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Paediatrics > Jaundice > Flashcards

Jaundice Flashcards

1
Q

What are LFT’s and what do they tell you

A

Bilirubin (SBR) - total and split - liver clearance / function
ALT / AST
Alkaline phosphatase
GGT

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2
Q

What should conjugated bilirubin be

A

10% of unconjugated

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3
Q

What are other tests and what do they show

A 
PT / INR - clotting
APTT - clotting
Albumin - produced in liver 
Blood glucose
Ammonia
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4
Q

What causes jaundice

A 
Haem broken down in spleen
Bilirubin produced
Insoluble can't excrete
Goes to liver and conjugates
Secreted into bile
Becomes urobilinogen
Reabsobed into portal and excreted in kidney 
Or become sterecobilin in stool
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5
Q

What enzymes conjugated

A

UDP glucoyuntransferase

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6
Q

When does jaundice become visible

A

Bilirubin >40-50

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7
Q

What are the different types of jaundice with time

A

Early - <24 hours
Intermediate
Prolonged >2 week or 21 if pre-term

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8
Q

What is always abnormal

A

Early

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9
Q

What causes early jaundice

A 
Haemolysis 
ABO / Rhesus mismatch
G6PD / Spherocytosis
Sepsis 
- Congenital or early 
Haematoma 
Haemorrhage - IVH
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10
Q

What do you do

A

Urgent SBR if suspect

Other tests

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11
Q

What suggests haemolytic

A

+ve DAT

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12
Q

What causes intermediate

A 
Physiological - most common
Sepsis
Haemolysis
Abnormal conjugated
Cephalohaematoma
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13
Q

What is abnormal conjugated

A 
Gilberts
Criger Najar
Absence of enzyme to conjugated
Isolated hyperbilirubin
Do FBC to rule out haemolytic
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14
Q

What causes physiological

A

Shorter RBC lifespan
Polycythaemic at birth
Immature liver function
Pre-mature and breast fed increase

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15
Q

What is always abnormal

A

Conjugated bilirubin
Suggest obstruction
Pale stool / dark urine = worry
Need split SBR

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16
Q

What causes obstruction

A 
Biliary atresia - early Dx is key (bile duct narrowed or absent resulting in cholestasis)
Gall stone
Tumour
Hirschprung
Cyst 
Alangile syndrome
17
Q

How does liver disease present

A

Jaundice if bilirubin >40

Most prominent in sclera

18
Q

What are other signs of cholestasis / biliary atresia

A 
Pruritus
Dark urine 
Pale stool
Fat malabsorption
May have HSM
Poor growth / feeding 
Cardiac murmur if associated abnormality
19
Q

How do you investigate jaundice at bed site

A

Bilirubinometer

20
Q

When can you not use

A

If <24 hours

21
Q

What do you do after bilirubinometer

A

Plot level on Rx line to see what Rx is needed
If <50 below Rx line= SBR
Split is important for biliary atresia

22
Q

What are other tests

A 
FBC
Blood film 
DAT for haemolytic 
Blood group 
G6PD
Urine and blood culture
Septic screen if unwell
U+E
LFT
TFT
Test to exclude a1- anti typisn or CF
23
Q

What imaging for obstruction

A

USS

Liver biopsy

24
Q

How do you treat biliary atresia

A

UDCA can be given in interim
Urgent Kasai Portoenterostomy
- Blocked bile duct removed and replaced with small intestine
Liver transplant if doesn’t work / severe end stage liver disease / portal HTN

25
Q

What are choledochal cyst

A

Cyst in bile duct so don’t get effective flow

26
Q

How do you Dx choledochal cyst

A

Split bilirubin
Pale stools
USS of bile duct

27
Q

What is alagille syndrome

A

Intrahepatic cholestsasis
Dysmorphism
Congenital cardiac disease

28
Q

How do you treat physiological jaundice

A 
Phototherapy to breakdown bilirubin and prevent complication 
Exchange transfusion if very severe 
Ig if immune process
May need transfusion if anaemia 
- Can do this in the womb
Assess need for SCBU
Ensure fluid requirements met
Monitor regular
29
Q

What is important to ask in the history if asked to see a baby with jaundice

A 
Age - preterm ? birth trauma? 
RF infection - maternal fever, PPROM, group B strep
Mothers blood group / known Ab 
Poo / pee / feed bottle or breast 
FH haemolytic disorder
30
Q

How would you examine a jaundice child

A 
A
B - RR, resp distress, SATS
C - CRT - sternal, BP 
D - temp, movement, BG 
E
31
Q

What does jaundice cause

A

Cross BBB and deposits in brain / basal ganglia causing kernicterus
Clinical acute encephalopathy

32
Q

What is acute encephalopathy

A 
Poor feed
Lethargy
Seizure
Hypotonia 
Shrill cry
33
Q

What does chronic encephalopathy

A 
Severe choreathetoid palsy
Sensorineural high freq loss
Vision - upward gaze
Seizure 
Hypotonia and hypertonia 
Hyperreflexia
Coma
34
Q

What are causes of prolonged jaundice that are not obstructive so unconjugated >14 day

A 
Breast milk
UTI 
Sepsis - exclude UTI 
Cystic fibrosis 
Hypothyroid 
Congenital CMV / toxoplasosis
Hepatitis
A1AT deficiency 
TPN
Haemochromatosis
Storage and metabolic disorder
35
Q

How does phototherapy work

A

Converts unconjugated bilirubin into isomers that can be exerted without conjugation in liver

36
Q

What should you do after phototherapy

A

Measure bilirubin 8-12 hours to ensure levels do not rise

37
Q

How do you treat

A

Optimise hydration / feeding
Phototherapy
Exchange transfusion

Paediatrics (35 decks)

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