I am needing help in a presenation of pathophysiology upper level course. I am doing a presentation on kernicterus caused from hyperbilirubin, but I am doing the case as if I am presenting to a class. So it is difficult to get some lab results and test as it seems that total bilirubin levels give away the diagnosis. I guess I am asking how can I explain that the patient has kernicterus from rH incompatabilty? The patient is 9 years old and I iwll add some lab test results that I have included already (see below), if you can just help maybe explain RH incompatability and how I can talk about it in presentation?

I am needing help in a presenation of pathophysiology upper level course. I am doing a presentation on kernicterus caused from hyperbilirubin, but I am doing the case as if I am presenting to a class. So it is difficult to get some lab results and test as it seems that total bilirubin levels give away the diagnosis. I guess I am asking how can I explain that the patient has kernicterus from rH incompatabilty? The patient is 9 years old and I iwll add some lab test results that I have included already (see below), if you can just help maybe explain RH incompatability and how I can talk about it in presentation?

History:

Any family history of significance? (hereditary diseases)

Family is originally from South Asia

Family has had a history of neonatal hyperbilirubin  (hereditary)

Any familial history regard kidney or liver failure? Yes mother remembers that one of her family members had a child pass away from liver disease.

Reactive to light and noise? Does not seem to react to noise, mother states that his reaction to noise started to diminish a couple days ago. The patient when tested for reaction to noise was unresponsive and when light test was administered, there were noticeable “odd” eye movements.

What # child is it for mother? First, second, etc..? This is the second child and the first was noted to have jaundice as a neonate and underwent light-therapy for it.

What has his food been intake been prior to him coming in?

Patient has had a decrease in appetite

Changes in mood? The patient has been very fussy and has been constantly crying (high-pitch). Seems to be restless.

How many wet diapers? Dirty diapers?May have been less than usual 3-5 a day

does the baby cry when you touch the abdomen or press it lightly?Yes, the baby does cry when abdomen is pressed upon

Imaging & test requests:

Physical: patient has been in hospital for 5+ hours and nurse has noticed patients back started to arch.

Ultrasound abdomen, specifically kidney and liver:

In the ultrasound you notice that the liver is enlarged, “swollen”.  Hepatic vein dilation, obstruction of common bile duct.

The kidney seems to have thickened renal capsules.

CT

EKG

Iron B12 and Folate levels

Iron: 50 mcg/dl

B12: 55 ng/l

Folate:9 ng/ml

Brain MRI

Light Meter àTranscutaneous bilirubin (TcB) measurement??

abdominal CT scan

reveals hepatomegoly and portal vein dilation

Liver biopsy

Reveals necrotic tissues in the liver

Tuberculosis test-negative

Colonoscopy

ERCP test

Reveals obstruction in the common bile duct

CSF

Elevated WBC:14.53 10^9/L

Elevated protein

Reduced glucose>45 mg/dl

Serum electrolytes

Sodium level :194 mEq/dl

Hepatitis test

Reticulocyte count: less than 1% normal values are 2-6%

Peripheral blood smear

RBC reduced

WBC increased

ABO typing with Rh factor test of MOTHER AND CHILD

Rh-negative and the infant is Rh-positive.????

ABO antibody test

Comb’s Test: Positive

ALT, AST, + ALP (liver tests)

AST: 165 units/L elevated

ALT: 50 units/L elevated

Gram strain to test for sepsis

Tox screen

Bilirubin levels :Total serum bilirubin level 20.7 to 59.9 mg/dl—0.5mg/dL/hr

First round showed bilirubin at 29 mg/dL @

Second round showed it has increased to 32 mg/dl  @

Rushed to emergency room

Blood culture

The post I am needing help in a presenation of pathophysiology upper level course. I am doing a presentation on kernicterus caused from hyperbilirubin, but I am doing the case as if I am presenting to a class. So it is difficult to get some lab results and test as it seems that total bilirubin levels give away the diagnosis. I guess I am asking how can I explain that the patient has kernicterus from rH incompatabilty? The patient is 9 years old and I iwll add some lab test results that I have included already (see below), if you can just help maybe explain RH incompatability and how I can talk about it in presentation? appeared first on commompapers.org.

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