Hoangthihangan unusual cause of jaundice

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AN UNUSUAL CAUSE OF JAUNDICE
Hoàng Thị Hằng

1. steat/o

muscle

steatorrhea

2. my/o

sound

myalgia

3. chole

Process of recording/picturing cholestasis

4. -stasis

skin

5. son/o

fat

6. ultra-

through

7. -graphy

stopping

8. cutane
9. per-

ultrasonography

percuaneous
skin

VOCABULARY
1.

2.
3.

4.

5.

Body piercing : making holes in parts of body to
wear a ring….
Sedimentation: act of depositing things
Percutaneous (a) done through the skin (~
injection)

Subside (v) to go back to normal level (The flood
waters gradually subsided.)
Induce (v) to cause sth

Case report
 Discussion


Presentation
 Medical history
 Examination
 Tests


PRESENTATION
3 months of general malaise, myalgia, painless
jaundice
 25kg loss
 Pale diarrhea, steatorrhea; passing stools 20
times/day
 Urine: darkening


MEDICAL HISTORY- SOCIAL HISTORY
5units of alcohol/ week
 No occupational exposure to hepatitis/hepatotoxic

chemicals
 No bl products, body piercing, previous episodes
of jaundice.


EXAMINATION
Be cachetic & icteric
 No signs of chronic liver disease/tattoos evident
 No fever
 No lymphadenopathy/ testicular
atrophy/organomegaly


INVESTIGATION
Full bl count, urea, electrolytes, random glucose:
normal
 Clotting & coagulation, hepatitis investigations:
normal
 Autoantibody testing: normal
 Abdominal ultrasonography: normal liver, biliary
tree, no biliary obstruction
 CT: normal liver size & texture
 Percutaneous liver biopsy: evidence of cholestasis
 MR cholangiopancreatography: normal


CONSIDERATION



Liver transplant

REFERRAL- GASTROENTEROLOGIST
Poor appetite
 Frequent bowel motions
 Stool examination: steatorrhea
 Thyroid function tests:  thyrotoxicosis


REFERRAL - ENDOCRINOLOGISTS
No further investigation & management
 Examination: not tachycardic
 No sweating, tremor, goiter, thyroid eye disease,
skin changes
 Thyroperoxidase & thyroid stimulating hormone
receoptor antibodies: +
 Diagnosis: thyrotoxicosis
 Treatment: carbimazole


IMPORVEMENT
Next few weeks: improve liver function
 Weight gain
 Less bowel frequency
 Jaundice: reduce

 Thyroid function: normalize


RESULT


Treatment:
carbimazole
 carbimazole & levothyroxine




1 Y later
Euthyroid, well
 Regain original weight
 Thyroid stimulating hormone receptor antibodies: 

DISCUSSION- THYROTOXICOSIS
Associated with various abnormalities in liver
function
 A cause of profound cholestasis (associated with
steatorrhea)  steatorrhea, weight loss
 Thyroid hormone concentrations: important for
normal hepatic function & metabolism of
bilirubin
 Lack of knowledge: (thyroid- liver abnormalities)
 misdiagnose mistakes in management

under-reporting


LIVER- THYROID
Hyperthyroidism hepatic inflammation,
fibrosis, centrilobular necrosis
 Hyperthyroidism: induce increased metabolic
rate increased oxidative capacity, oxidative
damage of tissue.
 Thyroid hormones: might have direct toxic effect
of hepatic tissue (thyroid hormones: increase
production of insulin-like growth factor within
liver)
 Liver dysfunction vs thyroid disease




Autoimmune hepatitis

TREATMENT WARNINGS
Association bw thyroiditis & primary biliary
cirrhosis
 Treatment: thionamide therapy hepatic
dysfunction (hepatotoxicity) hepatic failure
with morbidity and mortality


Hoangthihangan unusual cause of jaundice

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