[Seetal]

An otherwise healthy 3-week-old boy is brought to the physician's office because of jaundice and dark urine for the past 2 weeks. He has hepatomegaly, and his stools are loose, clay colored, and acholic. Serum conjugated bilirubin concentration is increased. Which of the following is the most likely cause of the hyperbilirubinemia?

(A) Defect in cholesterol synthesis
(B) Deficiency of glucuronosyltransferase
(C) Hemolysis
(D) Inflammation of the terminal ileum
(E) Obstruction of the biliary system

 

[sam01]

i wish i could have more informations.Anyway,i m thinking about Dubin Johnson.So i choose A

 

[HouseWannabe]

I am thinking E, just because he's 3 weeks and this manifested a week after birth. Biliary obstruction is common in infants and the dark urine and pale stool usually points to a liver problem...

 

[sam01]

I am thinking E, just because he's 3 weeks and this manifested a week after birth. Biliary obstruction is common in infants and the dark urine and pale stool usually points to a liver problem...

you can find the same symptoms in Dubin Johnson.There s a problem in secretion into intrahepatic bile ducts. so all the symptoms of biliary obstruction can be seen. Anyway,I am not sure. Otherwise it could be alpha 1 antitrypsin deficiency, however, the baby is apparently healthy!

 

[Seetal]

the answer is E

E is correct. however, I don't have the explanation for it. but my MAIN clue was conjugated hyperbilirubinemia.

if anyone would care to explain y it is E pls?

 

[doctorF]

i too think E is the ryt answer!!!

in obstructive jaundice the liver hepatocytes are functioning properly so the bilirubin conjugation is taking place well, but due to obstruction in the biliary system there is stasis and bile is backing up and is not goin to the deodenum, thus the stools are acholic and clay coloured. conjugated bilirubin backs up and increases in the blood causing increase in blood conjugated bilirubin. also there is pruritis and itching due to bile salts being backed up in the blood rather than secreted into the deodenum with bile

 

[sam01]

Thx guys.I m always confused with that hyerbilirubinemia stuff.

 

[HouseWannabe]

you can find the same symptoms in Dubin Johnson.There s a problem in secretion into intrahepatic bile ducts. so all the symptoms of biliary obstruction can be seen. Anyway,I am not sure. Otherwise it could be alpha 1 antitrypsin deficiency, however, the baby is apparently healthy!

I think with Dubin Johnson, the s/s appear almost after the first feeding, not a week after. Not a hundred percent sure on this though.

 

[ismail]

why u ppl not thinking abt congenital biliary atresia. same presenting pic . surely E the ans

 

[Seetal]

why u ppl not thinking abt congenital biliary atresia. same presenting pic . surely E the ans

hmm.. it does seem highly possible considering he is only 3-weeks old.