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Paeds AM > Yellow baby > Flashcards

Yellow baby Flashcards

1
Q

What are the LFTs?

A

Bilirubin- total and split
AST/ALT
Alkaline phosphatase
Gamma glutamyl transferase GGT

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2
Q

What is split bilirubin?

A

Conjugated and unconjugated bilirubin “split”

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3
Q

What is ALT and AST elevated in?

A

Hepatocellular damage

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4
Q

What is alkaline phosphatase elevated in?

A

Biliary disease

In children, other causes e.g. bone disease

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5
Q

What is GGT elevated in?

A

Biliary disease

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6
Q

What investigations test actual liver function?

A

Coagulation- prothrombin time, APTT
Albumin
Bilirubin

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7
Q

What is the clinical manifestation of paediatric liver disease?

A

Jaundice
Abnormal blood tests
Symptoms of chronic liver disease
Chronic liver disease- growth failure, malnutrition, ascites, varies, splenomegaly, encephalopathy

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8
Q

What are the types of causes of jaundice?

A

Prehepatic
Intrahepatic
Post hepatic

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9
Q

What is the process of bilirubin breakdown?

A

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

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10
Q

What is jaundice?

A

Yellow discolouration of skin and tissues due to accumulation of bilirubin

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11
Q

When does jaundice usually become visible?

A

> 40-50umol/l

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12
Q

What is classed as early jaundice?

A

<24 hours old

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13
Q

What is physiological jaundice?

A

Unconjugated jaundice

Develops after first day of life as it takes time to build up

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14
Q

What is classed as intermediated jaundice?

A

24 hours- 2 weeks

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15
Q

What are the causes of intermediate jaundice?

A

Physiological
Breast milk
Sepsis
Haemolysis

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16
Q

What is classed as prolonged jaundice?

A

Baby > 2 weeks old

17
Q

What are the causes of prolonged jaundice?

A

Extrahepatic obstruction
Neonatal hepatitis
Hypothyroid
Breast milk

18
Q

What causes physiological jaundice?

A

Shortened RBC lifespan in infants
Relative polycythaemia
Relative immaturity of liver function

19
Q

What is breast milk jaundice?

A

Unconjugated jaundice

Can persist up to 12 weeks

20
Q

What investigations should be done if suspecting sepsis in jaundice?

A

Urine and blood cultures

TORCH screen

21
Q

What can cause haemolysis?

A 
ABO compatability
Rhesus disease
Bruising/cephalhaetoma
Red cell membrane defects
Red cell enzyme defects
22
Q

What ar the causes of abnormal coagulation?

A

Gilbert’s disease- common, mild

Crigler Najjar syndrome- very rare, severe

23
Q

What are the essential investigations for prolonged jaundice?

A

Split bilirubin

Stool colour

24
Q

What are the causes of prolonged jaundice?

A

Conjugated- biliary obstruction, neonatal hepatitis

Unconjugated- hypothyroid, breast milk jaundice

25
Q

What are the biliary obstruction causes of prolonged jaundice?

A

Biliary atresia
Choledochal cyst
Alagille syndrome

26
Q

What are the symptoms of biliary atresia?

A

Conjugated jaundice, pale stools

27
Q

What causes biliary atresia?

A

Congenital

Inflammatory damage to bile duct

28
Q

What investigations are done for biliary atresia?

A

Split bilirubin
Stool colour
US
Liver biopsy

29
Q

What is the possible complications of unconjugated jaundice?

A

Kernicterus

30
Q

What is the presentation of a choledochal cyst?

A

Conjugated jaundice, pale stools

31
Q

What investigations are done for a choledochal cyst?

A

Split bilirubin
Stool colour
US

32
Q

What is Alagille syndrome?

A

Genetic syndrome of intrahepatic cholestasis, dysmorphism and congenital cardiac disease

33
Q

What is kernicterus?

A

Unconjugated bilirubin can cross blood brain barrier

Neurotixicity and leaves deposits

34
Q

What are the early signs of kernicterus?

A

Encephalopathy- poor feeding, lethargy, seizures

35
Q

What are the late signs of kernicterus?

A

Severe choreathetoid cerebral palsy
Learning difficulties
Sensorineural deafness

36
Q

What is the treatment of unconjugated jaundice?

A

Phototherapy- visible light converts bilirubin to water soluble isomer

37
Q

What is the treatment of severe jaundice?

A

Exchange transfusion

Paeds AM (19 decks)

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