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INFANCY
INTRODUCTION
Cholestasis is not a disease but a
symptom of many disease .
It is an uncommon but potentially
dangerous condition which indicates
hepatobiliary dysfunction.
Cholestasis occurs in approximately 1 in
2,500 births
However distinguishing jaundice caused by cholestasis from
non-cholestasis is critical because cholestasis from the former is
much more likely to have a serious etiology that needs prompt
diagnosis and therapy.
Jaundice from non-cholestasis are usually characterised by
unconjugated hyperbilirubinaemia while does of cholestasis are
characterised by conjugated hyperbilirubinaemia.
Conjugated hyperbilirubinemia in the first month of life is
pathologic and may be serious or even life-threatening disease
requiring urgent evaluation
DEFINITION
CHOLESTEROL DIARRHOEA
(XANTHOMATOSIS) GWT RETARDATION
CA LOST
COPPER
(HEPATOTOXICITY )
FAT SOLUBLE VIT.
NIGHT BLINDNESS (A)
MET. BONE DX (D)
COAGULOPATHY(K)
NEUROMUSCULAR DEGEN (E)
DIAGNOSIS OF CHOLESTASIS IN
INFANCY
The Cholestasis Guideline Committee
recommends that any infant noted to be jaundiced at
2 weeks of age be evaluated for cholestasis with
measurement of total and direct serum bilirubin.
However, breast-fed infants who can be reliably
monitored and who have an otherwise normal history
(no dark urine or light stools) and physical
examination may be asked to return at 3 weeks of
age and, if jaundice persists, have measurement of
total and direct serum bilirubin at that time.
A detailed history and meticulous physical
examination could provide clues to a specific
diagnosis.
Once cholestasis is established the infant
should be referred to a gastroenterologist
where further investigation is done.
The work up should be done in a step wise
manner to rule out the causes.
conditions like sepsis, metabolic
disorders (galactosemia) and other
endocrinopathies which are life threatening
should be ruled out first.
Once they have been excluded the next
step is to rule out biliary atresia.
If this has been excluded then the causes
of intrahepatic cholestasis is next.
DIAGNOSTIC EVALUATION FOR NEONATAL CHOLESTASIS
ETIOLOGY TEST
Hepatic dysfunction Albumin, PT/PTT, AST, ALT, GGT, bilirubin
(total and direct)
Genetic errors in bile acid synthesis Bile acid levels in urine and serum