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  #1  
Old 08-12-2011
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Kids Six Week Old Infant with 12 mg Bilirubin

A 6-week-old infant is admitted to the hospital with jaundice. Her outpatient blood work demonstrated a total bilirubin of 12 mg/dL with a direct portion of 3.5 mg/dL. Which of the following disorders is most likely to be responsible?
a. ABO incompatibility
b. Choledochal cyst
c. Rh incompatibility
d. Gilbert disease
e. Crigler-Najjar syndrome
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Old 08-12-2011
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I would go with B) Cholecoductal cyst

ABO Incompatability & Rh Incompatability (Choices A & C) would result in Anemia. Anemia causes hemolytic jaundice but with uncojugated hyperbilirubinemia (indirect, not direct).

Gilbert Dx & Criggler Najjar syndrome (Choices D & E) cause indirect unconjugated hyperbilirubinemia since there is defects in bilirubin uptake by liver (gilbert) & bilirubin conjugation (criggler najjar).
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Old 08-12-2011
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direct portion is 3.5 so indirect is 12-3.5 .....maybe i ve confused things...correct me if i m wrobg please

i m with..crigler Najjar type 2
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Quote:
Originally Posted by MANIAKOS View Post
direct portion is 3.5 so indirect is 12-3.5 .....maybe i ve confused things...correct me if i m wrobg please

i m with..crigler Najjar type 2
Ah, I didnt think of it that way ...but then why not Gilbert ?
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Old 08-12-2011
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in gilbert jaundice appears after adolescence and after dehydration, infection etc
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Old 08-12-2011
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Quote:
Originally Posted by Hope2Pass View Post
Ah, I didnt think of it that way ...but then why not Gilbert ?
And also in addition to what maniakos stated, it would be very mild, bilirubin of 12 mg/dl isn't.
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Old 08-12-2011
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i would go wid e). criggler najjar syndrome....
since direct fration is < 50% of total bilirubin, its predominantly unconjugated. so we can rule out choledochal cyst. also gilberts would be very mild. wid ABO and Rh incompatibility , the child would nt have survived 6 weeks without any intervention..
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Old 08-14-2011
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b. Choledochal cyst
congenital anomaly resulting in obstruction of biliary tract which results in increased direct fraction of total bilirubin
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Old 01-15-2012
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Direct-reacting billirubin is greater that 20% of total --> Obstructive jaundice --> b. Choledochal cyst
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Old 01-15-2012
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Quote:
Originally Posted by Evergreen View Post
Direct-reacting billirubin is greater that 20% of total --> Obstructive jaundice --> b. Choledochal cyst
so the CB= 30%total bilirubin, it shouldn't be due to hemolysis ( in which CB<20%total bilirubin ). But why is choleduchal cyst accountable for only 30% CB? Should it be 50% or more as in typical obstruction?
Hope my Q make some sense.
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Old 01-15-2012
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The answer is b.

Obstructive jaundice (ie, direct-reacting bilirubin greater than 20% of the total) requires investigation in all infants.
ABO and Rh incompatibility occasionally cause direct hyperbilirubinemia if there were brisk hemolysis at birth, which would then lead to inspissated bile syndrome.
All of the other causes listed typically lead to indirect hyperbilirubinemia.
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Old 01-15-2012
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e. Crigler-Najjar syndrome , is the answer , Its a Indirect bilirubinemia not direct .. 12 - 3.5 = 8.5 indierect bilirubinemia due to Crigler-Najjar syndrome type 2 , had it been choledochal cyst it would be direct bilirubinemia ....
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Old 01-27-2013
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Default crijlar nijar syn

the answer is obvious
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Old 01-29-2013
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Correct Answer

crijlar nijar syn
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Old 01-29-2013
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e. Crigler-Najjar syndrome
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