Jaundice Flashcards
how is bilirubin made?
what happens to bilirubin in the liver?
- breakdown of the haem part of haemoglobin
- conjugated, then excreted
what is the point of bilirubin?
- aids absorption of fats and vitamins
what is the most common causes of unconjugated jaundice? (3)
conjugated?(5)
- haemolysis
- sickle cell disease
- spherocytosis
- (obstructive) hepatitis
- CF
- Cirrhosis
- obstructive hepatitis
- biliary atresia
what would a rapid onset jaundice indicate?
- haemolysis
what kind of symptoms should you ask about?
- anaemia: excessive fatigue (due to RBC breakdown)
- malaise: abdo pain and anorexia
- pruritis: itching, skin irritation, deposition of bile salts
- urine: very dark coloured (“coca-cola”) suggests conjugated
- steatorrhoea
what must you examine in children with jaundice?
- growth: failure to thrive
- skin signs: excoriations, spider naevi, clubbing and ascites
- hepatosplenomegaly: palpate liver for enlargement and firmness, splenomegaly in haemolysis
what does increased reticulocytes indicate?
- haemolysis (lots of immature RBCs)
what tests might you want to do to investigate jaundice?
- Hb: anaemia, reticulocytosis
- LFTs: bilirubin levels
- liver enzymes: elevated in hepatitis
- Alk phos: elevated in cirrhosis or long standing jaundice
- Serology: hepatitis virus
what kind of jaundice do you get dark urine and pruritus in?
anaemia and hepatosplenomegaly?
- cirrhosis
- haemolysis
what are possible viral causes for hepatitis?
what are the risk factors for Hep A?
what is the incubation period for Hep A
- Hep A,B and C
- EBV and CMV
- faecal contamination of food and water (dirty surroundings)
- 2-6 weeks
Most common age group for Hep A?
how do children tend to get Hep B?
- 5-15
- vertical transmission (no contamination with blood products) They are usually protected by mums Hep B antibodies
What is the onset of Hep A like? What other symptoms will they have?
what colour is the urine and stool?
- insidious onset: unwell child with anorexia and nausea
- jaundice appears 5 days later
- urine dark and stools pale
what will liver function tests show in Hep A?
how do you identify the virus in the blood?
- conjugated hyperbilirubinaemia
- high liver enzymes
- serology tests show surface and core antigens
when is hep A most infectious?
what is the management?
- during the prodromal phase
- by the time jaundice appears, there is no more virus
- supportive, hospital admission only for complications
what can be done for babies at risk of Hep B? (2)
- immunisation
- immunoglobulin injection at birth
