Jaundice in Infants Flashcards
Explain metabolism of bilirubin
Heme (breakdown of RBCs) ➡ ️biliverdin (RES) ➡️ bilirubin ➡️ conjugated with albumin to enter liver, then dissociates ➡️ binds with glucoronide (conjugation) ➡️ small intestine (stercobilin to stercobilinogen) or kidney (urobilin to urobilinogen)
Serum bilirubin in jaundiced patients
Greater than or equal to 2 mg/dL
*at least 5 mg/dL in Filipinos
✅Define unconjugated hyperbilirubinemia
✅Signs
☑️Increase in total bilirubin <20% as direct bilirubin
☑️jaundice, yellow stools, colorless urine
✅Define conjugated hyperbilirubinemia
✅Signs
☑️increase in total bilirubin greater than or equal to 20% as direct bilirubin
☑️jaundice, acholic stools, dark urine
[UH]
Possible etiologies
☑️increased production of bilirubin (increased conversion from heme to bilirubin)
☑️decreased conjugation (immature liver, breast milk jaundice)
Deficiency or absence of uridyk glucoronosyl transferase
Crigler-Najjar syndrome type 1 - absence
Crigler-Najjar syndrome type 2 - deficient
UGT receptor defect, variant of Crigler-Najjar syndrome
Gilbert’s syndrome
[CH]
Possible etiologies
☑️decreased excretion (intrahepatic) - may be infective, metabolic, inborn errors of metabolism, genetic, drug-induced
☑️impaired excretion (extra +/- intrahepatic) - extrahepatic biliary atresia, choledochal cyst
Management of patient with galactosemia
☑️contraindicated for breastfeeding
☑️may give lactose-free formula
Lab tests for URGENT INVESTIGATION of jaundiced infant
PT Blood glucose Specific tests for non-viral infections Urine test for reducing sugars Blood and urine cultures
SUBSEQUENT INVESTIGATIONS: jaundiced infant
Stool appearance Urine color UTZ of hepatobiliary tree Percutaneous liver biopsy \+/- 99Tc hepatobiliary scan
Complete obliteration or destruction of the hepatic or common bile duct
Extrahepatic biliary atresia
Extrahepatic biliary atresia: treatment
Medical: Phenobarbital, ursodeoxycholic acid
Supplement: vit. ADEK, Zn
