Pediatric Jaundice Flashcards
What is the treatment for unconjugated jaundice ?
Photo-therapy
Visible light - Not UV
Converts bilirubin to water soluble isomer
Define prolonged infant jaundice
Jaundice persisting beyond 2 weeks of life (3 weeks for preterm infants)
What are some of the conjugated causes of prolonged infant jaundice ?
Anatomical (biliary obstruction)
Neonatal hepatitis
What are some of the un-conjugated causes of prolonged infant jaundice ?
Hypothyroidism
Breast milk jaundice
Conjugated jaundice in infants is always abnormal and always requires further investigation, true or false ?
True the most important test in prolonged jaundice is a “split” bilirubin.
What are the 3 common causes of biliary obstruction in an infant/child ?
Biliary atresia Choledochal cyst Alagille syndrome (Congenital cardiac disease)
What is the most obvious jaundice sign in infants ?
Assessment of stool colour
How would a child with biliary atresia present ?
Prolonged conjugated worsening jaundice (pale stool and dark urine)
If not treated, what is the outcome of biliary atresia ?
Progression to liver failure if not identified and treated.
What is the most common indication for liver transplantation in children?
Biliary Atresia
Define biliary atreisa
Congenital fibro-inflammatory disease of bile ducts leading to destruction of extra-hepatic bile ducts
What is the surgical treatment for biliary atresia ?
Kasai portoenterostomy (best result if performed before 60 days (<9 weks)
What are some of the tests which can be used to assess for liver dysfunction ?
Bilirubin (Total bilirubin and “split” bilirubin (Conjugated and un-conjugated)
ALT/AST (Elevated in Hepatitis)
Gamma GT
Tests which can assess liver function ?
Coag screen (INR/PT) Albumin Bilirubin BM Ammonia
What is one of the most common signs of chronic liver disease in children ?
Growth Failure
Where is jaundice most prevalent on an infant ?
Usually most obvious ij the sclera
When in the jaundice most obvious on a child ?
Usually visible when total bilirubin >40-50umol/l
Pre-hepatic jaundice is mostly of un-conjugated/conjugated cause ?
Un-conjugated
Post-hepatic jaundice is mostly of unconjugated/conjugated origin ?
Mostly conjugated
Intrahepatic jaundice is mostly of unconjugated/conjugated origin ?
Mixed and unconjugated
If an infant has jaundice and they are <24 hours old what is the most likely cause ?
Always pathological (Haemolysis or sepsis)
If an infant is 24hrs-2 weeks old and has jaundice, what is the most likely cause ?
Physiological (Breast milk, sepsis or haemolysis)
If a baby has jaundice and they are > 2 weeks old what is the most likely cause ?
Extrahepatic obstruction, neonatal hepatitis, hypothyroidism or breast milk.
What is physiological jaundice ?
Unconjugated jaundice which develops after the first day of life.
What is breast milk jaundice ?
Uncionjugated jaundice which can persist to up to 12 weeks
What forms of haemolysis can cause early or intermediate jaundice ?
Rhesus disease
Bruising
Red cell membrane defects
What kind of conditions cause abnormal conjugation ?
Gilbert’s disease (common, mild)
Crigler-Najjar syndrome (v.rare and severe)
What is kernicterus ?
Unconjugated bilirubin is fat-soluble (water insoluble) so can cross BBB.
Neurotoxic and deposits in the brain.
What are the early signs of Kernicterus ?
Encephalopathy (poor feeding and lethargy and seizures)
What is the late consequences of kernicterus ?
Severe choreoathetoid cerebrsal palsy, learning difficulties, sensorineural deafness
