Normal bile physiology
Types of jaundice
Jaundice symptoms
Viral hepatitis
100
Name 3 components of bile
Bile acids, cholesterol, bilirubin, phosphatidylcholine, water
100

Give 4 risk factors for gallstone development

  • Female gender 
  • Increasing age 
  • Family history 
  • Rapid weight changes
100
What is the first sign of jaundice, and why does this occur?
  • Scleral icterus (yellowing of eyes) 
  • Due to high elastin content 
100

Describe the transmission of hep A

  • Faecal-oral 
  • In frozen berries and seafood
200

Draw the biliary tree

Common hepatic duct and cystic duct join to form common bile duct 

This joints the pancreatic duct, which enters the duodenum via hepatopancreatic ampulla of Vater

200

Give 4 causes of hepatocellular jaundice 

  • Alcoholic liver disease
  • Viral hepatitis 
  • Iatrogenic e.g. medication 
  • Hereditary haemochromatosis 
  • Autoimmune hepatitis
200

What are 3 causes of pseudo-jaundice?

Addisons disease, anorexia nervosa, ingestion of beta-carotene rich foods, hypothyroidism, diabetes mellitus

200

What type of people contract hepatitis D?

  • People already infected with hepatitis B
  • Attaches to HBsAg and cannot survive without this protein
300

Describe how bile release is stimulated 

Presence of fat in small intestine stimulates I cells to secrete CCK 

This causes gallbladder contraction and release of pancreatic enzymes 

300

What causes pre-hepatic jaundice? Give 4 examples 


  • Excessive RBC breakdown overwhelms liver's ability to conjugate bilirubin, causing unconjugated hyperbilirubinemia
  • E.g. in trauma, haemolytic anaemia, Gilbert's syndrome, Crigler-Najir syndrome, sickle cell disease, thalassemia 
300

Why does itching sometimes occur in jaundice?

  • Bilirubin interacts with MRGPRX4 (G-protein coupled receptor) affecting primary sensory neurons, causing itching. 
300

Which type of hepatitis virus contains DNA? 

  • Hepatitis B 
  • The rest are RNA
400

What happens to bile after it enters the duodenum?

Colonic bacteria deconjugate bilirubin into urobilinogen 

80% converted to stercobilin and excreted in faeces 

20% reabsorbed into bloodstream and into portal vein. Some reabsorbed by liver, a small portion converted to urobilin and excreted by kidneys. 

400

What are 2 types of pigment stones, and where do they usually form?

  • Brown: form within bile duct 
  • Black: form within the gallbladder, when excess bilirubin enters bile. Linked to chronic haemolysis and cirrhosis. 
400

Is dark (coca-cola) urine  more suggestive of post-hepatic or pre-hepatic jaundice?

  • Post hepatic
  • Bilirubin is conjugated, so is water soluble and can be excreted in the urine 
400

Describe the usual progression of hepatitis C, and how it is contracted

  • Most (55-85%) of people develop chronic infection. Can develop into cirrhosis, and lead to further complications like decompensation and liver cancer. 
  • Blood to blood transmission e.g. shared needles. Suspect if had transfusion or major surgery before 1990s
500

Describe the formation of bile 

Reticuloendothelial cells (macrophages) metabolise RBCs into haem and globin. Haem is further broken down into iron and biliverdin.

Biliverdin reduced into insoluble bilirubin. Binds to albumin and transported to liver, where it is conjugated to soluble bilirubin. 

500

What is Mirizzi syndrome?


Common hepatic duct obstruction caused by extrinsic compression from impacted stone in the cystic duct. Presents with jaundice, right upper quadrant pain, and fever.

500

What vitamin deficiencies result from obstructive jaundice, and which is the most serious acutely?

  • Blocks bile from reaching intestine, preventing absorption of fat soluble vitamins A,D,E,K 
  • Vitamin K deficiency reduces activation of clotting factors. Patients develop prolonged PT/INR and potential life-threatening haemorrhage
500

Describe the progression of hepatitis B 

  • In adults usually only causes acute illness 
  • Can become chronic infection if transmitted to neonate from mother. 4 stages = immune tolerance (2-3 decades), immune clearance, inactive carrier state, reactivation
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