A yellow baby Flashcards
split bilirubin - what two types?
conjugated
unconjugated
LFTs
Bilirubin (total and split)
ALT/AST (alanine aminotransferase/ aspartate aminotransferase)
alkaline phosphatase
gamma glutamyl transferase (GGT)
what LFTs are elevated in hepatitis (hepatocellular damage)
Alanine aminotransferase (ALT)
Aspartate aminotransferase (AST)
what LFTs are elevated in biliary disease?
alkaline phosphatase
Gamma glutamyl transferase
what tests assess liver FUNCTION?
coagulation (prothrombin time, APTT)
Albumin
Bilirubin
signs of chronic liver disease in children
- jaundice
- splenomegaly (with portal hypertension)
- ascites
- clubbing
- bruising/ petechiae
- spider naevi
- varices with portal hypertension
- muscle wasting
- encephalopathy
- growth failure
jaundice
yellow of skin and sclera due to accumulation of bilirubin
bilirubin
bi-product of haem degradation (RBC breakdown)
made in the spleen and passed on to the liver and gall bladder where it aids in digestion
liver dysfunction affects on bilirubin
liver cannot process and remove bilirubin from the bloodstream - therefore it builds up and causes a yellow tinge to the skin
what kind of bilirubin is present in cholestasis?
conjugated bilirubin
what kind of bilirubin is present in pre-hepatic jaundice?
unconjugated bilirubin
What kind of bilirubin is water insoluble?
unconjugated bilirubin
what kind of bilirubin is present in post-hepatic jaundice?
conjugated bilirubin
what kind of bilirubin is water soluble?
conjugated bilirubin
what kind of bilirubin is present in intra- hepatic jaundice?
mixed
conjugated and unconjugated bilirubin
how does bilirubin get excreted from the body?
stool and urine
causes of unconjugated bilirubin in children:
physiological jaundice
breast milk jaundice
infection (urinary)
haemolytic anaemia (ABO incompatibility, G6PD)
hypothryoidism
causes of early/ intermediate unconjugated infant jaundice
sepsis
haemolysis (rhesus disease, ABO incompatibility, G6PD)
abnormal conjugation (gilbert’s disease)
complications of unconjugated bilirubin in childhood jaundice
Kernicterus
what is Kernicterus?
unconjugated bilirubin is fat-soluble (water insoluble) so therefore can cross the blood-brain barrier
neurotoxic (and deposits in the brain)
what are the signs of kernicterus?
encephalopathy (poor feeding, lethargy, seizures)
what are the late consequences of kernicterus?
severe cerebral palsy
learning difficulties
sensorineural deafness
how do you treat unconjugated Jaundice?
phototherapy
visible light that converts unconjugated bilirubin into a water soluble isomer
what is prolonged infant Jaundice?
jaundice that persists beyond 2 weeks of life
3 weeks in preterm babies
what are the causes of prolonged infant Jaundice?
conjugated:
anatomical (biliary obstruction)
neonatal hepatitis
unconjugated:
hypothyroidism
breast milk jaundice
conjugated jaundice in INFANTS is always what?
abnormal
you must always further investigate
what is the most important test in prolonged jaundice?
split bilirubin
what could be the cause of prolonged infant jaundice?
anatomical (biliary obstruction)
neonatal hepatitis
hypothyroidism
breast-milk jaundice
how do you treat biliary atresia?
kasai portoenterostomy
small intestine gets attached to the liver
what investigations are done when diagnosing biliary atresia?
split bilirubin
stool colour
ultrasound
liver biopsy
