This document provides information on jaundice in children. It discusses the causes of jaundice including liver diseases like hepatitis A and B, gallstones, and metabolic conditions. It outlines the approach to evaluating jaundice including assessing risk factors, laboratory tests to differentiate medical and surgical causes, and classifications. Complications of severe jaundice like kernicterus are described. Sickle cell disease is presented as another potential cause of jaundice in children.
This presentation was done by Dr. Julius P. Kessy,MD. An intern Doctor at Dodoma Regional Referral Hospital (DRRH) during pediatrics unit clinical meeting and supervised by Dr. Christina K. Galabawa,MD,Mmed2, Pediatrics and Child Health, University of Dodoma (UDOM) in November, 2017.
This presentation focuses on Acute Bacterial Meningitis.
Viral and fungal cause is mentioned but focus is on bacterial meningitis in Pediatrics Patient.
Feel free to correct if there is any error.
Refer to other reference books for clarity.
This presentation was done by Dr. Julius P. Kessy,MD. An intern Doctor at Dodoma Regional Referral Hospital (DRRH) during pediatrics unit clinical meeting and supervised by Dr. Christina K. Galabawa,MD,Mmed2, Pediatrics and Child Health, University of Dodoma (UDOM) in November, 2017.
This presentation focuses on Acute Bacterial Meningitis.
Viral and fungal cause is mentioned but focus is on bacterial meningitis in Pediatrics Patient.
Feel free to correct if there is any error.
Refer to other reference books for clarity.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
1. Prof. Sushmita N. Bhatnagar
MBBS, M.S., M.Ch,M.Phil(Hospital Management)
HEAD, PEDIATRIC SURGERY
B.J WADIA CHILDREN’S HOSPITAL, MUMBAI
CONSULTANT PEDIATRIC SURGEON
BOMBAY HOSPITAL
JOINT SECRETARY
ASSOCIATION OF MEDICAL CONSULTANTS
JAUNDICE IN CHILDREN
8. WHICH DISEASES CAUSE JAUNDICE?
• Increased production of bilirubin
• Acute liver inflammation
• Infiltrative liver diseases
• Bile duct inflammation
• Blockage of bile ducts
• Drugs
• Genetic disorders
• Developmental abnormalities of bile ducts
• Jaundice of pregnancy
9. • Skin and sclerae -
yellow
• Stool - light colour,
clay coloured
• Dark urine
• Pain in abdomen
• Itching
• Trouble with sleeping
• Fatigue
• Swelling
• Ascites
• Mental confusion
• Coma
• Bleeding
WHAT PROBLEMS DO JAUNDICE CAUSE?
12. NEONATAL JAUNDICE
Neonatal jaundice is quite common
• >50% of normal newborns and
• 80% of preterm infants have some degree of
jaundice
Two types of neonatal jaundice:
• Normal / physiological
• Abnormal / non-physiological
13. WHY?
• PRODUCTION :
In term newborns, bilirubin production is 2-3 times
higher than in adults
• CLEARANCE
decreased in newborns, mainly due to deficiency of
enzyme UGT
• UGT activity in term infants at 7 days is ~1% of adult
liver and doesn’t reach adult levels until 14 weeks
• CIRCULATION
Increase enterohepatic circulation of bilirubin,
further increases bilirubin load
14. PRETERM INFANTS
• Even more RBC turnover and destruction
• Physiologically impaired conjugation and
elimination of bilirubin
• An even less mature liver
• Reduced bowel motility due to inadequate
oral intake
• Delayed elimination of meconium
• Increased enterohepatic circulation
15. PHYSIOLOGIC JAUNDICE
• Jaundice appears around 72 hrs of life
• Bilirubin peaks <14 mg/dl
• Direct bilirubin <10% of total bilirubin
• Rate of rise <5mg/dL/day
• Jaundice resolves in 1-2 weeks in term
infants, 2 weeks in preterm infants
16. NON-PHYSIOLOGIC JAUNDICE
• Early jaundice
• Starts on first day of life
• Jaundice of long duration
• >14 days in term or >21 days in preterm
infants
• Deep jaundice
• Palms and soles deep yellow
• Objectively, high bilirubin lab levels
• Jaundice with fever
19. WORK UP: LABORATORY STUDIES
• Where possible, confirm clinical jaundice with
bilirubin levels
• Possible additional investigations, depending
on likely diagnoses and lab availability:
• Hemoglobin/hematocrit (PCV) to look for hemolysis
• Blood smear
• Reticulocyte count
• WBC to look for signs of infection (WBC <5, WBC>20, or I:T
ratio >20%)
• Blood type of baby and mother, and Coombs test
• Syphilis serology (e.g. VDRL)
• G6PD screen, thyroid function tests, liver ultrasound
20. JAUNDICE AND ITS EFFECT
Deposits in
skin and
mucous
membranes
Unconjugate
d bilirubin
deposits in
the brain
Permanent
neuronal
damage
JAUNDICE
ACUTE BILIRUBIN
ENCEPHALOPATHY
KERNICTERUS
M
a
y
c
a
u
s
e
I
t
c
h
i
22. • Hepatitis A is transmitted by contaminated
food or water, or contact with a person
who is currently ill with the disease. The
hepatitis A virus is shed in the stools of an
infected person during the incubation
period of 15 to 45 days before symptoms
occur and during the first week of illness.
Blood and other bodily secretions may
also be infectious.
• The virus does not remain in the body
after the infection has resolved, and there
is no carrier state (a person or animal that
spreads the disease to others but does not
become ill).
• The symptoms associated with hepatitis A
are fever, poor appetite, nausea &
vomiting, abd pain ,jaundice & yellow
urine. This is because the liver is not able
to filter bilirubin from the blood.
• Risk factors include having a family
member who recently had hepatitis A,
HEPATATIS A
26. HEPATATIS B
Hepatitis B is transmitted via blood and other body fluids. Infection
can occur through:
• Contact with blood in healthcare settings -- this puts
physicians, nurses, dentists, and other healthcare
personnel at risk
• Blood transfusions
• Sharing needles during drug use
• Receiving a tattoo or acupuncture with contaminated
instruments
• Birth -- an infected mother can transmit the virus to the
baby during delivery or shortly thereafter
29. • Stones can present with jaundice,
especially the stones in the bile ducts
Obstructive jaundice
SUSPECT
INVESTIGATE
TREAT
CALCULUS DISEASE
30. CARE FOR ALL BABIES
Risk factors
identified?
Jaundi
ce
Examine for jaundice at every
opportunity especially in the
first 72 hours
An additional inspection
within 48 hours
YES NO
31. < 24 HOURS OF AGE
Visible
jaundice
MEDICAL EMERGENCY
Measure and record serum bilirubn
within 2 hours
Neonatology/Pediatric/Medical review
within 6 hours
Commence
phototherapy
Organise
transfer to
neonatal
referral center
YES
35. PROBLEMS WITH DELAY
• If significant brain damage occurs before treatment, a child can develop serious and
permanent problems, such as:
• cerebral palsy – a condition that that affect a child's movement and co-ordination
• hearing loss, which can range from mild to severe
• learning difficulties
• involuntary twitching of different parts of their body
• problems maintaining normal eye movements – people affected by kernicterus have a
tendency to gaze upwards or from side to side rather than straight ahead
• the normal development of the teeth can be disrupted resulting in teeth that are
misshapen, discoloured and vulnerable to tooth decay
36. TWO FORMS OF HYPERBILIRUBINEMIA
• Unconjugated / indirect hyperbilirubinemia:
• Pre-hepatic cause, or impairment in conjugation
VS.
• Conjugated / direct hyperbilirubinemia:
• Injury at the level of the hepatocytes, or post-
hepatic obstruction
• Consider diagnosis of conjugated
hyperbilirubinemia if direct bilirubin is >3mg/dL, or
is >10% of total bilirubin
37. DIFFERENTIAL DIAGNOSIS:
UNCONJUGATED
HYPERBILIRUBINEMIA
• Breastfeeding jaundice
• Occurs at 1-3 days of age; due to dehydration and lack of stooling (treat by increasing feeding frequency)
• Breast milk jaundice
• Occurs at 4-10 days of age; substance in breast milk inhibits glucuronyl transferase (treat by temporary
switch to formula)
• Hemolysis
• ABO/Rh incompatibility
• RBC membrane defects
• Alpha thalassemia
• G6PD deficiency
• Cephalohematoma
• Polycythemia
• Infection
• Hypothyroidism
• Gilbert’s
• impaired conjugation, associated with stress, no overt hemolysis
• Crigler-Najjar’s
• absent (type 1) or diminished (type 2) UDP-glucoronyl transferase
38. DIFFERENTIAL DIAGNOSIS:
CONJUGATED
HYPERBILIRUBINEMIA
• Biliary atresia
• ~60% of cases; an obliterative process of bile ducts; diagnosed by U/S or
biopsy
• Infection
• Hepatitis B, TORCH
• Metabolic
• Galactosemia
• Alpha-1-antitrypsin deficiency: most common genetic cause
• Dubin Johnson or Rotor’s syndrome: defective liver secretion of bilirubin
• Iatrogenic
• Drug-mediated
• TPN-related: occurs in ~2/3 of infants given TPN over 2 weeks of duration;
unknown mechanism, possibly mediated by bacterial endotoxins, oxidative
stress, glutathione depletion
• Idiopathic
• neonatal non-infectious hepatitis (diagnosis of exclusion)
39. THE CONCERN: KERNICTERUS
• Bilirubin exceeds albumin-
binding capacity, crosses BBB,
and deposits on basal ganglia
and brainstem nuclei
• Risks increase with levels >20
mg/dl
• Or lower levels in setting of sepsis,
meningitis, hemolysis,
hypothermia, hypoglycemia, or
prematurity
41. CAUSE ANALYSIS OF KERNICTERUS
• Early discharge <48hrs without follow-up within 48hrs
• Failure to check bilirubin level when jaundice within 24hrs of life
• Failure to recognize risk factors
• Underestimating severity by visual assessment
• Delay in initiating treatment
• Failure to respond to parental concerns
AAP Subcommittee on Neonatal Hyperbilirubinemia. Pediatrics 2001; 108: 763-765.
42. • Maternal:
• Race or ethnic group (Asian,
Mediterranean)
• ABO, Rh incompatibility
• Previous jaundiced infant
• Advanced maternal age
• Diabetes
• Infant:
• Gestation <38 weeks
• Bruising, cephalohematoma
• Infection
• G6PD deficiency
• Polycythemia
• Male gender
• Nutritional:
• Breastfeeding
• Weight loss
• Decreased feeding
frequency
• Decreased stooling
• Decreased urine output
WORK UP: ASSESS RISK FACTORS
43. JAUNDICE – CLASSIFICATION
WWW.DRSARMA.IN 43
• Normal Serum Bilirubin (SB) is 0.3 to 1.0 mg%
• Jaundice is increased levels of SB > 1.0 mg%
• Over production of Bilirubin (Hemolytic)
• From hemolysis of RBC
• Lysis of RBC precursors – Ineffective erythropoesis
• Impaired hepatic function (Hepatitic)
• Hepatocellular dysfunction in handling bilirubin
• Uptake, Metabolism and Excretion of bilirubin
• Obstruction to bile flow (Obstructive)
• Intrahepatic cholestasis
• Extrahepatic Obstruction (Surgical Jaundice)
45. SECOND STEP : IF SB > 1.0 MG
WWW.DRSARMA.IN 45
Is it unconjugated bilirubin ?
Haemolytic Jaundice
Is it Conjugated Bilirubin ? (> 20%)
Hepatocellular jaundice
Obstructive jaundice
47. THIRD STEP : IF CSB IS INCREASED
WWW.DRSARMA.IN 47
Do - AST and ALT (SGOT and SGPT)
Elevated AST and ALT
Hepatocellular jaundice
AKP, 5N, GGT will be normal
Do - Alkaline Phosphatase and GGT
AKP, GGT ↑↑ in Obstructive Jaundice
AST and ALT will be normal
48. FOURTH STEP : HEPATOCELLULAR
WWW.DRSARMA.IN 48
Hepatocellular – Features and D.D
Conjugated SB is increased
AST and ALT are increased
AKP, 5NS, GGT are normal
Hepititis – A,B,C,D,E, CMV,EBV
Toxic Hepatitis – Drugs, Alcohol
Malignancy – Primary Ca
Cirrhosis – ALD, NAFLD
49. LABORATORY TESTS
• Bilirubin level in serum (total and direct)
• Aminotransferase
• Alkaline phosphatase
• U/A for bilirubin and urobilogen
Complete blood count
Prothrombin time
Other laboratory tests
pertinent to history
Coombs test
Electrophoresis of
hemoglobin
Viral hepatitis panel
54. SICKLE CELL DISEASE
• .
• Sickle cell anemia is an inherited blood
disease in which the red blood cells produce
abnormal pigment (hemoglobin). The
abnormal hemoglobin causes deformity of
the red blood cells into crescent or sickle-
shapes, as seen in this photomicrograph
55. • JAUNDICE
• BODY PAIN/JOINT PAIN
• PAINFUL SWELLINGS
• TIRED/NOT WORKING
• POOR GROWTH
• RECURRENT RESP INFECTION
• STROKE
BLOOD TEST AT GAH
WHEN DO YOU SUSPECT SCD AND WHAT
SHOULD YOU DO
56. WHAT TO DO FOR PATIENT WITH SCD
• PROTECT AGAINST
DIARRHOEA
• GIVE PENICILLIN TILL
AGE 5
• HYDROXYUREA
• GENETIC ADVISE
59. WORK UP: LABORATORY STUDIES
• Where possible, confirm clinical jaundice with
bilirubin levels
• Possible additional investigations, depending on
likely diagnoses and lab availability:
• Hemoglobin/hematocrit (PCV) to look for hemolysis
• Blood smear
• Reticulocyte count
• WBC to look for signs of infection (WBC <5, WBC>20, or I:T
ratio >20%)
• Blood type of baby and mother, and Coombs test
• Syphilis serology (e.g. VDRL)
• G6PD screen, thyroid function tests, liver ultrasound
60. CLINICAL SYMPTOMS:
• Jaundice/Icterus:
• Newborn icterus notable once total bilirubin > 5-6 mg/dL (versus older
children/adults once > 2 mg/dL)
• Progresses cranially to caudally
• CAUTION: Visual assessment is subjective, inaccurate, and dependent on
observer experience!
• Keren et al Visual assessment of jaundice in term and late-preterm infants
(2009)
• Nurses at HUP used 5 point-scale to rate cephalocaudal extent of jaundice
• Showed weak correlation between predicted and actual levels
61. PRE-TERM VS. FULL-TERM
HYPERBILIRUBINEMIA:
• Pre-term infants at higher risk due to further reduced activity of liver
conjugating enzymes
• Pre-term infants can develop encephalopathy or kernicterus at lower total
bilirubin levels
62. DIRECT HYPERBILIRUBINEMIA:
• Considered elevated when:
• Level > 2.0 mg/dL (severe > 5.0 mg/dL)
• Level > 15% of total serum bilirubin
• Risk factors:
• Low gestational age
• Early and/or prolonged exposure to TPN
• Lack of enteral feeding
• Sepsis
• Clinical hallmarks: icterus, acholic stools, dark urine
63. DIFFERENTIAL DX OF DIRECT
HYPERBILIRUBINEMIA:
• More common causes:
• TPN-associated
• Hepatitis: Idiopathic, Infectious, Toxic
• Infection: Sepsis, TORCH, UTI
• Biliary atresia
• Inspissated bile plug
• Choledochal cyst
• Alpha-1-antitrypsin deficiency
• Galactosemia
64. DIFFERENTIAL DX OF DIRECT
HYPERBILIRUBINEMIA:
• Less common causes:
• Cholelithiasis
• Cystic fibrosis
• Hypothyroidism
• Rotor’s Syndrome
• Dubin-Johnson Syndrome
• Storage diseases (Niemann-Pick, Guacher’s)
• Metabolic disorders (tyrosinemia, fructosemia)
• Trisomy 21 or 18
• Drug-induced
• Shock
• Alagille Syndrome
• Zellweger Syndrome