Approach To Jaundice

Question 1

What are the red flags for non-pathological jaundice in neonates/infants?

Answer 1

• Jaundice >2 weeks old (3 weeks if premature)
• Diagnosis of “breastmilk” or “breastfeeding” jaundice by exclusion
• Check bilirubin count, including direct bilirubin if pale stools
• Associated signs:
• Sepsis
• Hypothyroidism (poor feeding, lethargy, relative bradycardia)
• Obstructive jaundice (pale stools, pruritis)
• Failure to thrive
• Organomegaly or abdominal mass
• Portal hypertension

Question 2

What are the signs of obstructive jaundice?

Answer 2

• Likely surgically-correctable cause
• Urgent surgical referral
• Signs:
• Pale stools
• Dark urine
• Raised GGT & ALP
• Conjugated hyperbilirubinaemia

Question 3

What should be considered with ascending cholangitis in a jaundiced child?

Answer 3

• Triad: right upper quadrant tenderness, fever, jaundice
• Possible associations:
• Obstructed gallstones
• Biliary ascariasis
• Previous Kasai for biliary atresia
• Choledochal malformation/cyst
• Urgent management:
• Broad-spectrum antibiotics
• IV fluids
• Referral

Question 4

What investigations should be done for a jaundiced child?

Answer 4

• Systematic investigations to work up infectious, metabolic, and anatomical differential diagnoses
• Include tests for:
• Infectious causes
• Metabolic disorders
• Anatomical abnormalities