Jaundice

Question 1

What age range is physiological jaundice associated with?

Answer 1

2-5 days

Question 2

Generally what is the cause of physiological jaundice?

Answer 2

The immature liver conjugating pathways are unable to deal with the breakdown of foetal haemoglobin, leading to an increase in uncongugated haemoglobin.

Question 3

List some causes of physiological cases of jaundice?

Answer 3

Increased bilirubin production
Reduced bilirubin uptake and binding by liver cells
Reduced conjugation
Reduced excretion

Question 4

What is the main cause of pathological jaundice within the first 24 hours?

Answer 4

Haemolysis causing an increase in the bilirubin concentration.

Question 5

What are some causes of haemolysis within the first 24 hours?

Answer 5

ABO blood incompatability
Rh immunisation
Sepsis

Question 6

What investigations are undertaken in a suspected haemolytic jaundice in the first 24hrs?

Answer 6

Total and conjugated serum bilirubin
Maternal and babies blood group
Antibody titres
FBC

Question 7

What are some causes of a ‘too high bilirubin’ within 24hrs -10 days?

Answer 7

Mild dehydration/ lack of milk supply
Haemolysis
Polcythaemia

Question 8

In terms of haemolysis causing jaundice between 1-10 days what is the main causes?

Answer 8

Breakdown of extravasated blood from bruising during delivery to swallowed blood, the blood is broken down to form bilirubin.

Question 9

What is the main cause of polycythaemia ?

Answer 9

A rare disease resulting in a too high red cell concentration.

Question 10

What are some causes of pathological jaundice lasting longer than 10 days?

Answer 10

Breast milk jaundice
Continued poor milk intake ( dehydration)
Haemolysis
Infection
Hypothyroidism

Question 11

What is the suspected cause of breast milk jaundice?

Answer 11

A protein within the breast milk slows down the conjugating pathways within the liver leading to an increased bilirubin concentration.

Question 12

Why is persistent conjugated jaundice bad?

Answer 12

Conjugated jaundice is always a pathological and abnormal finding.

Question 13

What are the two main causes of conjugated jaundice?

Answer 13

Hepatitis

Biliary atresia

Question 14

What is biliary atresia?

Answer 14

The biliary duct doesn’t connect to the small intestine, this leads to obstructive jaundice and is fatal unless treated.

Question 15

What is the most commonly referred symptom for biliary atresia?

Answer 15

Pale clay coloured stool with dark urine

Question 16

List some signs of jaundice

Answer 16

Lethargy
Poor feeding 
Temperature
Arching of the back and neck
Spasticity seizures