Manifestations of Gastrointestinal Disease in the Child

More documents

Recommendations

Info

Gastrointestinal Disease in the Child 727 TABLE 12. Causes of unconjugated hyperbilirubinemia in the neonate Increased bilirubin production Hemolytic disease Blood group incompatibility (Rh, ABO, minor groups) Membrane defects (spherocytosis, elliptocytosis, infantile pyknocytosis) Enzyme deficits (G6-PD, hexokinase, pyruvate kinase) Drugs (oxytocin, vitamin K) Increased breakdown Infection Hematoma, swallowed maternal blood Increased RBC mass Polycythemia (maternal diabetes, delayed cord clamp, small for gestational age, altitude) Decreased bilirubin metabolism Reduced uptake Portacaval shunt, hypoxia, sepsis, acidosis, congenital heart disease Decreased conjugation Crigler-Najjar type I, II Gilbert’s syndrome Lucey-Driscoll syndrome Hypothyroidism Panhypopituitarism Altered enterohepatic circulation Breastfeeding Free fatty acids, steroids, breast milk -glucuronidase Intestinal hypomotility Retained meconium Reduced intestinal flora Newborn, antibiotic use caused by immune-mediated or inherited red cell membrane defects, and less frequently hemoglobinopathies. Unconjugated bilirubin concentration will be affected by any condition which reduces the clearance of bilirubin from the liver. These are primarily inherited conditions resulting in defects in uridine glucuronyl transferase (UGT) the enzyme which conjugates bilirubin. These conditions include Crigler-Najjar syndrome types I and II and Gilbert Syndrome which are discussed in more detail in Chapter 13. The Lucey-Driscoll syndrome is a transient form of acquired reduction in UGT which is likely caused by an unidentified maternal serum factor. Congenital hypothyroidism and panhypopituitarism may also result in an unconjugated hyperbilirubinemia by unknown mechanisms.
728 FIRST PRINCIPLES OF GASTROENTEROLOGY TABLE 13. Causes of conjugated hyperbilirubinemia in the neonate Infection Bacterial urinary tract infection/sepsis Cytomegalovirus Rubella Herpes viruses: simplex; type 6 Toxoplasmosis Syphilis Other viruses: adenovirus, Coxsackie virus, echovirus, parvovirus B19 Metabolic Galactosemia Fructosemia Tyrosinemia Peroxisomal disorders Bile acid synthesis disorders 1 -antitrypsin deficiency Cystic fibrosis Niemann-Pick disease Endocrine disorders: hypopituitarism, hypothyroidism Neonatal hemochromatosis Progressive familial intrahepatic cholestasis Bile duct disorders Extrahepatic Biliary atresia Bile duct perforation, stenosis Neonatal sclerosing cholangitis Choledochal cyst Cholelithiasis Intra/extrahepatic masses Inspissated bile/bile plug Intrahepatic Alagille’s syndrome Byler’s disease (familial progressive cholestasis) Nonsyndromic bile duct paucity Miscellaneous Parenteral nutrition Intestinal obstruction Shock Trisomy 21
Page 2 and 3: 14 Manifestations of Gastrointestin
Page 4 and 5: Gastrointestinal Disease in the Chi
Page 6 and 7: lying organic disease, continued no
Page 12 and 13: 2.1.6 MANAGEMENT Management of the
Page 16 and 17: apnea, or are very intermittent, as
Page 56 and 57: decreased bile excretion leads to i
Page 58: Gastrointestinal Disease in the Chi

Manifestations of Gastrointestinal Disease in the Child

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?