Jaundice

Question 1

When’s Jaundice noted?

Answer 1

Neonates - >5mg/dl

Older children - > 2mg/dl

Question 2

Causes of prolonged NEONATAL Jaundice

Answer 2

1. Unconjugated Hyperbilirubinaemia
   Blood - Haemolysis
   Endocine - Breast milk jaundice, Hypothyroidism, Hypopituitarism
   Persistent infection - UTI, Congenital infection
   Drug - e.g. Septrin (sulfamethoxazole and trimethoprim)
   Resolution of clot - IVH, Cephalhaematoma
   Familial - Gilbert’s and Crigler - Najjar
2. Conjugated Hyperbilirubinaemia
   Biliary Atresia
   Neonatal Hepatitis Syn
   Cholestasis Secondary to severe haemolysis / TPN
   Dubin Johnson Syndrome and Rotor Syndrome
3. Metabolic Diseases (Rare in Chinese)
   —> Conjugated Hyperbilirubinaemia
   ( Alpha 1 Antitrypsin def; CF; Galactosaemia; Wilson’s disease)
   —> Unconjugated Hyperbilirubinaemia
   Fructosaemia; Galatosaemia; Aminoacidaemia

Question 3

Steps to examination of Neonatal Jaundice

Answer 3

1. Note general activities eg. Dullness in bb with sepsis
2. Features of Congenital infections (SGA, Microcephaly, skin rash or petachiae, lymphadenopathy and hepatosplenomegaly)
3. Jaundice with greenish hue in obstructive lesion and the presence of Pallor implies chronic haemolysis
4. Features of Congenital Hypothyroidism and Goitre
5. Abdo- Evidence of portal hypertension, organomegaly, cystic mass in RUQ (Choledochal cyst)
6. CVS - murmur in congenital rubella Syn or Alagille’s syn
7. Chest - Infections in CF
8. Limbs - Wasting
9. Fundi - Choroidoretinitis

Question 4

Causes of POST- NEONATAL Jaundice

Answer 4

1. Haemolysis 
Acute on Chronic
2. Liver problems 
Acute Hepatitis - Infection, Drug/ poison, Metabolic
Chronic Hepatitis - Auto-immune disease
3. Drug Induced
4. Surgical cause - Obstructive Jaundice
5. Familial non-haemolytic, eg. Gilbert's

Question 5

Steps to examination of Post-Neonatal Jaundice

Answer 5

1. Note if Jaundice is assoc with Pallor and fever
2. Note patient’s general status and activity and growth status and activity and growth status
3. Face - Dysmorphism -Cooley’s face / Moon face; Limbs - cold, coarse skin
4. Eyes - Catarct; Kayser Fleisher ring: brown ring at limbus of cornea
5. Look for signs of chronic liver disease - Clubbing, Palmar erythema, Spider Naevi. Note skin for bruise and rash
6. Watch out for features of liver failure: Confusion, tremor, Fetor Hepaticus
7. Abdo (if found to have PALLOR)
   Surgical scar
   Evidence of portal hypertension, umbilical hernia
   Organomegaly
   Ascites
   PR for stool clearance
   Buttock (wasted, ?Rash)
   Urinalysis

Question 6

Alagille’s Syndrome

Answer 6

1. Face - prominent forehead, long nose, deep seated eyes, prominent chin
2. Jaundice
3. Hepatomegaly with biliary hypoplasia and later portal hypertension
4. Skeletal - Spina Bifida and hemivertebra
5. CVS - Pheripheral PS/