Neonatal Jaundice

Question 1

Name some LFTs

Answer 1

Bilirubin (total, split)
ALT
AST 
Alkaline phosphatase
Gamma glutamyl transferase

Question 2

When are ALT and AST elevated

Answer 2

Elevated in hepatocellular damage

Hepatitis

Question 3

When is ALP rasied

Answer 3

In biliary disease

Question 4

When is GGT generally rasied

Answer 4

In biliary disease

Question 5

Name some tests to actually assess liver function

Answer 5

Coagulation (prothrombin time, APTT)
Albumin
Bilirubin

Question 6

Signs of liver failure in children

Answer 6

Encephalopathy 
Jaundice 
Epistaxis 
Ascites
Peripheral neuropathy 
Liver palms
Clubbing
Varices with portal hypertension s
Spider naevi 
Muscle wasting from malnutrition 
Hypersplenism

Question 7

What is jaundice

Answer 7

yellow discolouration of the skin and tissue due to accumulation of bilirubin

Question 8

Where is jaundice usually most obvious

Answer 8

Sclera

Question 9

Describe bilirubin metabolism W

Answer 9

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

Question 10

What is haemoglobin broken down into

Answer 10

Haem

Globin

Question 11

What is the globin portion broken down into

Answer 11

Amino acids

Question 12

Is most pre-hapetic jaundice conjugated or unconjugated

Answer 12

Unconjugated

Question 13

Is most hepatic jaundice conjugated or unconjugated

Answer 13

Mix of both

Question 14

Is more post hepatic jaundice conjugated or unconjugated

Answer 14

Conjugated

Question 15

What should you remember about early jaundice <24hrs

Answer 15

ALWAYS PATHOLOGICAL

Question 16

Causes of early jaundice <24hrs

Answer 16

Haemolysis

Sepsis

Question 17

Define the timing of intermediate jaundice

Answer 17

24hrs to 2 weeks old

Question 18

Name potential causes of intermediate neonatal jaundice

Answer 18

Physiological
Breast milk
Sepsis
Haemolysis

Question 19

Define the timing of prolonged jaundice

Answer 19

> 2 weeks old

Question 20

Potential causes of prolonged neonatal jaundice

Answer 20

Extrahepatic obstruction,
Neonatal hepatitis, Hypothyroidism,
Breast milk

Question 21

Describe physiological jaundice

Answer 21

Shorter RBC life span
More broken down
Relative immaturity of liver function
Leads to increased bilirubin

Question 22

Is physiological jaundice bilirubin conjugated or un

Answer 22

Unconjugated

Question 23

When does physiological jaundice occur

Answer 23

First few days of life

Question 24

What is the cause of breast milk jaundice

Answer 24

Exact reason unknown

Question 25

Is breast milk jaundice conjugated or unconjugated

Answer 25

Unconjugated

Question 26

For how long can breast milk jaundice persist

Answer 26

Up to 12 weeks

Question 27

Potential causes for haemolysis in newborn

Answer 27

ABO incompatibility 
Rhesus disease
Bruising/cephalohaematoma 
Red cell membrane defect
Red cell enzyme defect

Question 28

Name 2 diseases where there is abnormal conjugation of bilirubin

Answer 28

Gilbert’s disease

Crigler-Najjar syndrome

Question 29

Ix for ABO incompatibility

Answer 29

Blood group

DCT +ve

Question 30

Ix for Rhesus disease

Answer 30

Blood group

DC +ve

Question 31

Ix for bruising/cephalohaematoma

Answer 31

O/E

Question 32

Example of a red cell membrane defect

Answer 32

Spherocytosis

Question 33

How would you Dx hereditary spherocytosis

Answer 33

Blood film