JAUNDICE: the causes

The liver has many functions. One of the liver's functions is to produce and secrete bile into the intestines to help digest dietary fat. Another is to remove toxic chemicals or waste products from the blood, and bilirubin is a waste product. The liver removes bilirubin from the blood. After the bilirubin has entered the liver cells, the cells conjugate (attaching other chemicals, primarily glucuronic acid) to the bilirubin, and then secrete the bilirubin/glucuronic acid complex into bile. The complex that is secreted in bile is called conjugated bilirubin. The conjugated bilirubin is eliminated in the feces. (Bilirubin is what gives feces its brown color.) Conjugated bilirubin is distinguished from the bilirubin that is released from the red blood cells and not yet removed from the blood which is termed unconjugated bilirubin. Jaundice occurs when there is 1) too much bilirubin being produced for the liver to remove from the blood. (For example, patients with hemolytic anemia have an abnormally rapid rate of destruction of their red blood cells that releases large amounts of bilirubin into the blood), 2) a defect in the liver that prevents bilirubin from being removed from the blood, converted to bilirubin/glucuronic acid (conjugated) or secreted in bile, or 3) blockage of the bile ducts that decreases the flow of bile and bilirubin from the liver into the intestines. (For example, the bile ducts can be blocked by cancers, gallstone (inflammation of the bile ducts). The decreased conjugation, secretion, or flow of bile that can result in jaundice is referred to as cholestasis: however, cholestasis does not always result in jaundice.

Solved paper of MEDICINE -Congenital Heart Diseases

1. Persistent ductus arteriosus, which one is not a clinical sign/symptom?

a. Growth maybe reterted

b. dysponea is the 1st symptom

c. mechinary murmur

d. right to left shunt at infancy may lead to rise pulmonary artery pressure

e. ECG alters in all cases



2. Regarding coarctation of Aorta which one is incorrect ?



a. A diastolic murmur is usualy heard posteriorly

b. Femoral pulse is weaker

c. MRI is ideal for demostrating the lesion

d. The ECG may show left venticular hypertrphy

e. Headches may occur from hypertension



3. Death may occur from Coarctation of Aorta if left untreated not likely due to ?

a. Left venticular failure

b. Aortic dissection

c. Cerebral hemorrahge

d. Sudden Cardiac death


4. Following all are Tetralogy fallot's clinical sign/symptoms except ?



a. Right to left shunt

b. loud ejection systolic murmur

c. cynosis, digital clubbing

d. Anemia

e. Polycythemia



5. BOOT-shaped heart is seen in which of the following disorder?

a. Coarctation of aorta
b. Tetralogy fallot
c. Venttcular septal defect
d. PDA
e. none of above

6. Most effective single investigation test for Tetralogy fallot is ?

a. ECG
b. Cardiac markers
c. Echocardiography
d. CPC
e. MRI

7. what happens in Ebstein's anomaly ?

a. Tricuspid valve is dysplastic and displaced
b. Aorta arises from RV
c. Aorta arises from both of RV and LV
d. Absent Tricuspid orifice
e. Pulmonary artery hypoplastic