of common bile duct

• Liver metastasis• Peritoneal disease and

ascites

Patients that go yellow

• Several cases of jaundice due to different causes

• Thought about history, examination and investigations