EMQs in Clinical Medicine.pdf - Peshawar Medical College

Jaundice – answers 173
C
A
J
L
M
Hepatitis A is an RNA virus that is spread by the faecal–oral route. It is
particularly associated with travellers. Treatment is supportive because
the condition is usually self-limiting.
A 35-year-old woman presents with fever, malaise and jaundice. On
examination she has moderate hepatomegaly. She is anti-smooth
muscle antibody and antinuclear antibody positive.
Chronic autoimmune hepatitis occurs most frequently in women and has
associations with many other autoimmune diseases. Type I disease is
associated with the presence of antinuclear and/or anti-smooth muscle
antibodies.
Immunosuppressive therapy, e.g. corticosteroids, azathioprin, can induce
remission in most cases. The patient may eventually require liver
transplantation (recurrence after transplantation is still possible).
A 25-year-old man presents with recurrent episodes of asymptomatic
jaundice.
Patients with Gilbert’s syndrome may describe a family history of
asymptomatic jaundice. This condition involves an unconjugated hyperbilirubinaemia
where a rise in bilirubin is seen particularly on fasting,
dehydration, illness, etc. It is thought to result from underactivity of
UDP-glucuronyl transferase activity, an enzyme involved in the
conjugation of bilirubin. It is important to educate patients that there is
no underlying liver disease and that Gilbert’s syndrome is essentially
a benign condition.
A 4-year-old patient presents with anaemia and mild jaundice.
Hb 7 g/dl, reticulocytes 14 per cent. Electrophoresis result
pending.
Markers of haemolytic anaemia on a peripheral blood film include
reticulocytosis (caused by increased erythrocyte production), elevated
serum unconjugated bilirubin, reduced plasma haptoglobin and increased
urinary urobilinogen. Remember that urinary urobilinogen is absent
in cholestatic jaundice.
A 45-year-old man with ulcerative colitis presents with jaundice,
pruritus and abdominal pain. ALP is raised and anti-mitochondrial
antibodies negative.
Anti-mitochondrial antibodies are associated with primary biliary
cirrhosis not primary sclerosing cholangitis. There is an association of
primary sclerosing cholangitis with HLA-B8 and -DR3. The fibrosis and
stricturing of the biliary tree give rise to a beaded appearance on
endoscopic retrograde cholangiopancreatography (ERCP).