Patients that go yellow Index Case Year One Lent Term.
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Transcript of Patients that go yellow Index Case Year One Lent Term.
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