Jaundice Flashcards
a raised ALT/AST could suggest what problems?
liver
muscle
heart
where are the enzymes ALT/AST produced?
in the mitochondria
in what two forms can bilirubin be spilt ?
direct (conjugated)
indirect (unconjugated)
is conjugated or unconjugatde bilirubin soluble?
conjugated bilirubin is soluble
what is jaundice ?
yellow discolouration of the skin due to accumulation of bilirubin
where is jaundice most noticeable ?
the sclera of the eyes
what are the three hepatic classifications of jaundice?
pre hepatic
hepatic
post hepatic
what are the three age classifications of jaundice?
early (<24hrs)
intermediate (<2weeks)
prolonged (>2weeks)
out of early, intermediate and prolonged what one is the most serious?
early
- RED FLAG
always pathological
state some causes of early jaundice?
haemolysis
sepsis
rhesus disease, spherocytosis, G6PD, filberts disease
what is a major cause of intermediate jaundice ?
physiologically normal due to breast feeding
why can baby gets jaundice normally physiologically?
HbF has a shorter RBC life span so there is more haemolysis to produce unconjugated bilirubin
state some causes of prolonged jaundice?
extra hepatic
neonatal hepatitis
hypothyroidism
what can hypothyroidism cause jaundice?
hypothyroidism prevents the conjugation of bilirubin so unconjugated bilirubin builds up
what is an important part of the examination to help determine the cause of jaundice ?
colour of stool
what is a serious complication of unconjugated jaundice?
kernicterus
- deposits of bilirubin in the brain
can unconjugated bilirubin cross the BBB?
yes
- because it is fat soluble
state some early signs of kernicterus ?
poor feeding, lethargy, seizures
state some late signs of kernicterus ?
cerebral palsy
learning difficulties
sensorineural deafness
state some causes of unconjugated jaundice?
- Hypothyroidism
* Breast milk jaundice
what is the main investigation of jaundice in children?
!!!!! split bilirubin !!!!
is conjugated or unconjugated hyperbilirubinaemia more serious?
conjugated jaundice
state some causes of conjugated jaundice ?•
• Anatomical (biliary obstruction)
• Neonatal hepatitis o Alpha-1-antitrypsin deficiency o Galactosaemia o Haemochromatosis o Hypothyroidism
what is a main cause of prolonged neonatal jaundice?
biliary atresia
what are some symptoms and signs of biliary atresia?
pale stools and dark urine
what is the treatment of biliary atresia before 60 days?
kasai portoenterostomy
what is the treatment of biliary atresia after 60 days?
liver transplant
what is the importantance of diagnosis of biliary atresia?
NEEDS EARLY DIAGNOSIS
what is a complication of biliary atresia?
liver failure
what is phototherapy used to treat unconjugated jaundice?
visible blue light
450nm
