1. Patients that go yellow Index Case Year One Lent Term

2. Jaundice What does the term jaundice mean?

3. Bilirubin-where can things go wrong? excess bilirubin production (Haemolysis) impaired uptake by the hepatocyte (hepatocellular jaundice) failure of conjugation (hepatocellular jaundice) impaired secretion of conjugated bile into the bile canaliculi (hepatocellular jaundice) impairment of bile flow subsequent to secretion by the hepatocyte (obstructive or cholestatic jaundice)

6. Yellow Patient 1 35 year old man Feeling tired and run down GP notices jaundice and splenomegaly

7. Yellow Patient 2 30 year old lady Social problems Acute admission unwell and jaundiced

8. Yellow Patient 3 50 year old female Episodes of abdominal pain over last few months Now acute attack, pain severe so calls ambulance

9. Yellow Patient 4 65 year old man Lost weight over last 3 months, off food, no abdominal pain Daughter who is nurse notices jaundice

10. History and Examination What specific questions are you going to ask? What are you going to look for when you examine the patient?

11. Investigations Which?

12. NN+Haemolytic ++++++Hepatocellular ++++ Cholestatic AlkPTransam inases Bilirubin Liver Function Tests Jaundice BilirubinALTALkP Haemolytic+NN Hepcellular++++++ Cholestatic++++

13. Ultrasound

14. Abdominal Ultrasound showing multiple gallstones in gallbladder

15. US shows stone in Common Bile Duct

16. MRCP showing stone in Common Bile Duct

17. ERCP showing stone in Common Bile Duct

18. CT Abdomen Mass in head of pancreas Obstruction of common bile duct Liver metastasis Peritoneal disease and ascites

19. Patients that go yellow Several cases of jaundice due to different causes Thought about history, examination and investigations