Gastroenterology (Jaundice)

Question 1

what test would you carry out to determine if the jaundice is pre haptic, hepatic or post hepatic?

Answer 1

split bilirubin

Question 2

what tests are useful to assess liver function?

Answer 2

coagulation

• prothrombin
• APTT

albumin

bilirubin

blood glucose & ammonia (late disease)

Question 3

what does elevated AST/ALT indicate?

Answer 3

hepatocellular damage

Question 4

what does elevated alkaline phosphatase indicate and is this naturally higher or lower in children and why?

Answer 4

biliary disease

higher in children due to growing bone

Question 5

what are the signs of chronic liver disease in children?

Answer 5

growth failure 
jaundice 
spider naevi 
bruising, petechiae 
splenomegaly 
hepatomegaly
portal hypertension 
ascites
encephalopathy 
varices 
cholestasis 
rickets due to vitamin D deficiency 
clubbing

Question 6

what are the features of cholestasis?

Answer 6

pale stool 
dark urine 
fat malabsorption
deficiency in fat soluble vitamines 
pruritus

Question 7

at what bilirubin level does it become visible?

Answer 7

> 40-50 umol/L

Question 8

a neonate of 10 hours old shows signs of jaundice.

is this physiological jaundice?

Answer 8

no

if the baby is < 24 hours then it is always pathological

Question 9

what age of neonate can physiological jaundice occur?

Answer 9

> 24hrs - 2 weeks

Question 10

what are the causes of jaundice in neonates > 2 weeks old?

Answer 10

biliary obstruction
- biliary atresia, choledochal cyst, alagille syndrome

neonatal hepatitis
- hypothyroidism, haemochormatosis

breast milk

Question 11

what are the causes of jaundice in an infant 24hrs- 2 weeks?

Answer 11

physiological
breast milk
sepsis
haemolysis

Question 12

how does physiological jaundice occur?

Answer 12

shorter RBC life span in neonates (80-90 days)
relative polycythaemia
relative immaturity of liver function

Question 13

how long can breast milk jaundice persist?

Answer 13

up to 12 weeks

Question 14

what is the main complication from neonatal jaundice?

Answer 14

kernicterus

Question 15

how does kernicterus occur as a complication of jaundice?

Answer 15

unconjugated bilirubin is water insoluble and fat soluble
therefore can cross the blood brain barrier
deposits in the brain and is neurotoxic

Question 16

what are the early signs of kernicterus?

Answer 16

encephalopathy

• poor feeding
• lethargy
• seizures

Question 17

what are the late late consequences of kernicterus?

Answer 17

learning disability
severe choreoathetoid cerebral palsy
sensorineural deafness

Question 18

what is the treatment for neonatal jaundice?

Answer 18

phototherapy

Question 19

when is infant jaundice prolonged?

Answer 19

persists for > 2 weeks

> 3 weeks if preterm

Question 20

what is the most important test to carry out if a neonate has prolonged jaundice?

Answer 20

split bilirubin

determine if conjugated if not

Question 21

how does biliary atresia present?

Answer 21

jaundice (conjugated)
pale stools
dark urine

Question 22

what is biliary atresia?

Answer 22

congenital fibre-inflammatory disease of bile ducts leading to destruction of extra-hepatic bile ducts

Question 23

what are the treatment options for biliary atresia?

Answer 23

kasai potoenterostomy surgery

transplantation

Question 24

when do you have to perform biliary atresia surgery by and why?

Answer 24

before 60 days (<9 weeks)

after this time, success of surgery decreases rapidly)

Question 25

what tests would you carry out to investigate for biliary atresia?

Answer 25

split bilirubin
stool colour
ultrasound
liver biopsy

Question 26

what are the causes of neonatal hepatitis?

Answer 26

alpha-1 antitrypsin deficiency 
galactosaemia 
tyrosinaemia
urea cycle defects
haemochromatosis 
hypothyroidism 
glycogen storage disorders
viral hepatitis 
parental nutrition

Question 27

what are causes of prolonged jaundice in neonates?

Answer 27

biliary obstruction

• biliary atresia
• choledochal cyst
• alagille syndrome

neonatal hepatitis