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    Jaundice 11.28.2018

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    Emily Eresuma
    A 2-month old boy presented for a well-child check with jaundice visible on his skin and eyes. On exam, he was found to have jaundice extending to his abdomen and scleral icterus. Initial labs showed an elevated total bilirubin of 11.0 with a direct fraction of 0.5. Differentials considered included infectious, obstructive, and hematologic causes of jaundice. Further workup was pursued to help determine the etiology.

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    Jaundice 11.28.2018

    Uploaded by

    Emily Eresuma
    398 views13 pages
    A 2-month old boy presented for a well-child check with jaundice visible on his skin and eyes. On exam, he was found to have jaundice extending to his abdomen and scleral icterus. Initial labs showed an elevated total bilirubin of 11.0 with a direct fraction of 0.5. Differentials considered included infectious, obstructive, and hematologic causes of jaundice. Further workup was pursued to help determine the etiology.

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    Pediatric Morning Report

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    A 2-month old boy presented for a well-child check with jaundice visible on his skin and eyes. On exam, he was found to have jaundice extending to his abdomen and scleral icterus. Initial labs showed an elevated total bilirubin of 11.0 with a direct fraction of 0.5. Differentials considered included infectious, obstructive, and hematologic causes of jaundice. Further workup was pursued to help determine the etiology.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    398 views13 pages

    Jaundice 11.28.2018

    Uploaded by

    Emily Eresuma
    A 2-month old boy presented for a well-child check with jaundice visible on his skin and eyes. On exam, he was found to have jaundice extending to his abdomen and scleral icterus. Initial labs showed an elevated total bilirubin of 11.0 with a direct fraction of 0.5. Differentials considered included infectious, obstructive, and hematologic causes of jaundice. Further workup was pursued to help determine the etiology.

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    © All Rights Reserved
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    Download as pptx, pdf, or txt
    of 13

    MORNING

    Tim Ohlsen REPORT


    11/28/2018
    A CASE…

    • A 2 month old boy comes into your office for well child check and…

    Actually me
    A CASE…

    • A 2 month old boy comes into your office for well child check and…

    Yep, that’s
    jaundice

    Look at that jaundice!


    TIME FOR QUESTIONS
    Weight: 50.4% | Height: 49.7% | OFC: 44%
    Afebrile, vitals normal

    Gen: Awake and alert, well-appearing


    HEENT: AFOF, +cradle cap, +posterior plagiocephaly,
    +scleral icterus
    CV: RRR, Normal S1/S2, no m/r/g, good pulses EXAM
    Resp: Normal effort, CTAB
    Abd: Normal bowel sounds, soft, NTND, no HSM
    GU: Normal
    Skin: Jaundiced to abdomen
    Neuro: Appropriate, good tone, tracking well
    Hepatic/Cholestatic Hematologic Endocrine/Metabolic
    Infectious hepatitis RBC membrane Hypothyroid
    Alagille Syndrome defects Hypopituitarism
    Biliary Atresia RBC enzyme Galactosemia
    deficiency (G6PD)
    Choledochal Cyst Drugs/toxins
    Hemoglobinopathy
    Other Biliary Metabolic disorder
    Obstruction Autoimmune hemolytic NOS
    anemia
    Rotor Syndrome
    DIC
    Dubin-Johnson Other
    Syndrome Breastmilk jaundice
    DIFFERENTIAL Alpha-1 antitrypsin Cystic fibrosis
    CHF
    Poor conjugation TORCH infection
    Gilbert Syndrome Carotenemia?
    Crigler-Najjar
    Syndrome
    DIAGNOSTIC ALGORITHM

    QUESTIONS TO ANSWER QUESTIONS ANSWERED

    • Is this sepsis? • No
    • Is this an obstructive (cholestatic) • Fractionated bilirubin, CMP
    process?
    • CBC and reticulocyte count
    • Is this a hematologic process?
    Hepatic/Cholestatic Hematologic Endocrine/Metabolic
    Infectious hepatitis RBC membrane Hypothyroid
    Alagille Syndrome defects Hypopituitarism
    Biliary Atresia RBC enzyme Galactosemia
    deficiency (G6PD)
    Choledochal Cyst Drugs/toxins
    Hemoglobinopathy
    Other Biliary Metabolic disorder
    Obstruction Autoimmune NOS
    hemolytic anemia
    Rotor Syndrome
    DIC
    Dubin-Johnson Other
    DIFFERENTIAL Syndrome Breastmilk jaundice
    Alpha-1 antitrypsin Cystic fibrosis
    CHF
    Poor conjugation TORCH infection
    Gilbert Syndrome Carotenemia?
    Crigler-Najjar
    Syndrome
    Direct Indirect Either
    hyperbilirubinemia hyperbilirubinemia Hypothyroid
    Alagille Syndrome RBC membrane defects Hypopituitarism
    Biliary Atresia RBC enzyme deficiency Galactosemia
    Choledochal Cyst (G6PD)
    Metabolic disorder NOS
    Other Biliary Obstruction Hemoglobinopathy
    TORCH infection
    Autoimmune hemolytic
    anemia
    Infectious hepatitis (None)
    DIC
    Alpha-1 antitrypsin Carotenemia
    DIFFERENTIAL Gilbert Syndrome
    Rotor Syndrome
    Crigler-Najjar Syndrome
    Dubin-Johnson
    Syndrome
    Drugs/toxins
    Cystic fibrosis Sepsis
    CHF Breastmilk jaundice
    (FIRST PASS) WORKUP

    • CMP/gGTP
    • CBC/smear
    • Retic count
    • TSH!
    • Check newborn screen
    • +/- Coombs, LDH/hapto, TORCH, urine
    reducing substances, A1AT, sepsis workup
    LABS

    CMP CBC/Retic Other:


    Lytes: normal WBC: 3.4 (L), ?ANC 700 TSH: 2.9
    Glucose: normal Hb: 10.7 DAT (days later): negative
    AST 70 Hct: 30.6 LDH/Haptoglobin (later):
    ALT 30 Plt: 319 boring
    Total Bili 11.0 RBC: 3.6 Repeat smear (later): boring?
    Direct Bili 0.5 MCV: 85.5 Repeat bili: 5.7
    Albumin 3.9 MCHC: 35.0 G6PD: normal
    GGTP: Normal RDW: 13.8
    Retic Hb: 30.6 (high 35.5)
    Retic %: 1.4 (high 1.5%)
    Smear: 1+ schistocytes, 2+
    tear drop cells
    AN UNFULFILLING END
    QUESTIONS

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