Gastroenterology (Jaundice) Flashcards
what test would you carry out to determine if the jaundice is pre haptic, hepatic or post hepatic?
split bilirubin
what tests are useful to assess liver function?
coagulation
- prothrombin
- APTT
albumin
bilirubin
blood glucose & ammonia (late disease)
what does elevated AST/ALT indicate?
hepatocellular damage
what does elevated alkaline phosphatase indicate and is this naturally higher or lower in children and why?
biliary disease
higher in children due to growing bone
what are the signs of chronic liver disease in children?
growth failure jaundice spider naevi bruising, petechiae splenomegaly hepatomegaly portal hypertension ascites encephalopathy varices cholestasis rickets due to vitamin D deficiency clubbing
what are the features of cholestasis?
pale stool dark urine fat malabsorption deficiency in fat soluble vitamines pruritus
at what bilirubin level does it become visible?
> 40-50 umol/L
a neonate of 10 hours old shows signs of jaundice.
is this physiological jaundice?
no
if the baby is < 24 hours then it is always pathological
what age of neonate can physiological jaundice occur?
> 24hrs - 2 weeks
what are the causes of jaundice in neonates > 2 weeks old?
biliary obstruction
- biliary atresia, choledochal cyst, alagille syndrome
neonatal hepatitis
- hypothyroidism, haemochormatosis
breast milk
what are the causes of jaundice in an infant 24hrs- 2 weeks?
physiological
breast milk
sepsis
haemolysis
how does physiological jaundice occur?
shorter RBC life span in neonates (80-90 days)
relative polycythaemia
relative immaturity of liver function
how long can breast milk jaundice persist?
up to 12 weeks
what is the main complication from neonatal jaundice?
kernicterus
how does kernicterus occur as a complication of jaundice?
unconjugated bilirubin is water insoluble and fat soluble
therefore can cross the blood brain barrier
deposits in the brain and is neurotoxic
what are the early signs of kernicterus?
encephalopathy
- poor feeding
- lethargy
- seizures
what are the late late consequences of kernicterus?
learning disability
severe choreoathetoid cerebral palsy
sensorineural deafness
what is the treatment for neonatal jaundice?
phototherapy
when is infant jaundice prolonged?
persists for > 2 weeks
> 3 weeks if preterm
what is the most important test to carry out if a neonate has prolonged jaundice?
split bilirubin
determine if conjugated if not
how does biliary atresia present?
jaundice (conjugated)
pale stools
dark urine
what is biliary atresia?
congenital fibre-inflammatory disease of bile ducts leading to destruction of extra-hepatic bile ducts
what are the treatment options for biliary atresia?
kasai potoenterostomy surgery
transplantation
when do you have to perform biliary atresia surgery by and why?
before 60 days (<9 weeks)
after this time, success of surgery decreases rapidly)
