The Cribsiders S4 Ep65: Liver Lovers Unite! An Approach to Pediatric and Adolescent Hyperbilirubinemia
Oct 5, 2022
Dr. Nivian Blondet, a pediatric gastroenterologist and hepatologist from Seattle, dives into the complexities of pediatric hyperbilirubinemia. She clarifies the differences between unconjugated and conjugated bilirubin, emphasizing their impact on diagnosis and treatment. The discussion covers key assessments like splenomegaly, innovative parental monitoring tips, and the critical timing of surgeries like CASAI for biliary atresia. Additionally, she addresses health inequities in pediatric care, stressing the importance of thorough evaluations and community support.
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Jaundice Differentiation
- Jaundice in older babies and children differs from newborns, depending on whether it's conjugated or unconjugated bilirubin.
- This distinction helps determine the cause and guides the differential diagnosis, regardless of age.
Bilirubin Types
- Conjugated (direct) and unconjugated (indirect) bilirubin differ in how they're measured and their relation to albumin.
- Direct bilirubin, partially bound to albumin, clears slower than conjugated bilirubin, an active metabolite.
Bilirubin Metabolism
- Bilirubin forms from red blood cell breakdown in the spleen, travels to the liver unconjugated, gets conjugated, and is excreted in the intestines.
- Problems can occur at each stage, causing unconjugated or conjugated hyperbilirubinemia.