Yellow Baby Flashcards
4 functions of liver
Metabolism
Clotting
Glycogen storage
Toxin excretion
Assessing liver function
Coagulation Albumin Bilirubin Blood glucose Ammonia
What is jaundice?
Yellow discolouration of skin and tissue
Jaundice is visible in the sclera when bilirubin reaches what level?
Greater than 40-50 umol/l
Differential for jaundice
B carotenemia - won’t be present in sclera, affects skin only
Bilirubin metabolism -
Post mature erythrocytes –> Reticular Endothelial System
- -> Haem
- -> Bilverdin - reduced to unconjugated
Liver –> conjugated
- -> Bile
- -> Small Intestine
- -> Urobilinogen
- -> Stercobilin (in stools) or to the kidney
3 types of jaundice
Prehepatic - unconjugated
Intrahepatic - mixed
Post hepatic - conjugated
What test will help indicate the type of jaundice?
Split bilirubin
2 causes of early neonatal jaundice (< 24 hours)
Haemolysis
Sepsis
Causes of haemolysis in the newborn
ABO Haemolytic Disease of the Newborn
Bruising
Cephalhaematoma
Breakdown produces bilirubin
Investigation of SEPSIS in the newborn
Urine
Blood culture
TORCH screen
What infections are in a TORCH screen?
Toxiplasmosis Rubella Cytomegalovirus Herpes simplex HIV
Causes of intermediate jaundice in a newborn (2 hours to 2 weeks)
Physiological
Breast Milk
Sepsis
Haemolysis
Causes of prolonged jaundice (> 2 weeks) in the newborn
Extrahepatic obstruction
Neonatal hepatitis
Hypothyroidism
Breast milk
What type of jaundice is physiological jaundice?
Unconjugated
Occurs AFTER 1st day of life
Why does physiological jaundice occur?
Shorter RBC lifespan
Relative polycythaemia
Immature liver function
Causes of breast milk jaundice
Inhibited UDP by progesterone
Increased enterohepatic circulation
Type of bilirubin occuring in breast milk jaundice
Unconjugated up to 12 weeks
Kernicterus is a neurological complication of jaundice. How does it occur?
Unconjugated bilirubin is water soluble and able to cross the BBB
Accumulates and deposits
Early - encephalopathy
Late - sensorineural deafness, cerebral palsy
Symptoms of encephalopathy in new born
Poor feeding
Lethargy
Seziures
Treatment for prehepatic jaundice
Phototherapy
Visible light 450nm
Converts bilirubin to water soluble isomer
Other cause of early/intermediate unconugated jaundice
Genetic
Gilbert’s
Crigler - Najjar
Abnormal conjugation
Causes of prolonged infant jaundice
Neonatal hepatitis
Anatomy
Breat milk
Hypothyroidism
3 causes of biliary obstruction in newborn
Atresia
Choledochal cyst
Allagille sydrome
Investigations of atresia
Split bilirubin
Stool test
Ultrasound
Biopsy
Investigations of choledochal cyst
Split bilirubin, Stool, Ultrasound
Conjugated jaundice - pale stool
3 features of Allagille syndrome
Intrahepatic cholestasis
Dysmorphism
Congenital heart disease
Aetiology of atresia
Inflammation and fibrosis destroys bile duct
Complication of atresia
Liver failure
Most common cause of liver transplant in children
Signs of atresia
Prolonged, worsening, conjugated jaundice
Pale stools
Dark urine
Treatment of atresia
Kasai portoenterostomy
- strips away bile ducts
- small intestine linked to liver
What is the genetic phenotype for Neonatal Hepatitis?
Alpha 1 AT deficiency
