paediatric liver Flashcards
1.
Which LFT is raised in hepatocellular dameage
ALT
Which LFTs are raised in biliary disease
ALP and GGT
What is the best way to assess liver function
Check the prothrombin time or the INR
What is the most common clinical manifestation of liver disease in children
Jaundice
What is the bilirubin level in jaundice
Usually greater than 40-50 micromol/l
What is conjugated bilirubin
Glucoronic acid gets added to the bilirubin in the liver
Which bilirubin is water soluble
Conjugated is soluble in water - unconjugated is insoluble in water
What kind of bilirubin is associated with prehepatic jaundice
Mostly unconjugated
What kind of bilirubin is associated with intra-hepatic jaundice
mixed - conjugated and unconjugated
What kind of bilirubin is associated with post-hepatic jaundice
Mostly conjugated bilirubin
What causes of jaundice are suspected when the baby is less than 24 hours old
Haemolysis or sepsis
What causes of jaundice are suspected in a child who is between 24 hours and 2 weeks old
- Breast milk
- sepsis
- haemolysis
- physiological
What causes of jaundice are suspected in children over 2 weeks old
- Extra-hepatic obstruction
- Neonatal hepatitis
- Hypothyroidism
- Breast milk
Describe physiological jaundice
Unconjugated jaundice which develops after the first day of life
What is the cause of physiological jaundice
Infants have a shorter red blood cell life span and are born with high blood cell count with immature liver function which can lead to jaundice due to excess red blood cell break down
Describe breast milk jaundice
Unconjugated jaundice that can persist up to 12 weeks
What is kernicterus
Unconjugated bilirubin crossing the blood brain barrier due to it being fat solube
What is the presentation of kernicterus
- Encephalopathy (poor feeding, lethargy and seizures)
- Severe choreoathetoid cerebral palsy, learning difficulties and sensorineural deafness
What is the treatment for unconjugated jaundice
Phototherapy
Describe phototherapy
Visible light which converts bilirubin to water soluble isomer which makes it unable to cross the blood brain barrier
Describe gilberts disease
Slight reduction of the UDP glucuronyl transferase and therefore glucuronic acid cannot get added to bilirubin and therefore the bilirubin stays unconjugated
Describe Crigler-Najjar syndrome
almost no UDP glucuronyl transferase and therefore glucuronic acid cannot be added to bilirubin which therefore leads to more unconjugated bilirubin - more severe version of gilberts disease
Define prolonged infant jaundice
Jaundice that persists beyond 2 weeks of life
What are the causes of prolonged infant jaundice
Conjugated:
- Anatomical biliary obstruction
- Neonatal hepatitis
Unconjugated:
- hypothyroidism
- Breast milk jaundice
