Neonatal Jaundice Flashcards
Name some LFTs
Bilirubin (total, split) ALT AST Alkaline phosphatase Gamma glutamyl transferase
When are ALT and AST elevated
Elevated in hepatocellular damage
Hepatitis
When is ALP rasied
In biliary disease
When is GGT generally rasied
In biliary disease
Name some tests to actually assess liver function
Coagulation (prothrombin time, APTT)
Albumin
Bilirubin
Signs of liver failure in children
Encephalopathy Jaundice Epistaxis Ascites Peripheral neuropathy Liver palms Clubbing Varices with portal hypertension s Spider naevi Muscle wasting from malnutrition Hypersplenism
What is jaundice
yellow discolouration of the skin and tissue due to accumulation of bilirubin
Where is jaundice usually most obvious
Sclera
Describe bilirubin metabolism W
RBC broken down in reticuloendothelial system in the spleen
To form unconjugated bilirubin
Then travels to the liver bound to albumin
Where conjugation occurs
Then stored in the gallbladder
And released with bile into the small intestine
Some urobillinogen goes to creates stercobilin (and is excreted in poo giving it the brown colour)
Some is excreted by the kidneys as urine giving it the yellow colour
What is haemoglobin broken down into
Haem
Globin
What is the globin portion broken down into
Amino acids
Is most pre-hapetic jaundice conjugated or unconjugated
Unconjugated
Is most hepatic jaundice conjugated or unconjugated
Mix of both
Is more post hepatic jaundice conjugated or unconjugated
Conjugated
What should you remember about early jaundice <24hrs
ALWAYS PATHOLOGICAL
Causes of early jaundice <24hrs
Haemolysis
Sepsis
Define the timing of intermediate jaundice
24hrs to 2 weeks old
Name potential causes of intermediate neonatal jaundice
Physiological
Breast milk
Sepsis
Haemolysis
Define the timing of prolonged jaundice
> 2 weeks old
Potential causes of prolonged neonatal jaundice
Extrahepatic obstruction,
Neonatal hepatitis, Hypothyroidism,
Breast milk
Describe physiological jaundice
Shorter RBC life span
More broken down
Relative immaturity of liver function
Leads to increased bilirubin
Is physiological jaundice bilirubin conjugated or un
Unconjugated
When does physiological jaundice occur
First few days of life
What is the cause of breast milk jaundice
Exact reason unknown
Is breast milk jaundice conjugated or unconjugated
Unconjugated
For how long can breast milk jaundice persist
Up to 12 weeks
Potential causes for haemolysis in newborn
ABO incompatibility Rhesus disease Bruising/cephalohaematoma Red cell membrane defect Red cell enzyme defect
Name 2 diseases where there is abnormal conjugation of bilirubin
Gilbert’s disease
Crigler-Najjar syndrome
Ix for ABO incompatibility
Blood group
DCT +ve
Ix for Rhesus disease
Blood group
DC +ve
Ix for bruising/cephalohaematoma
O/E
Example of a red cell membrane defect
Spherocytosis
How would you Dx hereditary spherocytosis
Blood film
