Jaundice Flashcards
How can causes of neonatal jaundice be separated?
<24 hours
24 hours - 2 weeks
>2 weeks
What is jaundice <24 hours indicate of?
Always pathological
What can cause jaundice <24 hours?
Sepsis
HAemolysis- rhesus haemolytic disease, ABO haemolytic disease, hereditary causes
What can cause jaundice 24 horus to 2 weeks?
Physiological Breast milk jaundice Polycythaemia Sepsis Haemolysis Cephalohaematoma
What type of jaundice is physiological jaundice?
Unconjugated
What causes physiological jaundice?
Short RBC lifespan in inflants
Relative polycythaemia
Relative immaturity of liver function
What type of jaundice is breast milk jaundice?
Unconjugated
How long can breast milk jaundice persist?
Up to 12 weeks
What does prolonged jaundice indicate?
Requires investigation
What can cause prolonged jaundice?
Breast milk Hypothyroid Pyloric stenosis Cholestasis Haemolysis Infection Hepatitis
What can cause conjugated prolonged jaundice?
Biliary obstruction
Neonatal hepatitis
Infection
What are some causes of biliary obstruction in neonates?
Biliary atresia
Choledochal cyst
Alagille syndrome
What is the presentation of biliary atresia?
Raare
Progressive jaundice after 2 weeks
Pale stool, dark urine
What is the investigation of biliary atresia?
Bloods- LFTs- increased conjugated bilirubin
US
What is the management of biliary atresia?
Urgent Kasai portoenterostomy
What is the presentation of a choledochal cyst?
Conjugated jaundice- pale stools, dark urine
What investigations ar done for choledochal cyst?
Split bilirubin
US
What is Alagille syndrome?
Inherited syndrome of intrahepatic cholestais, dysmorphism and congenital cardiac disease
What can cause unconjugated prolonged jaundice?
Hypothyroid
Breast milk aundice
HAemolysis
What investigations ar done for prolonged jaundice?
FBC and blood fil, U&Es, LFTs, TFTs Conjugated and unconjugated bilirubin Direct antiglobulin test- Coombs Urinalysis Suspect infection- blood and urine cultures
What is the indication for management of jaundice?
Treatment threshold chart
What is the management and mechanism of management of unconjugated jaundice?
Blue light therapy
Visible light converts bilirubin to water soluble isomer for excretion
What is the management of severe jaundice?
Exchange transfusion
Why is management indicated for unconjugated jaundice?
Unconjugated bilirubin can cross blood brain barrier and is neurotoxic
What can uncnjugated jaundice cause?
Kernicterus
How does kernicterus present?
Encephalopathy- poor feeding, lethargy, seizures
What are the complications of kernicterus?
Severe cerebral palsy
Learning difficulties
Sensorineural deafness
