Jaundice

Question 1

Is bilirubin fat soluble?

Answer 1

yes - can also be called indirect or unconjugated bilirubin

Question 2

How is bilirubin transported

Answer 2

on albumin

Question 3

Where is bilirubin conjugated?

Answer 3

Liver

Question 4

What do you need for conjugation?

Answer 4

glucose
oxygen
glucuronyl transferase

Question 5

Where is conjugated bilirubin excreted?

Answer 5

Small intestine

Question 6

What happens in the small intestine to the billirubin?

Answer 6

bacteria convert billirubin into a brown pigments - stercobilinogen which makes feces brown
some bilirubin is changed into urobilinogen which makes your urine yellow

Question 7

If the liver function is not optimal the result will be?

Answer 7

higher serum levels of unconjugated bilirubin (pathological jaundice)

Question 8

what are the normal serum level for total bilirubin in neonates?

Answer 8

50 umols

Question 9

What is the definition of jaundice?

Answer 9

Yellow colour of the skin due a serum bilirubin over 35mmols in neonates

Question 10

If the jaundice is classified as post-hepatic, this means the cause is?

Answer 10

after the liver conjugated the bilirubin

Question 11

In hepatic jaundice the total serum bilirubin is elevated , true or false?

Answer 11

true

Question 12

in neonates what is the most common cause of jaundice?

Answer 12

Haemolysis

Question 13

What classification is breastmilk jaundice (pathological or physiological)

Answer 13

pathological - non-haemolytic

Question 14

Signs and symptoms of jaundice in the neonate?

Answer 14

yellow skin
yellow eyes
poor feeding
lethargic
high - pitched cry
irritability
hypotonia in early stages
hypertonia in late stages

severe cases
seizures
cerebral palsy
kernicterus

Question 15

What is Kramers rule?

Answer 15

scoring the extent of jaundice.

Question 16

diagnostic testing for jaundice?

Answer 16

total (SBR)
full blood count
blood type and testing for rhesus incompatibility (coombs)
TORCH screen if pathological

Question 17

What are the jaundice classifications?

Answer 17

Pre hepatic - overproduction and impaired uptake by the liver
hepatic - decreased conjugation
post hepatic - decreased excretion

Question 18

What percentage of full term baby’s experience physiological jaundice?

Answer 18

50%

Question 19

What percentage of premature baby’s have physiological jaundice?

Answer 19

80%

Question 20

Which sex is physiological jaundice more common in?

Answer 20

Males

Question 21

physiological jaundice is most common in which ethnic group?

Answer 21

Asian - unsure why

Question 22

What is the definition of pathological Jaundice?

Answer 22

either develops within the 1st 24 -48 hours or 14 days or later

Question 23

How is jaundice treated?

Answer 23

early and frequent feeding
fluid intake
prevent hypoxia and hypoglycemia
UV light