1. Hepatic And Post-hepatic Jaundice Sonal Pruthi Roll Number - 82

2. Defective Hepatic Uptake Abnormal Conjugation Hepatocellular Damage Gilbert’s Syndrome Drugs Rifampicin Novobiocin Probenecid Viral Hepatitis Alcoholic Hepatitis Drug Induced Hepatitis Autoimmune hepatitis Toxic Hepatitis Criggler Najjar Syndrome Viral Hepatitis Drugs Primaquine Novobiocin Pregnanediol Chloramphenicol Hepatic Jaundice

3. Hepatitis AHepatitis BHepatitis CHepatitis D Hepatitis E EBVCMV Viral Hepatitis

4. Hepatitis A

5. HBsAg HBeAg Total Anti-HBc IgM Anti-HBc Anti-HBe Anti-HBs HBV DNA Hepatitis B

6. HBV DNA

7. HBsAg

8. HBeAg

9. Total Anti - HBc

10. IgM-Anti HBc

11. Hepatitis C

13. Clinical Features- Hepatic Jaundice Icterus Spider telangiectasia Asterixis Palmar erythema Fetor hepaticus Gynaecomastia Testicular atrophy Ascites

14. Obstructive Jaundice Intrahepatic Cholestasis Extrahepatic Cholestasis Primiary Biliary Cirrhosis Primary Sclerosing Cholangitis Dubin Johnson Syndrome Rotor’s Syndrome BRIC PFIC Drugs - phenothiazines Bile duct strictures Common duct stone. Periampullary carcinoma

15. Gall bladder Stone The majority of cases (approximately 80%)are asymptomatic (silent) gall stones, discovered accidentally by abdominal sonar. Obstruction of common bile duct leading to pain & jaundice

16. Periampullary Carcinoma CBD Duodenum Ampulla Pancreas

17. Clinical features - Obstructive Pain due to gallbladder disease, malignancy or stretching of the liver capsule Fever due to ascending cholangitis Palpable and / or tender gallbladder Enlarged liver usually smooth

18. Investigations HepaticPost-hepatic Total BilirubinIncreased Conjugated Bilirubin Increased Unconjugated Bilirubin IncreasedNormal UrobilinogenIncreasedDecreased/ absent StercobilinNormalReduced/absent

19.  ALT and AST – Raised ALT specific for liver injury ALT>1000 IU/L - suggestive of Hepatocellular injury AST:ALT > 2:1 Suggestive of ALD AST:ALT < 1 Suggestive of viral hepatitis Enzymes that reflect damage to hepatocytes

20. Enzymes that reflect Cholestasis  Alkaline Phosphatase – Raised  large bile duct obstruction  Intrahepatic cholestasis  Gamma Glutamyl transferase  more sensitive marker for cholestasis as compared to ALT

21. Investigations  Prothrombin Time  might be increased in cases of hepatic jaundice.  Disorders that lead to Vitamin K deficiency  Serum ANA and Anti Smooth Muscle Antibody  positive in patients with PBC

22. Clinical Vignette Match the clinical description with the most likely disease process. a. Primary biliary cirrhosis b. Sclerosing cholangitis c. Anaerobic liver abscess d. Hepatoma e. Hepatitis C f. Hepatitis D g. Hemochromatosis

23. A 40-year-old white female complains of pruritus. She has an elevated alkaline phosphatase and positive antimitochondrial antibody test. CHOOSE 1 DISEASE PROCESS

24. A 70-year-old male with a long history of diverticulitis has low-grade fever, elevated alkaline phosphatase, and right upper quadrant pain. CHOOSE 1 DISEASE PROCESS

25. A 30-year-old male with ulcerative colitis develops jaundice, pruritus,and right upper quadrant pain. Liver biopsy shows an inflammatory obliterative process affecting intrahepatic and extrahepatic bile ducts. CHOOSE 1 DISEASE PROCESS

26. A 40-year-old white male complains of weakness, weight loss, and abdominal pain. On examination, the patient has diffuse hyperpigmentation, icterus and a palpable liver edge. Polyarthritis of the wrists and hips is also noted. Fasting blood sugar is 185 mg/dL. The most likely diagnosis is a. Insulin-dependent diabetes mellitus b. Pancreatic carcinoma c. Addison’s disease d. Hemochromatosis

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