3 - Paeds - Gastro - Jaundice Flashcards Preview

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Flashcards in 3 - Paeds - Gastro - Jaundice Deck (17):
1

why are >50% of newborns visibly jaundiced

-marked physiological release of Hb from breakdown of RBCs (high Hb conc at birth)
-newborns RBC lifespan only 70d
-hepatic bilirubin metabolism less efficient in first few days

2

Neonatal jaundice important to deal with because???

-unconj bilirubin can deposit in basal ganglia - causing kernicterus
-sign of other disorder eg haemolytic anaemia, infection, metab disease, liver disease

3

Kernicterus - encephalopathy due to? occurs when?

unconj bilirubin deposition in BG and brain stem nuclei

when unconj bilirubin level exceeds albumin binding capacity - free bilirubin can then cross BBB.

4

clinical features of kernicterus - pre-severe? if severe?

lethargy, poor feeding

if severe - irritability, incr muscle tone -> arched back, seizures, coma

5

Infants who survive kernicterus may develop which 3 things?

LDs
sensorineural deafness
choreoathetoid cerebral palsy

6

describe the bilirubin pathway or conjugation etc

Hb breakdown > unconj bili bound to albumin > enters liver > conjugated > excretion in bile
conj bili (water sol) give urine and stools darkness

7

causes of unconj jaundice (5)

breast milk jaundice (physiological), infection (UTI), Hypothyroidism, Haemolytic anaemia (G6PD def), high GI obstruction (PS)

8

Causes of conjugated jaundice (3)

bile obstruction (biliary atresia, choledochal cyst)
neonatal hepatitis syndrome (CF, a1 Antitrypsin def, congenital infection)
Intrahepatic biliary hypoplasia

9

What suggests conj jaundice

dark urine and pale stools
hepatomegaly and poor wt gain also

10

Classification by age - causes
<24h
2d-2wks
>2wks

<24h - usually haemolysis - important to ID before unconj bili levels get too high
2d-2wks - physiological
>2wks (persistent/prolonged neonatal jaundice) - ?biliary atresia - usually unconj due to breast milk/infection/congenital hypothyroidism

11

Haemolytic disorders causing EARLY jaundice (4)

rhesus disease - usually dealt with antenatally
ABO incompatibility - less severe than Rh
G6PD def - mainly ethnic males
Spherocytosis - FHx, spherocytes on blood film

12

Features of congenital infection causing jaundice

conj bili
infants have other signs eg growth restriction, hepatosplenomegaly, thrombocytopenic purpura

13

2d - 2wk jaundice - 3 causes

breast milk jaundice (inc enterohepatic circ of bii)
Dehydration (poor intake/delay)
Infection (unconj from poor fluid intake, haemolysis, reduced hep function + inc enterohepatic circ)

other - crigler najjar

14

Ix to do initially?

inspection in bright natural light -> sclera, gums, blanched skin (starts on head > trunk/limbs)
Stool colour - pale = biliary tree/post hepatic obstruction of conj bili

15

Ix to do once seen jaundice O/E? what to consider in ethnic/preterm babies?

measure with transcutaneous meter or blood sample - a high TC measurement must be checked with bloods


preterm/ethnic have lower threshold

16

MGMT - initially? then? when to step up? to what?

correct poor intake/dehydration
then phototherapy
step up if bili reached dangerous levels - to Exchange transfusion (continue phototherapy)

17

What can phototherapy cause? what if bili rising?

can cause macular rash and bronze discolouration if conj jaundice - if rising, give continuously

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