Patients that go yellow Index Case Year One Lent Term.

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Patients that go yellow Index Case Year One Lent Term

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

Page 1: Patients that go yellow Index Case Year One Lent Term.

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