03.12 Jaundice in Children Flashcards Preview

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Flashcards in 03.12 Jaundice in Children Deck (38)
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1

Also known as icterus
Yellow discoloration of the skin and sclerae due to excess bilirubin in the blood

Jaundice

2

Increased levels of conjugated bilirubin

Direct hyperbilirubinemia

3

Increased levels of unconjugated bilirubin

Indirect hyperbilirubinemia

4

Primary site of erythropoiesis

Bone marrow

5

Hemoglobin is then phagocytosed by _____, and is split into globin and heme

Macrophages (RES)

6

In the third step, heme is converted into ____ through the action of ____

Biliverdin
Heme oxygenase

7

The formed biliverdin is rapidly reduced to free ___ through the aciton of ____

Bilirubin
Biliverdin reductase

8

Site of conjugation for bilirubin

Liver

9

Released bilirubin is conjugated to ____ through the action of ____

Glucoronic acid
Glucoronyltransferase

10

The conjugated form of bilirubin has the following characteristics

Greenish
Water soluble
Readily excreted

11

The conjugated bilirubin is then secreted through ____ in the _____

Ampulla of Vater
2nd segment of the duodenum

12

The conjugated bilirubin is acted upon by bacteria in the ____ , which causes the removal of glucuronic acid through ___, and converting the conjugated bilirubin into ____

Terminal ileum and proximal colon
Hydrolysis
Urobilinogen

13

Colorless
Water soluble

Urobilinogen

14

90% of the urobilinogen is further oxidized by bacteria forming ____, which is oxidized to ____ that contributes to the brown color of the feces

Stercobilinogen
Stercobilin

15

Etiology of direct hyperbilirubinemia

Decreased excretion by the damaged hepatic parenchymal cells
Disease of the biliary tract

16

Often signifies a serious hepatic or systemic illness

Conjugated direct hyperbilirubinemia

17

Etiologies of indirect hyperbilirubinemia

Increased load of bilirubin to be metabolized by the liver (hemolytic anemia, polycythemia, shortened red cell life, increased enterohepatic circulation, infection)
Damaged or reduced activity of the transferase enzyme (genetic deficiency, hypoxia, infection, thyroid deficiency)
Factors that competes for or blocks the transferase enzymes (drugs, etc)
Factors that lead to absence or decreased amounts of enzyme or to reduction of bilirubin uptake by the liver cells (genetic defect, prematurity

18

Also known as icterus neonatorum
Occurs in 60% of term infants and 80% of preterm infants

Physiologic jaundice

19

Most common reason of bilirubin accumulation in physiologic jaundice is a ______

Breakdown of fetal RBC

20

Visible manifestations of jaundice in icterus neonatorum appears at the _____ when serum bilirubin levels are _____

2nd-4th day of life
5-6 mg/dL

21

Under normal circumstances, the level of indirect bilirubin in umbilical cord serum is _____ and rises at a rate of ____

1-3 mg/dL
<5 mg/dL/day

22

Hyperbilirubinemia (___ mg/dL) in 13% of breastfed infants in the ____ due to _____ with _____ is referred to as ____

12
1st week of life
Decreased milk intake
Dehydration or reduced caloric intake
Breastfeeding jaundice

23

Mild form of dehydration in 1st week of life due to decreased milk intake
May be due to the shift towards non-exclusive breastfeeding

Breastfeeding jaundice

24

Hyperbilirubinemia (___ mg/dL) after the ___ in 2% of BF infants is referred to as ____

10-30
7th day of life
Breastmilk jaundice

25

Some milk has a ____ that causes the breastmilk jaundice

Glucoronidase

26

Warning signs for pathological jaundice

Appears int he first 24 hours of life
Serum bilirubin rising at a rate faster than 5mg/dL
Serum bilirubin > 12 mg/dL
Jaundice persists after 10-14 days of life
Direct-reacting bilirubin >2 mg/dL

27

Types of jaundice

Physiologic
Pathologic

28

Causes of increased direct bilirubin

Sepsis
Intrauterine infection (toxoplasmosis, CMV, rubella, herpes, syphilis)
Severe hemolytic disease
Choledochal cyst
Cystic fibrosis
Galactosemia
Alpha1-antitrypsin deficiency
Tyrosinemia

29

Looks for Abs that may stick to your red blood cells and cause RBCs to die early

Coombs test

30

Most common cause of indirect hyperbilirubinemia in the infant is _____

Isoimmunization