Jaundice Flashcards
when get serum bilirubin?
at 24 hr and 36 hrs
how check for jaundice
blanch forehead first though
is newborn jaundice always pathologic?
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
bilirubin peaks at 7-9 mg/dL around 48-96hrs and resolves by the fifth day for…what race?
black, Hispanic and white infants
when do east Asian infants have bilirubin peak?
72-120 hours of life, resolves by 10th day ..
why later? they have ethnic variation in UGT1A1
What can cause pathologic hyperbilirubinemia in less than first 24h?
Hemolytic dz
sepsis
polycythemia Hct over 65%
cephalohematoma
cephalohematoma def
fairly common
Benign injury from passing through birth canal
Bleed between skull and periosteum as blood is reabsorbed can overwhelm liver = hyperbilirubinemia sx
direct hyperbilirubinemia is due to
overload of conjugated bile (attached to albumin)
Usually due to cholestasis or blockage / stoppage of bile flow
7 conditions leading to pathologic indirect hyperbilirubinemia
due to increased production
(hemolysis)
MESHH PC Macrosomia Enzyme defect Sepsis HDFN Heritable RBC Membrane Dz
Polycythemia
Cephalohematoma
what are 6 things that lead to pathologic indirect hyperbilirubinemia due to decreased bilirubin clearance?
1 and 2. Crigler Najjar Syndrome type 1&2
- Gilbert syndrome
- Infant of DM mom
- Congenital hypothyroidism
- Galactosemia
what causes direct Hyperbilirubinemia
cholestasis: abnormal bile flow
2 definitions of direct bilirubin levels
If total bilirubin under 5 mg/dL
then direct = over 1mg/dL
if total serum bilirubin over 5
direct = over 20% of TsB
what are most common causes of cholestasis?
Hepatitis
Endocrine disorders (congenital hypothyroidism)
Inborn errors of metabolism
alpha 1 antitrypsin def
total parenteral nutrition
sepsis
biliary atresia
what causes biliary atresia
progressive inflammation, fibrosis and obliteration of extrahepatic ducts
___ is most common indication for liver transplant for peds
biliary atresia
biliary atresia def
extrahepatic bile ducts are sclerosed leads to bile cannot exit liver
what is kasai procedure
surgical intervention for biliary atresia that must be done before 2 mo of age
to avoid liver transplant
___ is elevated with biliary atresia
GGT or gamma glutamyl transferase
how to calculate indirect bilirubin?
subtract direct bilirubin from total serum bilirubin
when total bilirubin is over ___ free bilirubin cross BB and causes brain encephalopathy
total bilirubin over 25 mg/dL
definition of “quick rate of tsB rise?”
When rises more than 0.2 mg / dL per hour
what is main differences of physiologic and pathologic newborn jaundice?
physiologic starts after 24hrs of age
level not high enough for tx
and self resolves 2-3 wks of age
