Pediatric emergency medicine trisk 0877 0877
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• Rotor syndrome
• Hypopituitarism
• Hypothyroidism
• Cystic fibrosis
• Idiopathic neonatal cholestasis or neonatal hepatitis syndrome
• Progressive intrahepatic cholestasis types 1 and 2 (PFIC1, PFIC2)
• Alagille syndrome
• Benign recurrent intrahepatic cholestasis (BRIC)
Obstruction
• Biliary atresia
• Choledochal cyst
• Cholelithiasis
• Choledocholithiasis
• Cholecystitis
• Cholangitis
• Primary sclerosing cholangitis
• Pancreatic disease
• Gallbladder hydrops
• Kawasaki disease
• Streptococcal infection
• Staphylococcal infection
• Tumors of the liver and biliary tree
HISTORY AND PHYSICAL EXAMINATION
The provider interviewing the patient and family with hyperbilirubinemia can
often differentiate the cause and severity of the underlying issue with a thorough
medical history and physical examination ( Fig. 44.1 ). The following questions
can help elucidate key points in differentiating the cause of conjugated
hyperbilirubinemia:
1. Is this the first episode of jaundice? (to distinguish between an acute event and
a chronic process)
2. Are the stools acholic? Is there abdominal pain? If so, does the pain increase
with certain foods? (to determine whether biliary obstruction is present)
3. Is fever, fatigue, emesis, or diarrhea present? (to investigate viral causes,
including EBV, hepatitis A, and hepatitis B)
4. Is itching present? (sign of bile acids in the skin)
