You’re asked to see a 45 -year-old female patient complaining of 2-day history of epigastric pain, nausea, vomiting, diarrhea. She has dark urine. O/E she is jaundiced and has mild epigastric tenderness. Labs: significantly Increasesd ALT, AST, ALP, GGT. Urobilinogen undetectable in urine.

• Bloods tests in Jaundice
  • How to differentiate between Obstructive and non-obstructive Jaundice via blood tests?
  • What is the normal bilirubin? when does Jaundice becomes apparent on the patient’s skin colour?
  • In what form does bilirubin circulate within the plasma?
  • Why is the coagulation profile deranged in this patient?
  • Which coagulation studies are affected?
  • How would you correct these coagulation abnormalities?
  • What is ALP? When does it increase?
  • What are ALT & AST? when do they increase?
• Obstructive Jaundice
  • How would you investigate this patient?
  • If you find a CBD stone on US, what to do?
  • What would be your diagnosis if the patient had fever, pain, chills?
  • How can you Manage ascending cholangitis?
  • Causes of Jaundice
  • Classification of obstructive Jaundice
• Bile

  • Function

  • Constituents

  • conjugation

  • Circulation

    • What is urobilinogen? How is it formed?
    • What is the enterohepatic circulation?
    • What are the advantages of enterohepatic circulation?
    • How much bile is secreted in 24 hours?
    • Complications of reduction of bile salts in small intestine?

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