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Conjugated Hyperbilirubinemia Pediatrics | Lecturio

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This video “Conjugated Hyperbilirubinemia” is part of the Lecturio course “Pediatrics” ► WATCH the complete course on

In this lecture we’re going to discuss conjugated hyperbilirubinemia and liver diseases in children this happens every now and then a child is born who is a little bit yellow and it turns out their having conjugated rather than unconjugated hyperbilirubinemia and it’s important in these conditions to know what exactly is going on so the definition of conjugated

Hyperbilirubinemia is more than one milligram per deciliter of total if the total of bilirubin is less than five or more than 20% of your total bilirubin if the total bilirubin is more than five so we have to remember that five cutoff in terms of how we define hyper cup bilirubin emia the differential diagnosis for a child with conjugated hyperbilirubinemia is

Generally either an extra hepatic problem where the bile can’t get out or an intra hepatic problem elevated conjugated bilirubin is never normal in a neonate and that’s an incredibly important fact unconjugated or indirect hyper billy is very common and we see it all the time but when it’s conjugated there is definitely a problem so when you see a patient with

Conjugated hyperbilirubinemia it’s important to take a good history family history is critical because there are inherited syndromes where children are more prone to liver disease asking about consanguinity is always important as well because obviously with consent when as families recessive disorders are more likely to show up understanding if there were any

Pregnancy complications can be helpful as well as some of these conditions are syndromic and there may be a problem or even more likely the mother may have obtained an infection during pregnancy some of the torch infections can cause a hepatitis and children speaking about the delivery and where there are any complications and certainly where there are any

Infectious exposures to the child are important it’s critical to do a good physical exam on these children specifically knowing their growth parameters and plotting them on a growth curve both height weight and head circumference is critical to understanding how this child is developing and if the hepatic disease is affecting them or if this is part of the

Syndrome accession understanding vital signs and making sure they’re normal are critical and of course a skin evaluation will give you a sense of just how bad the hyperbilirubinemia might be prior to actually getting the lab value conjunctival icterus is common in these patients and it may be how you find it the best place to look for jaundice may be under the

Tongue around the frenulum area patients if they have a cardiac condition and there are some conditions like alagille which we’ll talk about an admit in a bit that are associated with cardiac findings so understanding a cardiac murmur and listening for one is important as well the abdominal exam is of course critical especially feeling for that liver edge or doing

The scratch test which may be an even better way to assess for hepatomegaly and children of course labs are the mainstay and so obtaining a bilirubin is important remember especially in babies you can’t just get a total bilirubin you need to break it down into direct and indirect bilirubin emia that’s because while most children are indirect these children with

Conjugated hyperbilirubinemia can’t be missed and should not be lit with lights as they will develop copper baby syndrome of course checking the liver function tests is important and don’t forget the ggt which is useful for assessing the biliary tree because many of these children have abnormalities of the biliary tree synthetic function tests like pt/ptt inr

Are important for understanding whether liver is working it’s not enough to just know it’s inflamed we also want to know whether it’s functioning correctly

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Conjugated Hyperbilirubinemia – Pediatrics | Lecturio By Lecturio Medical