Jaundice Flashcards
LFT’s
bilirubin - total and split
ALT/AST
Alk Phos
GGT
When are transaminases raised?
hepatocellular damage - hepatitis
When is alk phos and GGT raised?
biliary disease
Tests to assess liver function
coagulation - APTT and PTT
bilirubin
albumin
blood glucose? ammonia?
Some signs of liver disease in children
growth failure encephalopathy jaundice ascites clubbing muscle wasting spider naevi
Where does bilirubin come from?
breakdown of RBC - haem
pre-hepatic jaundice bilirubin type
unconjugated
post-hepatic jaundice bilirubin type
conjugated
When is jaundice always pathological in neonates?
first 24 hours of life
causes of early jaundice
haemolysis
sepsis
causes of intermediate sepsis
physiological
breast milk
sepsis
haemolysis
causes of jaundice >2 weeks old
extraheptic obstruction
neonatal hepatitis
hypothyroidism
breast milk
“physiological” jaundice
shorter RBC life span
relative polycythaemia
immaturity of liver function
what kind of jaundice is physiological and when does it develop?
unconjugated
after first day of life
Breast milk jaundice
unconjugated
haemolysis causes
ABO incompatible
rhesus disease
spherocytosis
G6PD - enzyme defect
Complication of unconjugated bilirubin
kernicterus
kernicterus
unconjugated bilirubin is fat soluble and cross BBB
encephalopathy
cerebral palsy
Treatment for unconjugated jaundice
phototherapy
visible light - blue
causes of prolonged conjugated jaundice
biliary obstruction
hepatitis
Causes of prolonged unconjugated jaundice
hypothyroidism
breast milk jaundice
is conjugated or unconjugated jaundice in infants always abnormal?
CONJUGATED
Most important test in prolonged jaundice
split bilirubin
prolonged jaundice - biliary obstruction
biliary atresia
choledochal cyst
alagille syndrome
