Neonatal Jaundice Flashcards
(54 cards)
1
Q
biliary atresia common in
A
female
2
Q
idiopathic neonatal hepatitis common in
A
male
3
Q
Lethargy associated with
A
galactosemia
4
Q
itching
A
Cholestasis
5
Q
vomiting
A
galactosemia
6
Q
dark urine and pale stools: Pale stool persistent vs intermittent
A
Pale stool persistent BA , intermittent NHS
7
Q
.Fever , rash in pregnancy with and miscarriage with
A
TORCH, metabolic
8
Q
AGA
A
BA
9
Q
SGA
A
INH
10
Q
Poor feeding ,lethargy, hoarse cry constipation
A
hypothyroidism
11
Q
Convulsion
A
congenital infection
12
Q
Normal, Delayed development
A
BA , congenital
13
Q
Poor feeding
A
Galactosemia
14
Q
Consanguinity: ,Affected sib :
A
metabolic disease, INH
15
Q
Irritable , lethargic
A
congenital infection , metabolic disease
16
Q
Large anterior fontanelle
A
Hypothyroidism , down syndrome
17
Q
Microcephaly, Macrocephaly
A
CMV, Toxoplasmosis
18
Q
Cataract
A
galactosemia
19
Q
choreo-retinitis
A
CMV, rubella and toxoplasma.
20
Q
Cherry red spots:
A
Nieman –pick disease.
21
Q
Posterior emryotoxo
A
alagille syndrome.
22
Q
Optic nerve
hypoplasia
A
pan- hypopitutarism
23
Q
FTT
A
INH and congenital infection
24
Q
heart rate and RR.
A
increased in infections
25
dysmorphic features.
(Downs syndrome , hypothyroidism, alagille syndrome, cleft lip or palate
with BA)
26
RTI
downs syndrome , cystic fibrosis
27
Potty belly, umbilical hernia
hypothyroidism
28
Simian crease & clinodactly and sandal gap
| .
in Down syndrome
29
US: Absent/Small/non visualized gall bladder Ø Lack of post prandial contraction of GB. Ø Triangular cord sign(a cone shaped fibrotic mass cranial to the bifurcation of portal vein
BA
30
Hepatobiliary Scintigraphy: delayed uptake, normal excretion, normal uptake, absent excretion
Neonatal Hepatitis, Biliary Atresia
31
Percutaneous Liver Biopsy
Most important investigation in differentiating INH and BA.
32
Prerequisites: Normal CBC, PT, APTT & USG
Percutaneous Liver Biopsy could lead to bleeding, so these tests are needed
33
Kasai procedure followed by Liver Transplantation
BA
34
life long thyroxine
Hypothyroidism
35
Kasai Procedure statistics
Bile flow re-established in 90% if performed prior to
8 weeks of life and less than 20% if performed
after 12 weeks of life.
36
Complications of Kasai procedure
ascending cholangitis and re-
obstruction as well as failure to re-establish bile
flow.
37
Liver Transplantation
Indications: u Biliary atresia is the most common indication for transplant.
u When initial treatment was given lately/ Portoenterostomy not done
u Failed portoenterostomy
u Decompensated cirrhosis and end stage liver disease despite initial successful Kasai.
38
the single most important determinant in successful management of BA.
Early kasai Age(< 8 wks)
39
hepatobiliary disorders resulting in Cholestasis characterized by
Jaundice Ø High/dark colored urine Ø Pale stools + Ø Direct bilirubin > 1.5 mg% or > 20% of total, beyond 14 days of life
40
```
How does it differ from neonatal jaundice?
onset
Type of bilirubin
Severity
complications
```
41
BA types
42
Biliary Atresia
Biliary atresia: 1 in 10000 to 15000 infants. Female predominance
u It is a progressive obliterative inflammatory process involving the bile ducts, resulting in
obstruction of bile flow leading to cholestasis, hepatic fibrosis, and eventually cirrhosis.
u Average birth weight , hepatomegaly with firm to hard consistency
u Associated with many anomalies
u No well-documented familial cases
43
Idiopathic Neonatal Hepatitis
Idiopathic neonatal hepatitis: 1 in 5000 to 10000 live
birth. With male predominance and familial cases
(15-20%)
u Generally normal stools or acholic stools with onset
at one month-old ,Low birth weight .
u Normal liver on exam or hepatomegaly with normal
to firm consistency. u characteristic “giant cell hepatitis” lesion is present
on liver biopsy & for which no infectious, genetic,
metabolic or anatomic cause is identified
44
BA VS INH
45
Choledochal Cyst
Localized cystic dilatation of common bile
duct is called choledochal cyst.
u •25% patient present in neonates with prolonged jaundice & cholestasis.
46
Triad of choledochal cyst
1. Intermittent jaundice 2. Recurrent abdominal pain 3. Abdominal mass
47
Galactosemia
Here galactose-1-phosphate accumulation occur due to galactose-1- phosphate Uridyl transferase enzyme deficiency.
u• Present with vomiting, loose motion, persistent jaundice, FTT, hepato- splenomegaly, septicemia, cataract, repeated hypoglycemia and convulsion.
48
Inspissated Bile Syndrome
Conjugated hyperbilirubinemia resulting from severe jaundice associated
hemolysis due to Rh or ABO incompatibility is termed as inspissated bile
syndrome.
49
Alpha-1-antitrypsin Deficiency
Alpha-1-antitrypsin makes up 90% of alpha-1- globulin fraction
u Biopsy also shows accumulation of PAS-positive, diastase-resistant eosinophilic granule.
u Varying degrees of fibrosis correlate with disease prognosis.
50
TPN Related Cholestasis
u It develops in >50% of infants with birth weight <1000 gram & in <10% of
term infants after giving prolonged parenteral feeding.
u This may be due to lack of enteral feeding →reduction of gut hormone
secretion → reduce bile flow → biliary stasis.
51
Murmur
: congenital rubella syndrome ,down syndrome , alagille
syndrome)
choledochal
52
firm hepatomegaly,
| splenomegaly
BA
53
Right hypochondric mass:
choledochal cyst.
54
Ascites
late
| stage 3-4 months later
