Jaundice

Question 1

a raised ALT/AST could suggest what problems?

Answer 1

liver
muscle
heart

Question 2

where are the enzymes ALT/AST produced?

Answer 2

in the mitochondria

Question 3

in what two forms can bilirubin be spilt ?

Answer 3

direct (conjugated)

indirect (unconjugated)

Question 4

is conjugated or unconjugatde bilirubin soluble?

Answer 4

conjugated bilirubin is soluble

Question 5

what is jaundice ?

Answer 5

yellow discolouration of the skin due to accumulation of bilirubin

Question 6

where is jaundice most noticeable ?

Answer 6

the sclera of the eyes

Question 7

what are the three hepatic classifications of jaundice?

Answer 7

pre hepatic
hepatic
post hepatic

Question 8

what are the three age classifications of jaundice?

Answer 8

early (<24hrs)
intermediate (<2weeks)
prolonged (>2weeks)

Question 9

out of early, intermediate and prolonged what one is the most serious?

Answer 9

early
- RED FLAG
always pathological

Question 10

state some causes of early jaundice?

Answer 10

haemolysis
sepsis

rhesus disease, spherocytosis, G6PD, filberts disease

Question 11

what is a major cause of intermediate jaundice ?

Answer 11

physiologically normal due to breast feeding

Question 12

why can baby gets jaundice normally physiologically?

Answer 12

HbF has a shorter RBC life span so there is more haemolysis to produce unconjugated bilirubin

Question 13

state some causes of prolonged jaundice?

Answer 13

extra hepatic
neonatal hepatitis
hypothyroidism

Question 14

what can hypothyroidism cause jaundice?

Answer 14

hypothyroidism prevents the conjugation of bilirubin so unconjugated bilirubin builds up

Question 15

what is an important part of the examination to help determine the cause of jaundice ?

Answer 15

colour of stool

Question 16

what is a serious complication of unconjugated jaundice?

Answer 16

kernicterus

- deposits of bilirubin in the brain

Question 17

can unconjugated bilirubin cross the BBB?

Answer 17

yes

- because it is fat soluble

Question 18

state some early signs of kernicterus ?

Answer 18

poor feeding, lethargy, seizures

Question 19

state some late signs of kernicterus ?

Answer 19

cerebral palsy
learning difficulties
sensorineural deafness

Question 20

state some causes of unconjugated jaundice?

Answer 20

• Hypothyroidism

* Breast milk jaundice

Question 21

what is the main investigation of jaundice in children?

Answer 21

!!!!! split bilirubin !!!!

Question 22

is conjugated or unconjugated hyperbilirubinaemia more serious?

Answer 22

conjugated jaundice

Question 23

state some causes of conjugated jaundice ?•

Answer 23

• Anatomical (biliary obstruction)

•	Neonatal hepatitis 
o	Alpha-1-antitrypsin deficiency 
o	Galactosaemia 
o	Haemochromatosis 
o	Hypothyroidism

Question 24

what is a main cause of prolonged neonatal jaundice?

Answer 24

biliary atresia

Question 25

what are some symptoms and signs of biliary atresia?

Answer 25

pale stools and dark urine

Question 26

what is the treatment of biliary atresia before 60 days?

Answer 26

kasai portoenterostomy

Question 27

what is the treatment of biliary atresia after 60 days?

Answer 27

liver transplant

Question 28

what is the importantance of diagnosis of biliary atresia?

Answer 28

NEEDS EARLY DIAGNOSIS

Question 29

what is a complication of biliary atresia?

Answer 29

liver failure

Question 30

what is phototherapy used to treat unconjugated jaundice?

Answer 30

visible blue light

450nm