Paediatric Jaundice Flashcards
(48 cards)
What functions does the liver have?
- makes clotting factors
- metabolism e.g. absorption, digestion materials produced
- storage of glycogen etc
- filter for the body
What are the liver function tests?
- bilirubin (total or split)
- ALT/AST (alanine aminotransferase/ aspartate aminotransferase)
- alkaline phosphatase
- gamma glutamic transferase (GGT)
What do the transaminases tell you about the liver?
- that there is hepatocellular damage
- also can be an indicator of cardiac or muscle damage
What does alkaline phosphatase tell you about the liver?
that there is biliary inflammation
What is the best test to assess liver function?
coagulation tests i.e. prothrombin time/ INR or APTT (activated partial thromboplastin time)
What are other good tests of liver FUNCTION?
- albumin
- bilirubin
- (blood glucose)
- (ammonia)
What is the main clinical manifestation of paediatric liver disease?
jaundice - especially in young babies
What are 2 other ways that paediatric liver disease might present?
- incidental finding of abnormal blood test
- symptoms/signs of chronic liver disease (rare)
What are signs of chronic liver disease in children?
- growth failure
- jaundice
- encephalopathy
- varices with portal hypertension
- spider nave
- muscle wasting from malnutrition
- bruising and petechiae
- splenomegaly with portal hypertension
- hepatorenal failure
- clubbing
- loss of fat stores
- rickets secondary to vit. D deficiency
- ascites
- hypotonia
- peripheral neuropathy
How can you identify jaundice?
yellowy discolouration of skin and tissues, including the sclera
When does jaundice usually become visible?
when total bilirubin >40-50umol/l
What is the diagnosis of infant jaundice dependent on?
- understanding bilirubin metabolism
- age of the infant
Bilirubin metabolism.
Breakdown of RBCs get unconjugated bilirubin.
Unconjugated bilirubin transported bound to albumin to liver.
Liver conjugates bilirubin using UDP glucuronyl transferase.
Conjugated bilirubin carried in bile to small intestine.
Some conjugated bilirubin gets excreted in faeces and urine. Rest gets taken up by enterohepatic circulation again.
What kind of bilirubin would you find in pre-hepatic jaundice?
mostly unconjugated
What kind of bilirubin would you find in intrahepatic jaundice?
mixed unconjugated/ conjugated
What kind of bilirubin would you find in post-hepatic (cholestasis) jaundice?
mostly conjugated
What are the 3 classifications of neonatal jaundice?
- early
- intermediate
- prolonged
What age range would class neonatal jaundice as early? What would cause it? Is it serious?
- happens in neonates <24 hours old
- ALWAYS pathological
- caused by haemolytic, sepsis
What age range would class neonatal jaundice as intermediate? What would cause it? Is it serious?
- happens in neonates between 24 hours and 2 weeks old
- may be pathological
- can be caused by normal physiology, breast milk, sepsis, haemolytic etc
What age range would class neonatal jaundice as prolonged? What would cause it? Is it serious?
- happens in neonates over 2 weeks old
- may be pathological and must be investigated
- can be caused by extra hepatic obstruction, neonatal hepatitis, hypothyroidism, breast milk
Why can a baby have ‘physiological’ jaundice?
- shorter RBC life span in infants
- have a relative polycythaemia (lots of RBCs) so make lots of unconjugated bilirubin
- relative immaturity of liver function in neonates might mean that the liver cannot handle all of the bilirubin, so get jaundiced
- is a form of unconjugated jaundice
What are features of breast milk jaundice?
- physiological jaundice in child who is breastfeeding
- prolonged physiological jaundice
- can last up to 12 weeks
- unconjugated jaundice
What are other causes of early/ intermediate unconjugated infant jaundice?
- sepsis
- haemolysis e.g. after traumatic birth getting rid of a bruise or cephalhaematoma or having a red cell enzyme defect (G6P deficiency)
- abnormal conjugation
What is a serious complication of unconjugated jaundice?
kernicterus
