Jaundice Flashcards
What is jaundice and how is it clinically identified in adults?
Jaundice is characterized by yellow discoloration of the skin and sclera. In adults, examining the sclera is the easiest way to detect jaundice.
Why is detecting jaundice in newborns more challenging?
Detecting jaundice in newborns is more challenging because of the difficulty in seeing the sclera. Therefore, it is easier to detect jaundice in the skin of newborns.
At what bilirubin level does clinical jaundice become evident?
Clinical jaundice becomes evident when bilirubin levels are about 75 µmol.
How does the difficulty of detecting jaundice increase in dark-skinned infants?
Detecting jaundice in dark-skinned infants is more difficult due to the skin pigmentation.
What technique can be used to detect jaundice in newborns with difficulty in seeing the sclera?
Gently pressing on the tip of the infant’s nose and then examining the color of the skin immediately upon releasing the pressure can help detect jaundice in newborns.
How common is jaundice in newborns?
Jaundice is extremely common in newborns, with 60% of term infants and 80% of pre-term infants exhibiting visible clinical jaundice in the first week of life. Additionally, up to 10% of breastfed infants may show jaundice at 1 month of age.
Why is it important to understand the underlying physiology of jaundice in newborns?
Understanding the underlying physiology of jaundice in newborns is crucial for recognizing when jaundice may be pathological and knowing how to investigate and treat it.
What should healthcare providers be able to recognize regarding jaundice in newborns?
Healthcare providers should be able to recognize when jaundice in newborns may be pathological, as opposed to physiological, and require further investigation and treatment.
What are some important aspects of investigating jaundice in newborns?
Investigating jaundice in newborns involves understanding the underlying cause, which may include assessing bilirubin levels, evaluating liver function, and considering any underlying conditions or risk factors.
How should jaundice in newborns be treated?
Treatment for jaundice in newborns may vary depending on the underlying cause and severity. Options may include phototherapy, exchange transfusion, addressing any underlying conditions, and ensuring adequate feeding and hydration.
Where are red blood cells removed from circulation, and what happens to them afterward?
Red blood cells are primarily removed from circulation in the reticulo-endothelial system, mainly in the spleen. After removal, hemoglobin from these red blood cells is broken down into heme and globin.
What happens to globin after the breakdown of hemoglobin?
Globin, a component of hemoglobin, is metabolized into amino acids after the breakdown of hemoglobin.
How is heme metabolized after the breakdown of hemoglobin?
Heme, another component of hemoglobin, is metabolized into biliverdin, which is then converted into bilirubin.
Besides the breakdown of hemoglobin, when else is bilirubin formed?
Bilirubin is also formed during the breakdown of myoglobin and cytochromes, not just hemoglobin.
What is the primary binding protein for unconjugated bilirubin in plasma?
Unconjugated bilirubin in plasma is primarily bound to albumin
How is unconjugated bilirubin primarily removed in the fetus?
In the fetus, most unconjugated bilirubin is rapidly removed by the placenta. However, about 10% is still conjugated in the fetal liver and excreted into the gut.
What happens to unconjugated bilirubin in the fetal gut?
In the fetal gut, unconjugated bilirubin is deconjugated by the enzyme beta glucuronidase and then reabsorbed via the enterohepatic circulation.
How is fetal bilirubin maintained to facilitate its excretion across the placenta?
Most fetal bilirubin is maintained in the unconjugated state to facilitate its excretion across the placenta.
What enzyme is responsible for conjugating bilirubin in the newborn infant?
In the newborn infant, bilirubin is conjugated with glucuronic acid by the enzyme glucuronyl transferase.
How does the handling of bilirubin change after separation from the placenta in newborn infants?
After separation from the placenta, progressively more bilirubin is taken up by the liver and conjugated with glucuronic acid by the enzyme glucuronyl transferase in newborn infants.
What is the characteristic of conjugated bilirubin regarding its solubility and toxicity?
Conjugated bilirubin is water-soluble and is not toxic to brain tissue.
How is conjugated bilirubin excreted from the body?
Conjugated bilirubin is excreted through the bile duct system into the duodenum.
What happens to most of the conjugated bilirubin in the gut?
Most of the conjugated bilirubin in the gut is broken down to stercobilin by bacteria, to be excreted in the stool.
What is the fate of some of the conjugated bilirubin in the gut?
Some of the conjugated bilirubin in the gut is de-conjugated (back into unconjugated bilirubin) and reabsorbed.