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B - Paediatrics MANAGEMENT > Jaundice > Flashcards

Jaundice Flashcards

1
Q

What is jaundice already known as?

A

Icterus

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2
Q

What is jaundice?

A

A yellow discolouration of the skin and whites of the eyes due to high bilirubin levels

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3
Q

When does jaundice occur?

A

When serum bilirubin is >25-30mmol/L

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4
Q

What can jaundice be classified into?

A
  • Unconjugated
  • Intrahepatic
  • Cholestatic (obstructive)
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5
Q

What are the causes of unconjugated jaundice?

A
  • Excess bilirubin production
  • Impaired liver uptake
  • Thalassaemia
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6
Q

Give three examples of things causing excess bilirubin production leading to jaundice

A
  • Haemolysis
  • Sickle cell anaemia
  • Impaired conjugation
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7
Q

Give two examples of causes of haemolysis

A
  • Spherocytosis

- G6PD deficiency

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8
Q

Give two examples of impaired conjugation

A
  • Gilbert synrome

- Crigler-Najjar syndrome

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9
Q

What is intrahepatic jaundice due to?

A

Hepatocyte damage, with or without cholestasis

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10
Q

What is found on bloods in intrahepatic jaundice?

A

Unconjugated or mixed hyperbilirubinaemia

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11
Q

What are the categories of causes of intrahepatic jaundice?

A
  • Infections
  • Toxins
  • Metabolic
  • Biliary hypoplasia
  • Cardiovascular
  • Autoimmune
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12
Q

What infections can cause intrahepatic jaundice?

A
  • Viral hepatitis, including chronic hepatitis
  • Bacterial hepatitis
  • Toxoplasma gondii
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13
Q

What toxins can cause intrahepatic jaundice?

A
  • Drugs or poisons

- Fungi

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14
Q

Give 4 examples of drugs that can cause intrahepatic jaundice?

A
  • Paracetamol (in overdose)
  • Sodium valproate
  • Anti-TB drugs
  • Cytotoxic drugs
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15
Q

What metabolic disorders can cause intrahepatic jaundice?

A
  • Galactosaemia or hereditary fructose intolerance
  • Wilson’s disease
  • Alpha-1 anti-trypsin deficiency
  • Hypothyroidism
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16
Q

What can biliary hypoplasia be subdivided into?

A
  • Syndromic

- Non-syndromic

17
Q

Give an example of a syndromic cause of biliary hypoplasia

A

Alagille syndrome

18
Q

What autoimmune disorders can cause intrahepatic jaundice?

A

Autoimmune hepatitis

19
Q

What are the causes of cholestatic (obstructive) jaundice?

A
  • Biliary atresia
  • Choledochal cyst
  • Primary sclerosing cholangitis
  • Cholelithiasis
  • Cholecystitis
  • Cystic fibrosis
  • Obstructive tumours or cysts
20
Q

What is the main presenting feature of jaundice?

A

Yellowing of whites of eyes or skin

21
Q

What are the other features of jaundice?

A
  • Itchy skin
  • Darker urine
  • Pale stools
22
Q

What needs to be included in the history for jaundice?

A
  • Medications
  • Family history
  • Overseas travel
  • Past blood transfusions
23
Q

What needs to be checked for on examination in jaundice?

A
  • Vital signs
  • Hepatic stigmata of chronic liver disease
  • Hepatomegaly or splenomegaly
  • Peripheral oedema
24
Q

What will further investigations in jaundice depend on?

A

Findings on history and examination

25
Q

What might further investigation include in jaundice?

A
  • FBC, blood film, and reticulocyte count
  • Coagulation studies
  • U&Es, SBR (total and unconjugated), LFTs, albumin, total protein
  • TFTs
  • Viral serology
  • Abdominal ultrasound, or CT/MRI
  • Liver biopsy
26
Q

What is the management for jaundice?

A
  • Remove or treat underlying cause
  • Treat any associated abnormalities
  • Phototherapy may be helpful
27
Q

What associated abnormalities may need to be treated in jaundice?

A
  • Blood glucose
  • Clotting
  • Liver failure
28
Q

When is phototherapy useful in jaundice?

A

Only when there is a significant unconjugated component, e.g. Criger-Najjar syndrome

29
Q

Add kernicterus

Oo

A

Gg

B - Paediatrics MANAGEMENT (106 decks)

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