Yellow Baby

Question 1

4 functions of liver

Answer 1

Metabolism
Clotting
Glycogen storage
Toxin excretion

Question 2

Assessing liver function

Answer 2

Coagulation
Albumin
Bilirubin
Blood glucose
Ammonia

Question 3

What is jaundice?

Answer 3

Yellow discolouration of skin and tissue

Question 4

Jaundice is visible in the sclera when bilirubin reaches what level?

Answer 4

Greater than 40-50 umol/l

Question 5

Differential for jaundice

Answer 5

B carotenemia - won’t be present in sclera, affects skin only

Question 6

Bilirubin metabolism -

Answer 6

Post mature erythrocytes –> Reticular Endothelial System

• -> Haem
• -> Bilverdin - reduced to unconjugated

Liver –> conjugated

• -> Bile
• -> Small Intestine
• -> Urobilinogen
• -> Stercobilin (in stools) or to the kidney

Question 7

3 types of jaundice

Answer 7

Prehepatic - unconjugated
Intrahepatic - mixed
Post hepatic - conjugated

Question 8

What test will help indicate the type of jaundice?

Answer 8

Split bilirubin

Question 9

2 causes of early neonatal jaundice (< 24 hours)

Answer 9

Haemolysis

Sepsis

Question 10

Causes of haemolysis in the newborn

Answer 10

ABO Haemolytic Disease of the Newborn
Bruising
Cephalhaematoma
Breakdown produces bilirubin

Question 11

Investigation of SEPSIS in the newborn

Answer 11

Urine
Blood culture
TORCH screen

Question 12

What infections are in a TORCH screen?

Answer 12

Toxiplasmosis
Rubella
Cytomegalovirus
Herpes simplex
HIV

Question 13

Causes of intermediate jaundice in a newborn (2 hours to 2 weeks)

Answer 13

Physiological
Breast Milk
Sepsis
Haemolysis

Question 14

Causes of prolonged jaundice (> 2 weeks) in the newborn

Answer 14

Extrahepatic obstruction
Neonatal hepatitis
Hypothyroidism
Breast milk

Question 15

What type of jaundice is physiological jaundice?

Answer 15

Unconjugated

Occurs AFTER 1st day of life

Question 16

Why does physiological jaundice occur?

Answer 16

Shorter RBC lifespan
Relative polycythaemia
Immature liver function

Question 17

Causes of breast milk jaundice

Answer 17

Inhibited UDP by progesterone

Increased enterohepatic circulation

Question 18

Type of bilirubin occuring in breast milk jaundice

Answer 18

Unconjugated up to 12 weeks

Question 19

Kernicterus is a neurological complication of jaundice. How does it occur?

Answer 19

Unconjugated bilirubin is water soluble and able to cross the BBB
Accumulates and deposits
Early - encephalopathy
Late - sensorineural deafness, cerebral palsy

Question 20

Symptoms of encephalopathy in new born

Answer 20

Poor feeding
Lethargy
Seziures

Question 21

Treatment for prehepatic jaundice

Answer 21

Phototherapy
Visible light 450nm
Converts bilirubin to water soluble isomer

Question 22

Other cause of early/intermediate unconugated jaundice

Answer 22

Genetic
Gilbert’s
Crigler - Najjar
Abnormal conjugation

Question 23

Causes of prolonged infant jaundice

Answer 23

Neonatal hepatitis
Anatomy
Breat milk
Hypothyroidism

Question 24

3 causes of biliary obstruction in newborn

Answer 24

Atresia
Choledochal cyst
Allagille sydrome

Question 25

Investigations of atresia

Answer 25

Split bilirubin
Stool test
Ultrasound
Biopsy

Question 26

Investigations of choledochal cyst

Answer 26

Split bilirubin, Stool, Ultrasound

Conjugated jaundice - pale stool

Question 27

3 features of Allagille syndrome

Answer 27

Intrahepatic cholestasis
Dysmorphism
Congenital heart disease

Question 28

Aetiology of atresia

Answer 28

Inflammation and fibrosis destroys bile duct

Question 29

Complication of atresia

Answer 29

Liver failure

Most common cause of liver transplant in children

Question 30

Signs of atresia

Answer 30

Prolonged, worsening, conjugated jaundice
Pale stools
Dark urine

Question 31

Treatment of atresia

Answer 31

Kasai portoenterostomy

• strips away bile ducts
• small intestine linked to liver

Question 32

What is the genetic phenotype for Neonatal Hepatitis?

Answer 32

Alpha 1 AT deficiency