Jaundice Flashcards
Difference between breastmilk and breastfed jaundice
Breastmilk caused by breastfeeding
Breastfeeding jaundice caused by not feeding
What are the factors in breast milk that cause BM jaundice x5
Pregnane-3,2-diol
B glucuronidase
Interleukin IL1B
Epidermal growth factors
Alpha feto protein
How does pregnane-3,20-diol cause BM jaundice
Inhibits the process of conjugation that happens in the liver
Describe how B glucuronidase causes BM jaundice
It promotes deconjugation of bilirubin in the intestinal brush border hence promoting its reabsorption and not secretion
How does interleukin IL1 beta cause BM jaundice
It causes a cholestatic effect that causes hyperbilirubinemia
RBC lifespan in newborn infants
70 days
Where is bilirubin deposited in the brain to cause kernicterus x2
Basal ganglia
Brainstem nuclei
What property makes unconjugated B to able to cross the BBB
It is lipid soluble
Acute (2) and severe (4) manifestations of kernicterus
Acute- lethargy, feeding problems
Severe- irritability, seizures, coma, increased muscle tone (opisthotonos)
Complications of kernicterus x3
CP
Learning difficulties
Sensorineural deafness
Factors affecting management of jaundice x4
Age of patient
Age of onset
Bilirubin levels
Rate of rise in levels
Clinical presentation of sever Rh hemolytic disease x3
Anemia
Hepatoplenomegaly
Hydrops fetalis
Investigation for ABO incompatibility and what is shows
Coombs test - antibodies on the surfaces of RBCs
Enzyme responsible for deconjugation and conjugation
B glucuronidase
Urine diphosphoglucuronic glucuronosyltransferase
Causes of conjugated hyperbilirubinemia appearing after 2 weeks x2
Bile duct obstruction
Neonatal hepatitis
Conjugation occurs but there is impaired excretion of bile and bilirubin
MOA of phototherapy and when is it not done
It converts unconjugated bilirubin to a water soluble isomer that can be excreted in urine
Not done it conjugated hyperB because it causes a bronze baby
Side effects of phototherapy x3
Macular rash
Eye discomfort
Bronze baby
How much blood is given in exchange transfusion
2x90ml is infants blood volume
Causes of jaundice appearing between 2hrs 2weeks x5
Hemolysis
Polycythemia
Breast milk jaundice
Infections eg UTI
Crigler Najjar syndrome- low to no UDPGT
Difference between Gilbert syndrome (GS) and Crigler Najar (CN)
GS- less severe, intermittent jaundice, does not require treatment
CN- more severe, persistent jaundice, requires transplant
