Peds Jaundice and GI

Question 1

Why is it important to differentiate between direct and indirect hyperbilirubinemia?

Answer 1

Direct (conjugated) Hyperbilirubinemia is always pathologic in an infant

Question 2

Coombs Test

Direct Description and Use (2)

Answer 2

Direct test uses anti-IgG Abs to look for antibodies against Rh or A/B antigens

Used when mom is Rh negative or Type O blood and baby is Type A/B/AB
Tests for ABO incompatibility causing hemolytic disease of the newborn

Question 3

Why is it important to keep feeding a baby PO when they have hyperbilirubinemia?

Answer 3

Stool passage allows for the clearance of bilirubin from the body

Question 4

Unconjugated Hyperbilirubinemia

Non-Pathologic Etiologies (4)

Answer 4

Physiologic Jaundice
Breast Feeding Jaundice (dehydration)
Breast Milk Jaundice (deconjugating enzymes in milk)
Premature birth

Question 5

Unconjugated Hyperbilirubinemia
Pathologic Etiologies (4)

Answer 5

ABO incompatibility
Deficiency of hepatic uptake from hypoalbuminemia
Gilbert Syndrome
Crigler-Najjar Types 1 and 2

Question 6

Conjugated Hyperbilirubinemia

Etiologies (4) and Criterion

Answer 6

UTI/Sepsis
Biliary atresia (cholestasis)
Hypothyroidism
Galactosemia

Conjugated BR > 20% of Total Bilirubin

*It should be noted that conjugated hyperbilirubinema in a newborn is rare

Question 7

Crigler-Najjar Type 1 vs Type 2

Descriptions and Prognosis

Answer 7

Type 1:
Absence of UGT1A1 activity
Death in neonatal period

Type 2:
Decreased UGT1A1 activity
Benign prognosis

Question 8

Bilirubin Induced Neurological Dysfunction (Kernicterus)

Pathophysiology

Answer 8

Unconjugated bilirubin crosses blood brain barrier and deposits in the basal ganglia

Question 9

Neonatal Bilirubin Toxicity

Signs and Symptoms (7)

Answer 9

Hypertonia
Poor suckling
High pitched cry
Stupor 
Seizures
Fever
Opisthotonus (tetanus)

Question 10

How does jaundice phototherapy work? (2)

Answer 10

Blue light isomerizes bilirubin making it water soluble

Bilirubin can then be excreted in urine

Question 11

Biliary Atresia

Signs and Symptoms (3)

Answer 11

Cholestatic jaundice
Hepatomegaly
Acholic stools

Question 12

Gastroesophageal Reflux Disease

Definition, Symptoms (3) and Diagnosis (2)

Answer 12

Symptomatic Gastroesophageal Reflux

Hard to feed
Cry a lot
Low weight

Esophageal pH monitoring
Manometry

Question 13

Intussusception

Incidence, Location, Symptoms (5) and Diagnosis (2)

Answer 13

One of the most common on peds intestinal obstruction

Most commonly ileum invaginates into colon at ileocecal junction

Irritability
Colicky pain
Emesis
Red currant jelly stools
Intermittent lethargy

Ultrasound
Coiled spring appearance from air enema

Question 14

Pyloric Stenosis

Incidence, Symptoms (3) Diagnosis (3) Treatment

Answer 14

Common (1:500) seen in first 2-4 weeks

Projectile vomiting
Poor weight gain and dehydration
Hypochloremic hypokalemic metabolic alkalosis

Olive sized epigastric mass
Peristaltic waves
String sign on X-ray

Pylormyotomy

Question 15

Hirschsprung Disease

Etiology, Clinical Suspicion (2), Clinical Features (3) Treatment (3)

Answer 15

Failure of ganglion cells to migrate to lower colon

Any baby who fails to pass a BM in first 24-48 hours
Or baby who requires repeated rectal stimulation to pass BM

Palpable stool throughout abdomen
Empty rectal vault
Never having unassisted BM

Diverting cholostomy with ganglionic bowel
Resection of aganglionic bowel
Anastomosis of ganglionic bowel with rectum