Notes in Case 2: Hyperbilirubinemia

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Published	03/02/2024	{{c1::Bilirubin}} is a waste product of RBC heme metabolism. It is excreted in the {{c2::feces > urine}}
Published	03/02/2024	In splenic macrophages, heme is metabolized to {{c1::biliverdin}} by the enzyme {{c2::heme oxygenase}}
Published	03/02/2024	In splenic macrophages, biliverdin is reduced to {{c1::unconjugated bilirubin}}
Published	03/02/2024	What type of bilirubin is formed in the splenic macrophages? {{c1::Unconjugated/indirect bilirubin::Conjugated or Unconjugated}}
Published	03/02/2024	Unconjugated bilirubin travels in the blood bound to {{c1::albumin}}
Published	03/02/2024	Unconjugated bilirubin is removed from the blood by the {{c1::liver::organ}}
Published	03/02/2024	In the liver, unconjugated bilirubin is converted to {{c1::conjugated bilirubin}} via the enzyme {{c2::UDP-glucuronosyltransferase (UGT)}}
Published	03/02/2024	Conjugated (direct) bilirubin is excreted in bile and metabolized by bacterial flora, producing {{c1::urobilinogen}}
Published	03/02/2024	Most (80%) of urobilinogen is excreted in feces as {{c1::stercobilin}}, which gives stool its brown color
Published	03/02/2024	~ 18% of urobilinogen is returned to the liver via {{c1::enterohepatic}} circulation
Published	03/02/2024	~ 2% of urobilinogen is excreted in urine as {{c1::urobilin}}, which gives urine its yellow color
Published	03/02/2024	Is unconjugated (indirect) bilirubin water soluble?{{c1::No (insoluble)}}
Published	03/02/2024	Is conjugated (direct) bilirubin water soluble?{{c1::Yes}}
Published	03/02/2024	The "-ogen" suffix (e.g. urobilinogen) indicates a(n) {{c1::colorless::colored or colorless}} compound
Published	03/02/2024	The "-in" suffix (e.g. stercobilin) indicates a(n) {{c1::colored::colored or colorless}} compound
Published	03/02/2024	{{c3::Pancreatic}} adenocarcinoma often presents as obstructive {{c1::jaundice}} with a(n) pain{{c2::less}}, palpable gallbladder
Published	03/02/2024	{{c3::Pancreatic}} adenocarcinoma is associated with the serum tumor markers {{c1::CA 19-9}} and {{c2::CEA}} (less specific)
Published	03/02/2024	Treatment of pancreatic {{c2::adenocarcinoma}} includes the {{c1::Whipple}} procedure, chemotherapy, and radiation
Published	03/02/2024	{{c1::Gilbert}} syndrome is due to {{c2::mildly low}} UDP-glucuronosyltransferase activity
Published	03/02/2024	{{c1::Gilbert}} syndrome presents with jaundice during stress, illness, or fasting
Published	03/02/2024	Does Gilbert syndrome result in unconjugated or conjugated hyperbilirubinemia? {{c1::Unconjugated}}
Published	03/02/2024	{{c1::Crigler-Najjar}} syndrome is due to {{c2::absent}} UDP-glucuronosyltransferase activity
Published	03/02/2024	Does Crigler-Najjar syndrome result in unconjugated or conjugated hyperbilirubinemia? {{c1::Unconjugated}}
Published	03/02/2024	{{c1::Crigler-Najjar}} syndrome causes jaundice and kernicterus early in life; patients often die within a few years
Published	03/02/2024	{{c1::Dubin-Johnson}} syndrome is due to a deficiency of {{c2::bilirubin canalicular transport}} protein
Published	03/02/2024	Does Dubin-Johnson syndrome result in unconjugated or conjugated hyperbilirubinemia? {{c1::Conjugated}}
Published	03/02/2024	{{c1::Dubin-Johnson}} syndrome presents with a grossly black liver, but is otherwise not clinically significant
Published	03/02/2024	Does Rotor syndrome result in unconjugated or conjugated hyperbilirubinemia? {{c1::Conjugated}}
Published	03/02/2024	What is the treatment of ascending cholangitis?{{c1::Stabilize pt as needed (e.g., IV fluids)}} → {{c1::start abx (cipro or amp-gent + metro)}} → {{c1…
Published	03/02/2024	What is the diagnostic test for biliary strictures?{{c1::MRCP}}
Published	03/02/2024	What is the treatment for choledocholithiasis?{{c1::ERCP with sphincterotomy and stone removal; elective cholecystectomy}}
Published	03/02/2024	What is treatment for gallstone pancreatitis without cholangitis?{{c1::Early elective cholecystectomy}}
Published	03/02/2024	What is the management for post-cholecystectomy bile leak?{{c1::ERCP}}
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