Jaundice

Question 1

List the 5 categories of neonatal jaundice

Answer 1

1. Physiological
2. Haemolytic
3. Non-haemolytic pathological
4. Hepatic
5. Obstructive

Question 2

Timeline of physiological jaundice

Answer 2

Starts by day 3, stops by day 7

Question 3

What types of jaundice present with high UNCONJUGATED bilirubin

Answer 3

Physiological
Haemolytic
Non-haemolytic pre hepatic

Question 4

What types of jaundice present with high CONJUGATED bilirubin

Answer 4

Hepatic

Obstructive

Question 5

Which type of jaundice will NOT cause kernicterus? Why?

Answer 5

Hepatic/ obstructive

Conjugated bilirubin cannot cross the blood brain barrier

Question 6

Which type of bilirubin is excreted in stools

Answer 6

Stools = Conjugated bilirubin

Question 7

Which type of bilirubin is excreted in urine

Answer 7

Urine = Unconjugated bilirubin

Question 8

At what bilirubin level is jaundice concerning

Answer 8

> 308umol

Question 9

At what bilirubin level is jaundice visible

Answer 9

> 34umol

Question 10

2 main treatments for jaundice

Answer 10

Phototherapy

Blood transfusion

Question 11

How does phototherapy work

Answer 11

Adds oxygen to bilirubin so it dissolves easily in water -> easier for liver to break down

Question 12

Breastmilk jaundice vs breastfeeding jaundice

Answer 12

Breastmilk = insufficient gut flora at birth, so longer time to breakdown bilirubin

Breastfeeding = insufficient milk intake, so not passing out stools & urine as often

Question 13

Causes of haemolytic jaundice

Answer 13

• Thalassaemia
• G6PD deficiency
• Rhesus incompatibility
• Sepsis

Question 14

Causes of non-haemolytic pathological jaundice

Answer 14

• Breastfeeding jaundice
• Breastmilk jaundice
• UTI, other infections
• Gilbert’s syndrome

Question 15

Causes of hepatic jaundice

Answer 15

Hepatitis
TORCH infections (toxoplasmosis, Rubella, CMV, HSV, Others: VZV)

Question 16

Causes of obstructive jaundice

Answer 16

Biliary atresia

Question 17

What timeline of jaundice suggests pathological cause

Answer 17

Jaundice <24h or >14 days

Question 18

3 main pathophysiology for physiological jaundice

Answer 18

1. Foetal RBC lifespan 90 days instead of 120 days in adult
2. Low conversion of bilirubin to urobilinogen by intestinal flora
3. Low activity of enzyme glucuronosytransferase (converts unconjugated bilirubin to conjugated bilirubin for excretion in GI tract)

Question 19

What kind of jaundice does inborn errors of metabolism cause

Answer 19

Hepatic jaundice

Question 20

Definition of prolonged jaundice in

• term baby
• premature baby

Answer 20

Term: jaundice >2 weeks
Premature: jaundice >3 weeks