MBBS 2021 Important Topics and Materials for 1st Year, 2nd Year, 3rd Year and Final Year
Approach for a patient with Jaundice
History(focus on medication/drug exposure)
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Physical examination
Lab Tests: Bilirubin with fractionation, ALT, AST, ALP, PT and Albumin
Isolated elevation of the bilirubin
Direct Hyperbilirubinemia (Direct > 15%)
Inherited Disorders: Dubin Johnson Syndrome Rotor's Syndrome
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Indirect Hyperbilirubinemia (Direct <15%)
Drugs: Rifampicin Probenecid
Inherited disorders: Gilbert's Syndrome Criggler Najjer Syndrome
Hemolytic disorders Ineffective erythropoiesis
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Bilirubin and other LFTs Also deranged
Hepatocellular Pattern: ALT/AST elevated out of proportion to ALP
- Viral Serologies Hepatitis A IgM, HbsAg, HCV RNA
- Toxicology Screen Acetaminophen level
- Ceruloplasmin (if patient<40yrs)
- ANA, SMS, LKM, SPEP
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Additional virologic testing CMV DNA, EBV capsid antigen, Hepatitis D antibody, Hepatitis E IgM
Liver Biopsy
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Cholestatic pattern: ALP out of proportion to AST/ALP
Ultrasound
Dilated ducts Extrahepatic Cholestasis
CT/ERCP Ducts Not Dilated Intrahepatic Cholestasis
Serologic Testing AMA Hepatitis Serologies Hepatitis A, CMV, EBV
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MRCP/Liver Biopsy
Liver Biopsy
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