Yellow baby Flashcards
What are the LFTs?
Bilirubin- total and split
AST/ALT
Alkaline phosphatase
Gamma glutamyl transferase GGT
What is split bilirubin?
Conjugated and unconjugated bilirubin “split”
What is ALT and AST elevated in?
Hepatocellular damage
What is alkaline phosphatase elevated in?
Biliary disease
In children, other causes e.g. bone disease
What is GGT elevated in?
Biliary disease
What investigations test actual liver function?
Coagulation- prothrombin time, APTT
Albumin
Bilirubin
What is the clinical manifestation of paediatric liver disease?
Jaundice
Abnormal blood tests
Symptoms of chronic liver disease
Chronic liver disease- growth failure, malnutrition, ascites, varies, splenomegaly, encephalopathy
What are the types of causes of jaundice?
Prehepatic
Intrahepatic
Post hepatic
What is the process of bilirubin breakdown?
RBCs broken down to biliverdin then unconjugates bilirubin throughout the body
Travels to liver where bilirubin is converted to conjugated
Travels to bile then small intestine where it becomes,es urobiligen
Urobiligen either goes back to the liver, is excreted by the kidneys or converted to stercobilin excreted in stool
What is jaundice?
Yellow discolouration of skin and tissues due to accumulation of bilirubin
When does jaundice usually become visible?
> 40-50umol/l
What is classed as early jaundice?
<24 hours old
What is physiological jaundice?
Unconjugated jaundice
Develops after first day of life as it takes time to build up
What is classed as intermediated jaundice?
24 hours- 2 weeks
What are the causes of intermediate jaundice?
Physiological
Breast milk
Sepsis
Haemolysis
What is classed as prolonged jaundice?
Baby > 2 weeks old
What are the causes of prolonged jaundice?
Extrahepatic obstruction
Neonatal hepatitis
Hypothyroid
Breast milk
What causes physiological jaundice?
Shortened RBC lifespan in infants
Relative polycythaemia
Relative immaturity of liver function
What is breast milk jaundice?
Unconjugated jaundice
Can persist up to 12 weeks
What investigations should be done if suspecting sepsis in jaundice?
Urine and blood cultures
TORCH screen
What can cause haemolysis?
ABO compatability Rhesus disease Bruising/cephalhaetoma Red cell membrane defects Red cell enzyme defects
What ar the causes of abnormal coagulation?
Gilbert’s disease- common, mild
Crigler Najjar syndrome- very rare, severe
What are the essential investigations for prolonged jaundice?
Split bilirubin
Stool colour
What are the causes of prolonged jaundice?
Conjugated- biliary obstruction, neonatal hepatitis
Unconjugated- hypothyroid, breast milk jaundice
