Jaundice

Question 1

when get serum bilirubin?

Answer 1

at 24 hr and 36 hrs

Question 2

how check for jaundice

Answer 2

blanch forehead first though

Question 3

is newborn jaundice always pathologic?

Answer 3

no physiologic due to 3 differences in bilirubin metabolism

total bilirubin peak isn’t high enough to warrant tx

jaundice self resolves by2-3wks of age

any variant of this is pathologic

Question 4

bilirubin peaks at 7-9 mg/dL around 48-96hrs and resolves by the fifth day for…what race?

Answer 4

black, Hispanic and white infants

Question 5

when do east Asian infants have bilirubin peak?

Answer 5

72-120 hours of life, resolves by 10th day ..

why later? they have ethnic variation in UGT1A1

Question 6

What can cause pathologic hyperbilirubinemia in less than first 24h?

Answer 6

Hemolytic dz
sepsis
polycythemia Hct over 65%
cephalohematoma

Question 7

cephalohematoma def

Answer 7

fairly common
Benign injury from passing through birth canal

Bleed between skull and periosteum as blood is reabsorbed can overwhelm liver = hyperbilirubinemia sx

Question 8

direct hyperbilirubinemia is due to

Answer 8

overload of conjugated bile (attached to albumin)

Usually due to cholestasis or blockage / stoppage of bile flow

Question 9

7 conditions leading to pathologic indirect hyperbilirubinemia

due to increased production
(hemolysis)

Answer 9

MESHH PC 
Macrosomia 
Enzyme defect 
Sepsis 
HDFN 
Heritable RBC Membrane Dz 

Polycythemia
Cephalohematoma

Question 10

what are 6 things that lead to pathologic indirect hyperbilirubinemia due to decreased bilirubin clearance?

Answer 10

1 and 2. Crigler Najjar Syndrome type 1&2

3. Gilbert syndrome
4. Infant of DM mom
5. Congenital hypothyroidism
6. Galactosemia

Question 11

what causes direct Hyperbilirubinemia

Answer 11

cholestasis: abnormal bile flow

Question 12

2 definitions of direct bilirubin levels

Answer 12

If total bilirubin under 5 mg/dL
then direct = over 1mg/dL

if total serum bilirubin over 5

direct = over 20% of TsB

Question 13

what are most common causes of cholestasis?

Answer 13

Hepatitis
Endocrine disorders (congenital hypothyroidism)
Inborn errors of metabolism

alpha 1 antitrypsin def
total parenteral nutrition
sepsis
biliary atresia

Question 14

what causes biliary atresia

Answer 14

progressive inflammation, fibrosis and obliteration of extrahepatic ducts

Question 15

___ is most common indication for liver transplant for peds

Answer 15

biliary atresia

Question 16

biliary atresia def

Answer 16

extrahepatic bile ducts are sclerosed leads to bile cannot exit liver

Question 17

what is kasai procedure

Answer 17

surgical intervention for biliary atresia that must be done before 2 mo of age

to avoid liver transplant

Question 18

___ is elevated with biliary atresia

Answer 18

GGT or gamma glutamyl transferase

Question 19

how to calculate indirect bilirubin?

Answer 19

subtract direct bilirubin from total serum bilirubin

Question 20

when total bilirubin is over ___ free bilirubin cross BB and causes brain encephalopathy

Answer 20

total bilirubin over 25 mg/dL

Question 21

definition of “quick rate of tsB rise?”

Answer 21

When rises more than 0.2 mg / dL per hour

Question 22

what is main differences of physiologic and pathologic newborn jaundice?

Answer 22

physiologic starts after 24hrs of age
level not high enough for tx

and self resolves 2-3 wks of age