Worksheetspre-, post- hepatic disorders
Total questions: 21
Worksheet time: 11mins
Prehepatic jaundice
Hemolytic anemias
Hemolytic Disease of the Fetus and Newborn ( HDFN )
Gilbert’s Syndrome
Crigler – Najjar Syndrome
Hepatic inability to conjugate so much bilirubin
TBIL usually < 5.0 mg / dl
↑ Total Bilirubin ↑ Unconjugated Normal conjugated
Negative Urine Bilirubin
Hemolytic anemias
Hemolytic Disease of the Fetus and Newborn ( HDFN )
Gilbert’s Syndrome
Crigler – Najjar Syndrome
Mother – Newborn Blood Group incompatibility(ABO, Rh, or other )
Maternal IgG antibodies cross the placenta and attack fetal RBCs
Increased hemolysis of fetus or newborn’s RBCs
Hemolytic anemias
Hemolytic Disease of the Fetus and Newborn ( HDFN )
Gilbert’s Syndrome
Crigler – Najjar Syndrome
Genetic liver disease
Reduced activity of glucuronyl transferase
Most common hereditary cause of hyperbilirubinemia
Most patients asymptomatic
Hemolytic anemias
Hemolytic Disease of the Fetus and Newborn ( HDFN )
Gilbert’s Syndrome
Crigler – Najjar Syndrome
Type I
Complete absence of glucuronyl transferase
Potentially life-threatening
Type II
Decreased levels of glucuronyl transferase
Hemolytic anemias
Hemolytic Disease of the Fetus and Newborn ( HDFN )
Gilbert’s Syndrome
Crigler – Najjar Syndrome
Hepatic jaundice
Hemolytic anemias
Hemolytic Disease of the Fetus and Newborn ( HDFN )
Gilbert’s Syndrome
Crigler – Najjar Syndrome
Genetic defect
Defect of bilirubin transport
Most patients only symptom is jaundice
Dubin – Johnson and Rotor’s Syndrome
Physiological Jaundice of the newborn
Hepatitis - Inflammation of the liver
Cirrhosis
Cancer – hepatocellular carcinoma
Immature liver at birth
Temporary deficiency of UDPG
Small / moderate elevated unconjugated bilirubin lasting a few days
Dubin – Johnson and Rotor’s Syndrome
Physiological Jaundice of the newborn
Hepatitis - Inflammation of the liver
Cirrhosis
Cancer – hepatocellular carcinoma
Acute or chronic
Causes
Viruses – CMV, EBV, HAV, HBV, HCV, HDV, HEV
Bacteria
Chemicals, drugs, or alcohol
Dubin – Johnson and Rotor’s Syndrome
Physiological Jaundice of the newborn
Hepatitis - Inflammation of the liver
Cirrhosis
Cancer – hepatocellular carcinoma
Obstruction Jaundice
Bile duct obstruction
Gallstones
Tumors/Neoplasms
Inflammatory conditions: acute cholangitis or acute pancreatitis
pre-hepatic
hepatic
post-hepatic
Characterized by:
Increased Total and Conjugated Bilirubin
Increased Urine Bilirubin
Decreased Urine and Feacal Urobilinogen
Clay colored stools
pre-hepatic
hepatic
post-hepatic
Characterized by:
Increased Total and non-Conjugated Bilirubin
decreased Urine Bilirubin
pre-hepatic
hepatic
post-hepatic
Characterized by:
normal non-conjugated Bilirubin
Increased Total and Conjugated Bilirubin
usually, normal colored stool
pre-hepatic
hepatic
post-hepatic
Will not react with diazo reagent unless there are “accelerators”
( alcohol , caffeine-benzoate-acetate ) added
Indirect
Non-esterfied
Water insoluble
Unconjugated bilirubin
Conjugated Bilirubin
Always reacts with diazo reagent
Direct
Esterified
Water soluble
Unconjugated bilirubin
Conjugated Bilirubin
Miscellaneous other tests related to hepatic disease
Liver enzyme activity
AST, ALT, GGT, LDH
↓ albumin
↑ Protime ( PT )
↑ Ammonia
HAV, HBV, HCV, HDV, HEV, CMV
Miscellaneous other tests related to hepatic disease
Plasma proteins
AST, ALT, GGT, LDH
↓ albumin
↑ Protime ( PT )
↑ Ammonia
HAV, HBV, HCV, HDV, HEV, CMV
Miscellaneous other tests related to hepatic disease
Non – protein nitrogens
AST, ALT, GGT, LDH
↓ albumin
↑ Protime ( PT )
↑ Ammonia
HAV, HBV, HCV, HDV, HEV, CMV
Miscellaneous other tests related to hepatic disease
Viral infections
AST, ALT, GGT, LDH
↓ albumin
↑ Protime ( PT )
↑ Ammonia
HAV, HBV, HCV, HDV, HEV, CMV
The bilirubin can be measured directly with the formula to the right in ______
conjugated bilirubin ONLY
non-conjugated bilirubin ONLY
newborns
liver disease
Hemolysis causes false ______ bilirubin due to inhibition of diazo reaction
increased
decreased
