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Paediatrics > Paeds Yellow Baby > Flashcards

Paeds Yellow Baby Flashcards

1
Q

name 5 liver functions

A

Factory - production of proteins - albumin and clotting factors
Breakfast - metabolism of food
Storage centre. - glycogen
Excretion of toxic stuff

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2
Q

Name 2 Bilirubin tests

A

Total bilirubin

Split bilirubin

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3
Q

What is “Split bilirubin” ?

A

Direct (conjugated) + indirect (unconjugated)

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4
Q

ALT/AST (alanine aminotransferase/aspartate aminotransferase) are elevated in…

A

hepatocellular damage (“hepatitis”)

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5
Q

Alkaline phosphate and Gamma glutamyl transferase (GGT) are elevated in…

A

biliary disease

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6
Q

Name some Liver “function” tests (LFTs)

A

Bilirubin (total and split)
ALT/AST
Alkaline phosphate
Gamma glutamyl transferase (GGT)

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7
Q

Name some tests to assess liver FUNCTION

A

Coagulation
Albumin
Bilirubin

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8
Q

Name 2 tests that asses liver function with regards to coagulation

A 
Prothrombin time (PT)/ INR
aPTT
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9
Q

What does INR stand for and what is it?

A

International normalised ratio

measurement of how long it takes for blood to clot

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10
Q

What is the main clinical manifestation of paediatric liver disease?

A

JAUNDICE

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11
Q

What are other clinical manifestations of paediatric liver disease?

A

incidental finding of abnormal blood test

symtoms/signs of chronic liver disease

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12
Q

Signs of Chronic Liver Disease in Children

A 
Encephalopathy
Jaundice
think in terms of liver function:
coagulation:
- epistaxis 
-bruising and petechiae
think in terms of portal hypertension:
varices
hepatorenal failure
Ascites
Think in terms of Cholestasis:
fat malabsorption
Deficiency of fat-soluble vitamins
pruritus 
play stools 
dark urine
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13
Q

Other than the usual signs of chronic liver disease common to booth adults and children
what else would you expect to find in kids?

A

Growth failure

FTT

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14
Q

Jaundice is

A

yellow discolouration of skin and tissues due to accumulation of bilirubin

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15
Q

Jaundice is most obvious in the…

A

sclera

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16
Q

jaundice is usually visible when the total bilirubin is >

A

40-50 mol/L

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17
Q

The diagnosis of infant jaundice is dependent on 2 things….

A

understanding bilrubin metabolism

The age of infant

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18
Q

When RBCs are broken down

Globin is broken down to amino acids, iron is rested and have I broken down to ….

A

Biliverdin -> unconjugated bilirubin

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19
Q

Uncojugated bilirubin is water

A

insoluble

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20
Q

Uncojugated bilirubin is bound to … and transported to the …

A

albumin

liver

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21
Q

The liver …. uncojugated bilirubin

A

conjugates

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22
Q

conjugated bilirubin is water

A

soluble

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23
Q

conjugated bilirubin goes into the

A

bile

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24
Q

bile goes into the

A

small intestine

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25
Q

bile is broken down into

A

urobiligen

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26
Q

what 3 things can happen to urobiligen?

A

excreted by kidneys
excreted in stool
goes back to liver

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27
Q

If something goes wrong with bilirubin metabolism during the RBC to uncojugated bilirubin stage this is called ….. jaundice

A

Pre-hepatic jaundice

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28
Q

in Pre-hepatic jaundice there is mostly ….. bilirubin

A

uncojugated bilirubin

29
Q

If something goes wrong when the bilirubin is getting conjugated in the liver this is called ….. jaundice

A

intrahepatic jaundice

30
Q

In intrahepatic jaundice there is …. bilirubin

A

mixed bilirubin

uncojugated/ conjugated bilirubin

31
Q

If something goes wrong from the bile getting to the small intestine this is called

A

post hepatic jaundice (cholestasis)

32
Q

Post hepatic jaundice is mostly ….. bilirubin

A

conjugated

33
Q

Within how many hours old is early neonatal jaundice classified as

A

<24hrs

34
Q

Early neonatal jaundice is always…

A

pathological

35
Q

Causes of early neonatal jaundice include…

A

Haemolysis + Sepsis

36
Q

Time frame of intermediate neonatal jaundice

A

(24hrs - 2 weeks)

37
Q

Causes of intermediate neonatal jaundice include…

A

physiological, breast milk, sepsis, heaolysis

38
Q

time frame of prolonged neonatal jaundice

A

> 2 weeks

39
Q

Causes of prolonged neonatal jaundice include

A

Extrahepatic obstruction, neonatal hepatitis, hypothyroidism, breast milk

40
Q

Physiological jaundice happens because…
RBCs have a …. life span in infants
there is relative …cythaemia
and relative…. of liver function

A

Shorter
polycythaemia
immaturity

41
Q

In physiological jaundice there is …. bilirubin

A

unconjugated

42
Q

What type of milk is associated with intermediate jaundice of neonates?

A

Breast milk

-reason unclear

43
Q

What type of bilirubin is present in breast-milk jaundice?

A

Unconjugated

44
Q

In breast-milk jaundice you get more worried and investigate other things more when ….

A

it last for longer and longer

45
Q

What is a complication of pre-hepatic (unconjugated bilirubin) jaundice?

A

Kernicterus

46
Q

why can unconjugated bilirubin cross the blood-brain barrier in Kernicterus?

A

because it is fat-soluble (water insoluble)

47
Q

unconjugated bilirubin is neuro….. and leaves…. in the brain

A

toxic

deposits

48
Q

Early signs of kernicterus

A

encephalopathy- poor feeding, lethargy, seizures

49
Q

Late consequences of kernicterus

A

severe choreoathetoid cerebral palsy, learning difficulties, sensorineural deafness

50
Q

Treatment for unconjugated jaundice

A

Phototherapy

51
Q

Phototherapy is

A

visible light

52
Q

The light in phototherapy converts bilirubin to

A

a water soluble isomer

53
Q

Other causes of unconjugated early/ intermediate infant jaundice

A

Sepsis
Haemolysis
Abnormal conjugation (congenital stuff)

54
Q

Haemolytic causes of unconjugated infant jaundice

A 
ABO incompatibility
Rhesus disease
Bruising/cephalhaematoma
Red cell membrane defects (e.g. spherocytosis)
Red cell enzyme defects (e.g. G6PD)
55
Q

Conjugated causes for prolonged infant jaundice

A

Anatomical (biliary obstruction)

Neonatal hepatitis

56
Q

Unconjugated causes for prolonged infant jaundice

A

Hypothyroidism

Breast-milk jaundice

57
Q

Conjugated jaundice in infants is always… and …. requires further investigation

A

abnormal and always

58
Q

the most important test in prolonged jaundice is a

A

split bilirubin

59
Q

Causes of prolonged jaundice - biliary obstruction

A

BILLIARY ATRESIA
Choledochal cyst
Alagille syndrome

60
Q

Always asses the stool … in infants with prolonged jaundice

A

colour

61
Q

Biliary atresia is

A

Congenital fibro-inflammatory disease of bile ducts leading to destruction of extra-hepatic bile ducts

62
Q

Biliary atresia presents with

A

prolonged, conjugated jaundice

63
Q

In biliary atresia stools are.. and urine is …

A

pale and dark

64
Q

In biliary atresia there can be progression to … if not identified and treated

A

liver failure

65
Q

primary treatment for biliary atresia

A

Surgical fix - Kasai

duodenum connected up to liver

66
Q

Assessment of prolonged infant jaundice is primarily targeted at diagnosing patients with…

A

biliary atresia early

67
Q

What investigation do you ultimately need in biliary atresia?

A

liver biopsy

68
Q

Causes of neonatal hepatitis

A

Alpha-1- antitrypsin deficiency

galctosaemia

Paediatrics (15 decks)

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