Jaundice Flashcards
A worried mother comes to see you after having given birth to a health boy 1 week ago. The baby appears healthy apart from mild jaundice. How do you proceed?
Physiological jaundice is normal in 90% of babies. Reassure the mother that this should resolve by 2 weeks.
The mother returns 2 weeks later complaining that the jaundice has still not resolved, the baby appears well apart from this. What could be causing this?
If the baby had other symptoms and was unwell what potentially serious underlying pathology might you suspect?
Breast milk jaundice
Infection, Hypothyroidism, Galactosaemia, biliary atresia, choledochal cyst
Another baby, 3 weeks old presents to you at the GP also with jaundice. The mother reports the baby has also had pale stools.
The growth chart is showing faltering growth.
What investigations would you order?
Bilirubin levels
LFTs
TFTs
Abdominal USS
ERCP, liver biopsy
The results come back showing the child has a raised conjugated biliurubin, abnormal LFTs and the USS has demonstrated an absent gallbladder.
What management is this child likely to need?
What are the consequences if they do not receive this?
This child has biliary atresia. Without intervention they are likely to develop liver failure and die within 2 years.
They require surgery to enable drainage of bile from the liver.
A 6 day old baby whose parents have recently emigrated from china present to you in A&E. They report the child has been jaundiced since birth and is now drowsy, irritable and has had 2 seizures.
On examination the baby is lying with an arched back and has increased muscle tone.
What is the most likely diagnosis here?
Kernicterus
What is the most likely underlying pathology in this case?
Rhesus haemolytic disease of the newborn.
A routine blood test of a 10 day old baby shows deranged LFTs, with a high ALT.
The child is of a sub-saharan african origin, his parents having recently emigrated.
He has no symptoms and currently appears well.
What condition is it important to screen for in this case?
Hepatitis screen
The results come back:
HepBSag +ve
HepBSab -ve
Hep B Cag +ve
What is the diagnosis?
Acute infection with Hepatitis B
What is the main clinical risk for this patient?
This patient is likely to become a chronic carrier as he is a child. He will have an increased long term risk of developing hepatocellular carcinoma
