paediatric jaundice

Question 1

define jaundice

Answer 1

: yellowish discoloration of the skin, sclerae, and mucous membranes due to the deposition of bilirubin

Question 2

define cholestasis

Answer 2

any condition affecting bile formation or secretion or leading to biliary obstruction within the liver or in the biliary ducts between the liver and the duodenum

Question 3

cause of unconjugated hyperbillirubinemia

Answer 3

1.Increased hemoglobin breakdown
-hemolysis
#G6PD
#SICKLE CELL
#HEMOLYTIC DISEASE OF NEWBORN

Impaired hepatic uptake of bilirubin
-DRUGS
#rifampin, #probenecid, #sulfonamides

Defective conjugation of bilirubin
-hyperbilirubinemia
#Gilbert’s syndrome and Crigler-Najjar syndrome

-neonatal jaundice(immature hepatocytes + hyperbilli)

-liver diseases
#wilson's disease
#hepatitis
#cirrhosis

Question 4

causes of Conjugated hyperbilirubinemia

Answer 4

1)Decreased excretion/reuptake of bilirubin (Dubin-Johnson syndrome)

2]Intrahepatic cholestasis

• Liver disease (e.g., hepatitis or cirrhosis)
• Primary biliary cholangitis (autoimmune destruction of the intralobular bile ducts)

3)Extrahepatic cholestasis (biliary obstruction)
-Choledocholithiasis(gallstones)
-Tumors
#pancreatic head cancer, #gallbladder cancer
-Inflammatory processes #primary sclerosing cholangitis,

Question 5

pathophys of jaundice

Answer 5

elevated serum bilirubin, caused by prehepatic, intrahepatic, or posthepatic defects

UC/indirect hyperbilli

• increased hemoglibin bkdwn
• defective hepatic uptake
• defective hepatic conjugation

Question 6

sx of jaundiced

Answer 6

yellow eyes, skin, nails

Pale, clay-colored (acholic) stool 4
(bile containing the direct bilirubin cannot reach the colon due to cholestasis, this may lead to discolored stools. Alternatively, the direct bilirubin may be excreted via the urine, making it dark.)

Darkening of urine(increased urobillin in urine)

Pruritus (accumulated bile acids irritate peripheral nerves in the skin)

Fat malabsorption (lack of bile acid in duodenum results in reduced of lipids.)

(steatorrhea, weight loss)

Question 7

dg

Answer 7

LIVER FUNCTION TESTS 
1)hyperbillirubinemia induced cholestasis signs 
↑ Alkaline phosphatase (ALP)
↑ Gamma glutamyltransferase (γ-GT)
↑ Bilirubin 

2)liver ez
↑ ALAT&ASAT

3)coagulation study

IMAGING

US: dx types of cholestasis

ERCP for further imaging( pancreas)

Question 8

dg of PREHEPATIC

jaundidce

Answer 8

dark stool 
elevated indirect 
normal dirrect
normal/dark urine billirubin 
increased urobilinogen 
other markers 
anemia

Question 9

dg of INTRAHEPATICjaundidce

Answer 9

Pale, clay-colored (rarely dark) stool

↑indirect & ↑direct bilirubin

↑bilirubin in urine (dark urine)

Normal or ↑urobilinogen

other useful
markers
↑Transaminases
↑ Cholestatic enzymes

Question 10

EXTRA HEPATIC JAUNDICE DG

Answer 10

pale stool

normal indirect
very high direct
very dark urine d/2 increased direct bilirubin and urobillin

increased cholestatic enzymes

Question 11

dx of jaundice in newborn

Answer 11

deposition of carotene in the skin (carotenoderma) following excessive consumption of fruits and vegetables rich in carotene, such as carrots, sweet potatoes, kale, and oranges or multivitamin supplements. In contrast to jaundice, it does not lead to scleral icterus.

Question 12

rx

Answer 12

Management of the underlying condition
Cirrhosis
Hepatitis B, 
hepatitis C
Alcoholic liver disease
Primary biliary cholangitis, primary sclerosing cholangitis
Inherited hyperbilirubinemia
Pancreatic cancer, cholangiocarcinoma
Cholelithiasis and cholecystitis
Surgical excision of biliary cysts is the preferred treatment. Cholecystectomy is not necessary unless the gallbladder contains

Question 13

complications of jaundice

Answer 13

Hepatomegaly: Chronic biliary obstruction leading to backflow of bile may result in inflammation.

Risk of kernicterus in newborns with neonatal jaundice