Jaundice Flashcards

1
Q

Jaundice in neonates can be split into 3 categories

A

1) Early (<24hrs old)
2) Intermediate (<2wks)
3) Prolonged (>2wks old)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the major causes of early/intermediate jaundice?

A
Physiological Jaundice
Breast Milk Jaundice
Sepsis
Haemolysis
Abnormal Conjugation (genetic problems)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

All forms of Early/intermediate jaundice are unconjugated. What causes physiological jaundice?

A

Short RBC life span
Relative Polycythaemia
Immature Liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What causes haemolysis in neonates?

A

ABO incompatible
Rhesus Disease
Spherocytosis
G6PD deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What genetic causes can cause abnormal conjugation of bilirubin?

A

Gilbert’s Disease

Crigler-Najjar Syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How do we test to determine the source of early/intermediate jaundice?

A

Split bilirubin, LFTs, Albumin, Coagulation tests, Glc & ammonia

Urine & blood cultures + TORCH screen (For sepsis)

Blood group, DCT, blood film & G6PD Assay (for haemolysis)

Genetic Testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How do we manage early/intermediate jaundice?

A

Treat the cause

If really bad can do Blue Light phototherapy (only works for unconjugated jaundice)
The blue light converts bilirubin to a water soluble isomer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Kernicterus is a dangerous complication of unconjugated jaundice. What happens in it?

A

Unconjugated bilirubin is fat soluble
Crosses BBB
Deposited in brain (mostly basal ganglia)
Neurotoxic –> encephalopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How does kernicterus present?

A

Early –> Encephalopathy –> Poor feeding, lethargy & seizures

Late –> Cerebral palsy, LDs & SN deafness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the major causes of prolonged jaundice? (>2wks old, 3 if preterm)

A

Conjugated = Biliary Atresia, Choledochal cyst, Alagille Syndrome or neonatal hepatitis

Unconjugated = Hypothyroid or breast milk jaundice

Assume Biliary Atresia until proven otherwise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What happens in Biliary Atresia?

A

Fibroinflammatory disease –> destruction of extrahepatic ducts

Other signs include pale stool, dark urine and liver failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What happens in alagille syndrome?

A

Intrahepatic cholestasis (leading to conjugated jaundice), dysmorphism & congenital HDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are some causes of neonatal hepatitis?

A
Viral
Alpha-1-antitrypsin deficiency
Haemochromatosis
Parenteral Nutrition
High ammonia
etc etc
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How do you test someone who presents with prolonged jaundice?

A

1st) Split bilirubin
2nd) Check stool colour

Other Tests:

  • US for cysts & Atresia
  • Liver biopsy for Atresia and some hepatitises
  • Genotyping for Alagille Syndrome
  • Specific tests for hepatitis causes e.g. serology, TFTs, A-1-A level, Ammonia & Fe studies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How do we treat Biliary Atresia after confirming it with US & biopsy?

A

Kasai Portoenterostomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly