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paediatrics > A yellow baby > Flashcards

A yellow baby Flashcards

1
Q

split bilirubin - what two types?

A

conjugated

unconjugated

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2
Q

LFTs

A

Bilirubin (total and split)

ALT/AST (alanine aminotransferase/ aspartate aminotransferase)

alkaline phosphatase

gamma glutamyl transferase (GGT)

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3
Q

what LFTs are elevated in hepatitis (hepatocellular damage)

A

Alanine aminotransferase (ALT)

Aspartate aminotransferase (AST)

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4
Q

what LFTs are elevated in biliary disease?

A

alkaline phosphatase

Gamma glutamyl transferase

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5
Q

what tests assess liver FUNCTION?

A

coagulation (prothrombin time, APTT)

Albumin

Bilirubin

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6
Q

signs of chronic liver disease in children

A
  • jaundice
  • splenomegaly (with portal hypertension)
  • ascites
  • clubbing
  • bruising/ petechiae
  • spider naevi
  • varices with portal hypertension
  • muscle wasting
  • encephalopathy
  • growth failure
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7
Q

jaundice

A

yellow of skin and sclera due to accumulation of bilirubin

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8
Q

bilirubin

A

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

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9
Q

liver dysfunction affects on bilirubin

A

liver cannot process and remove bilirubin from the bloodstream - therefore it builds up and causes a yellow tinge to the skin

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10
Q

what kind of bilirubin is present in cholestasis?

A

conjugated bilirubin

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11
Q

what kind of bilirubin is present in pre-hepatic jaundice?

A

unconjugated bilirubin

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12
Q

What kind of bilirubin is water insoluble?

A

unconjugated bilirubin

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13
Q

what kind of bilirubin is present in post-hepatic jaundice?

A

conjugated bilirubin

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14
Q

what kind of bilirubin is water soluble?

A

conjugated bilirubin

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15
Q

what kind of bilirubin is present in intra- hepatic jaundice?

A

mixed

conjugated and unconjugated bilirubin

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16
Q

how does bilirubin get excreted from the body?

A

stool and urine

17
Q

causes of unconjugated bilirubin in children:

A

physiological jaundice

breast milk jaundice

infection (urinary)

haemolytic anaemia (ABO incompatibility, G6PD)

hypothryoidism

18
Q

causes of early/ intermediate unconjugated infant jaundice

A

sepsis

haemolysis (rhesus disease, ABO incompatibility, G6PD)

abnormal conjugation (gilbert’s disease)

19
Q

complications of unconjugated bilirubin in childhood jaundice

A

Kernicterus

20
Q

what is Kernicterus?

A

unconjugated bilirubin is fat-soluble (water insoluble) so therefore can cross the blood-brain barrier

neurotoxic (and deposits in the brain)

21
Q

what are the signs of kernicterus?

A

encephalopathy (poor feeding, lethargy, seizures)

22
Q

what are the late consequences of kernicterus?

A

severe cerebral palsy

learning difficulties

sensorineural deafness

23
Q

how do you treat unconjugated Jaundice?

A

phototherapy

visible light that converts unconjugated bilirubin into a water soluble isomer

24
Q

what is prolonged infant Jaundice?

A

jaundice that persists beyond 2 weeks of life

3 weeks in preterm babies

25
Q

what are the causes of prolonged infant Jaundice?

A

conjugated:

anatomical (biliary obstruction)

neonatal hepatitis

unconjugated:

hypothyroidism

breast milk jaundice

26
Q

conjugated jaundice in INFANTS is always what?

A

abnormal

you must always further investigate

27
Q

what is the most important test in prolonged jaundice?

A

split bilirubin

28
Q

what could be the cause of prolonged infant jaundice?

A

anatomical (biliary obstruction)

neonatal hepatitis

hypothyroidism

breast-milk jaundice

29
Q

how do you treat biliary atresia?

A

kasai portoenterostomy

small intestine gets attached to the liver

30
Q

what investigations are done when diagnosing biliary atresia?

A

split bilirubin

stool colour

ultrasound

liver biopsy

paediatrics (37 decks)

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