Pediatric Jaundice

Question 1

What is the treatment for unconjugated jaundice ?

Answer 1

Photo-therapy
Visible light - Not UV
Converts bilirubin to water soluble isomer

Question 2

Define prolonged infant jaundice

Answer 2

Jaundice persisting beyond 2 weeks of life (3 weeks for preterm infants)

Question 3

What are some of the conjugated causes of prolonged infant jaundice ?

Answer 3

Anatomical (biliary obstruction)

Neonatal hepatitis

Question 4

What are some of the un-conjugated causes of prolonged infant jaundice ?

Answer 4

Hypothyroidism

Breast milk jaundice

Question 5

Conjugated jaundice in infants is always abnormal and always requires further investigation, true or false ?

Answer 5

True the most important test in prolonged jaundice is a “split” bilirubin.

Question 6

What are the 3 common causes of biliary obstruction in an infant/child ?

Answer 6

Biliary atresia
Choledochal cyst
Alagille syndrome (Congenital cardiac disease)

Question 7

What is the most obvious jaundice sign in infants ?

Answer 7

Assessment of stool colour

Question 8

How would a child with biliary atresia present ?

Answer 8

Prolonged conjugated worsening jaundice (pale stool and dark urine)

Question 9

If not treated, what is the outcome of biliary atresia ?

Answer 9

Progression to liver failure if not identified and treated.

Question 10

What is the most common indication for liver transplantation in children?

Answer 10

Biliary Atresia

Question 11

Define biliary atreisa

Answer 11

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

Question 12

What is the surgical treatment for biliary atresia ?

Answer 12

Kasai portoenterostomy (best result if performed before 60 days (<9 weks)

Question 13

What are some of the tests which can be used to assess for liver dysfunction ?

Answer 13

Bilirubin (Total bilirubin and “split” bilirubin (Conjugated and un-conjugated)

ALT/AST (Elevated in Hepatitis)

Gamma GT

Question 14

Tests which can assess liver function ?

Answer 14

Coag screen (INR/PT)
Albumin
Bilirubin 
BM
Ammonia

Question 15

What is one of the most common signs of chronic liver disease in children ?

Answer 15

Growth Failure

Question 16

Where is jaundice most prevalent on an infant ?

Answer 16

Usually most obvious ij the sclera

Question 17

When in the jaundice most obvious on a child ?

Answer 17

Usually visible when total bilirubin >40-50umol/l

Question 18

Pre-hepatic jaundice is mostly of un-conjugated/conjugated cause ?

Answer 18

Un-conjugated

Question 19

Post-hepatic jaundice is mostly of unconjugated/conjugated origin ?

Answer 19

Mostly conjugated

Question 20

Intrahepatic jaundice is mostly of unconjugated/conjugated origin ?

Answer 20

Mixed and unconjugated

Question 21

If an infant has jaundice and they are <24 hours old what is the most likely cause ?

Answer 21

Always pathological (Haemolysis or sepsis)

Question 22

If an infant is 24hrs-2 weeks old and has jaundice, what is the most likely cause ?

Answer 22

Physiological (Breast milk, sepsis or haemolysis)

Question 23

If a baby has jaundice and they are > 2 weeks old what is the most likely cause ?

Answer 23

Extrahepatic obstruction, neonatal hepatitis, hypothyroidism or breast milk.

Question 24

What is physiological jaundice ?

Answer 24

Unconjugated jaundice which develops after the first day of life.

Question 25

What is breast milk jaundice ?

Answer 25

Uncionjugated jaundice which can persist to up to 12 weeks

Question 26

What forms of haemolysis can cause early or intermediate jaundice ?

Answer 26

Rhesus disease
Bruising
Red cell membrane defects

Question 27

What kind of conditions cause abnormal conjugation ?

Answer 27

Gilbert’s disease (common, mild)

Crigler-Najjar syndrome (v.rare and severe)

Question 28

What is kernicterus ?

Answer 28

Unconjugated bilirubin is fat-soluble (water insoluble) so can cross BBB.
Neurotoxic and deposits in the brain.

Question 29

What are the early signs of Kernicterus ?

Answer 29

Encephalopathy (poor feeding and lethargy and seizures)

Question 30

What is the late consequences of kernicterus ?

Answer 30

Severe choreoathetoid cerebrsal palsy, learning difficulties, sensorineural deafness