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Similar to Neonatal jaundice - Dr. Vishnu Biradar
Neonatal jaundice - Dr. Vishnu Biradar
- 1. YELLOW Dr.Vishnu Biradar MD, PDCC Fellow in Liver Transplant Cons. Pediatric Gastroenterologist DMH, Pune 08600800123
- 2. Q 1. Whichof following is neonatal cholestasis? A. S. Bil 10 , Direct 1.8 B. S. Bil 10, Direct 2.8 C. S. Bil 3, Direct 0.9 mg D. A + B + C E. B + C ?
- 3. Q 1. Whichof following is neonatal cholestasis? A. S. Bil 10 , Direct 1.8 B. S. Bil 10, Direct 2.8 C. S. Bil 3, Direct 0.9 mg D. A + B + C E. B + C E12n1234567890123456789d TIME Your Time Starts Now! UP!
- 4. Q 1. Whichof following is neonatal cholestasis? A. S. Bil 10 , Direct 1.8 B. S. Bil 10,Direct 2.8 C. S. Bil 3, Direct 0.9 mg D. A + B+ C E. B + C
- 5. Neonatal Cholestasis Prolonged elevation of conjugated bilirubin beyond 14 days of life >20% of total bilirubin if S.bil >5mg% >1 mg% if S.bil <5mg% 5
- 6. Neonatal Cholestasis Non-sickbaby Sick Baby 6
- 7. Q. If 1month old baby is not sick & conj. jaundice, what is next appropriate step? A. Observation B. USG Abdomen C. Complete LFT D. Thyroid Function Test E. None of the above ?
- 8. Q. If 1month old baby is not sick & conj. jaundice, what is next appropriate step? A. Observation B. USG Abdomen C. Complete LFT D. Thyroid Function Test E. None of the above E12n1234567890123456789d TIME Your Time Starts Now! UP!
- 9. Q. If 1month old baby is not sick & conj. jaundice, what is next appropriate step? A. Observation B. USG Abdomen C. Complete LFT D. Thyroid Function Test E. None of the above
- 10. To see urine& stool Taiwan model Pre stool card (2004) Post stool card (2005) Sensitivity of diagnosis 72% 97% Rate of Kasai < 60d 60% 74%
- 11. Stool card screening(Taiwan) Sensitivity : 97% Chen, Pediatrics 2006;117:1147-54.
- 12. Q. What doyou think is important parameter in LFT in non-sick child? A. Bilirubin B. SGOT & SGPT C. PT INR D. Total protein and Albumin E. Gamma Glutamyl-transpeptidase ?
- 13. Q. What doyou think is important parameter in LFT in non-sick child? A. Bilirubin B. SGOT & SGPT C. PT INR D. Total protein and Albumin E. Gamma Glutamyl-transpeptidase E12n1234567890123456789d TIME Your Time Starts Now! UP!
- 14. Q. What doyou think is important parameter in LFT in non-sick child? A. Bilirubin B. SGOT & SGPT C. PT INR D. Total protein and Albumin E. Gamma Glutamyl-transpeptidase (GGT)
- 15. Neonatal Cholestasis Non-sickbaby Sick Baby Pale Stools Pigmented Stools PFIC, GGT Bile Acid Synthetic Defect Moderately High Metabolic disease Genetic Disease High > 300 Normal / Low Biliary Atresia, PILBD, PSC, a-antitrypsin def. 15 Indian Pediatrics Volume 51 : March 15, 2014
- 16. Liver function tests • TB: between 6-10 mg/dL • DB: conjugated fraction raised • Enzymes: do not predict • Albumin: low if decompensated (cirrhosis) • ALP,GGT: high • INR: correctable coagulopathy (after 1-3 doses of Vitamin K
- 17. Q. Now, wedecided to do USG abdomen. What to look for? A. Liver echotexture B. Liver surface C. Common bile duct (CBD) D. Gall-bladder (GB) E. Portal Vein ?
- 18. Q. Now, wedecided to do USG abdomen. What to look for? A. Liver echotexture B. Liver surface C. Common bile duct (CBD) D. Gall-bladder (GB) E. Portal Vein E12n1234567890123456789d TIME Your Time Starts Now! UP!
- 19. Q. Now, wedecided to do USG abdomen. What to look for? A. Liver echotexture B. Liver surface C. Common bile duct (CBD) D. Gall-bladder (GB) E. Portal Vein
- 20. Neonatal Cholestasis Non-sickbaby Sick Baby Pale Stools Pigmented Stools Fasting USG Abdomen > 4 hours Normal GB Small GB < 1.5 cm length Absent GB Choledochal Cyst r/o Biliary Atresia Surgery 20 Indian Pediatrics Volume 51 : March 15, 2014 Abnormal CBD Infant : >2mm Older children : >3.5mm
- 21. Importance of Gallbladder Length of GB • Cut off suggested: 15 mm • Lack of smooth/complete echogenic mucosal lining • Irregular/lobular contour Contractility index Normal CI : 86% at 6 weeks 67% at 4 months Farrant, Br J Radiol 2001 Kanegawa et al, AJR, 2003
- 22. Q. What willyou do next to confirm BA? A. HIDA scan B. Liver Biopsy C. Per Operative Cholangiogram ?
- 23. Q. What willyou do next to confirm BA? A. HIDA scan B. Liver Biopsy C. Per Operative Cholangiogram E12n1234567890123456789d TIME Your Time Starts Now! UP!
- 24. Q. What willyou do next to confirm BA? A. HIDA scan B. Liver Biopsy C. Per Operative Cholangiogram
- 25. Neonatal Cholestasis R/oBiliary Atresia Age < 6 wks Age > 6 wks Age > 90 days with ascites Age > 120 days Non-sick baby, Pale Stools, Small/ Absent GB on fasting USG Sick Baby Kasai Porto-enterostomy Liver Transplant 25 Indian Pediatrics Volume 51 : March 15, 2014 + HIDA scan Liver Biopsy
- 26. Liver Biopsy H& E Stain CK 7 & 19 stain
- 27. LFT in sickchild, what to look for? A. Bilirubin B. SGOT & SGPT C. PT INR D. Total protein and Albumin E. Gamma Glutamyl-transpeptidase > 2, inspite of 3 doses of Vit-K Neonatal Liver Failure
- 28. Q. What investigationswill you do in sick baby except A. Malaria test B. TORCH C. Urine RM & CS D. HSV PCR E. GALT ?
- 29. Q. What investigationswill you do in sick baby except A. Malaria test B. TORCH C. Urine RM & CS D. HSV PCR E. GALT E12n1234567890123456789d TIME Your Time Starts Now! UP!
- 30. Q. What investigationswill you do in sick baby except A. Malaria test B. TORCH C. Urine RM & CS D. HSV PCR E. GALT
- 31. Neonatal Cholestasis Non-sickbaby Sick Baby Sepsis Screen Positive Urine/ Blood CMV PCR HSV PCR Serum ferritin r/o Galactosemia Urine NGRS By GALT Enzyme assay HLH/ NH 31 Urine for Succinylacetone Tyrosinemia Indian Pediatrics Volume 51 : March 15, 2014
- 32. Q. What isthe dose of Vit.-K in NCS? A. IV 1 mg B. IV 1 mg/kg/day C. IV 5 mg D. IV 10 mg ?
- 33. Q. What isthe dose of Vit.-K in NCS? A. IV 1 mg B. IV 1 mg/kg/day C. IV 5 mg D. IV 10 mg E12n1234567890123456789d TIME Your Time Starts Now! UP!
- 34. Q. What isthe dose of Vit.-K in NCS? A. IV 1 mg B. IV 1 mg/kg/day C. IV 5 mg D. IV 10 mg
- 35. Q. How frequentVit.-K to be given? A. Once a week B. Twice a week C. Once a month D. Twice a month ?
- 36. Q. How frequentVit.-K to be given? A. Once a week B. Twice a week C. Once a month D. Twice a month E12n1234567890123456789d TIME Your Time Starts Now! UP!
- 37. Q. How frequentVit.-K to be given? A. Once a week B. Twice a week C. Once a month D. Twice a month
- 38. Dose Route Calories125% Add MCT / puffed rice powder Vitamin A 5000-25000 IU/day Vitamin D 400-1200 IU/ day Vitamin E 50-400 IU/ day Vitamin K 2.5 mg twice weekly Oral 2-5 mg once monthly sc/im/iv Calcium 20-100 mg/kg/day Oral Phosphorous 25-50 mg/kg/day Oral Magnesium 1-2 mEq/kg/day Oral 0.3-0.5 mEq/ kg over 3 hours of 50 % solution IV Elemental iron 5-6 mg/kg/day Oral
- 39. Case 7 monthold boy C/o Gradually progressing abdominal distesnion with hepatomegaly and jaundice since 15 days No fever/ altered sensorium/ hemetemesis O/e: Vitals N PA: Gross ascites and tender hepatomegaly Budd-Chiary Syndrome
- 40.
- 41. Q. What reallyconstitutes BCS? A. Two hepatic vein block B. Three hepatic vein block C. IVC block D. All of the above E. Only B+C ?
- 42. Q. What reallyconstitutes BCS? A. Two hepatic vein block B. Three hepatic vein block C. IVC block D. All of the above E. Only B+C E12n1234567890123456789d TIME Your Time Starts Now! UP!
- 43. Q. What reallyconstitutes BCS? A. Two hepatic vein block B. Three hepatic vein block C. IVC block D. All of the above E. Only B+C
- 44.
- 45. Q. How canBCS present? A. Hepatomegaly and Ascites B. Splenomegaly without ascites / Portal HTN C. Fulminant Liver Failure D. A + C E. All of the above ?
- 46. Q. How canBCS present? A. Hepatomegaly and Ascites B. Splenomegaly without ascites / Portal HTN C. Fulminant Liver Failure D. A + C E. All of the above E12n1234567890123456789d TIME Your Time Starts Now! UP!
- 47. Q. How canBCS present? A. Hepatomegaly and Ascites (20- 30%) B. Splenomegaly without ascites / Portal HTN (65%) C. Fulminant Liver Failure (10%) D. A + C E. All of the above
- 48. Investigation • HemogramN • Bil T/D –0.5/0.2 • SGOT -55 • SGPT-11 • ALP - 493 • GGT - 145 • Total protein- 6.58 • Albumin – 3.93 • PT INR -13.6/11 • Factor V leiden mutation absent • Protein C & S assay normal • Anti-thrombin III levels – normal • Homocysteine levels normal
- 49. Radiological Investigation: USGAbdomen & CT Scan – Triphasic study A. All three hepatic veins showed chronic thrombosis with collaterals B. Hepatomegaly and ascites
- 50. Venoplasty Video A.Right Hepatic Venoplasty
- 51. Follow up –6 months Child is ascites free Wt. gain of 1.5 kg Serial doppler showed patency of right hepatic vein No deterioration in liver parameters
- 52.
- 53. Take Home Message Clinical features of BCS in children are protean. Absence of ascites doesn’t rule out BCS. Good doppler examination of hepatic veins and IVS is important Endovascular management of BCS is safe and effective treatment modality with good intermediate to long term results along with anti-coagulation
- 54.
Editor's Notes
- #16 .