Instructions
You are a medical student on placement in general practice. Finn Corrigan, 21 days old, is still yellow and has come back for the results of tests taken yesterday.
Interpret the results provided
Outline to the examiner:
- Your findings
- Your most likely diagnosis and differentials
- You do not need to take a history or examine the baby
- You do not need to outline a management plan
- The examiner will ask you one question at the end
Birth and newborn screening
Born at 39 weeks by normal vaginal delivery; birth weight 3.3 kg. Vitamin K and hepatitis B vaccine given at birth. Newborn bloodspot screen on day 2: normal, no conditions detected.
Growth and feeding
Exclusively breastfed and feeding well. Weight 3.8 kg (25th centile).
GP notes, yesterday
Yellow since day 3; did not need phototherapy. At the 2-week check the child health nurse thought it was breast milk jaundice. Mother says the stool and urine changes have been present for about a week. Settled, no vomiting, no fever. No family history of liver disease.
GP examination, yesterday
Alert and well; skin and sclerae yellow. Liver edge firm, 3 cm below the right costal margin; spleen not felt. No bruising, no dysmorphic features, no murmur.
Liver bloods, collected yesterday (day 20)
Total bilirubin 180 umol/L (under 20). Conjugated bilirubin 95 umol/L (under 5). GGT 640 U/L (15 to 200). ALP 590 U/L (100 to 500). ALT 84 U/L (5 to 45). AST 118 U/L (20 to 80). Albumin 34 g/L (28 to 44). INR 1.1 (0.9 to 1.3).
Other bloods, collected yesterday
Haemoglobin 126 g/L (100 to 180). White cell count 10.4 x10^9/L (5.0 to 19.5). Platelets 365 x10^9/L (150 to 450). TSH 3.1 mIU/L (1.0 to 9.0).
Nappy check, this morning
Held against a stool colour chart: stool pale and putty-coloured, matching the palest shades (normal is yellow, mustard or green). Urine dark yellow, staining the nappy lining (normal is colourless or pale yellow).
Bloods (collected yesterday, day 20 of life)
| Item | Value | Reference range |
|---|---|---|
| Total bilirubin | 180 umol/L | <20 umol/L |
| Conjugated bilirubin | 95 umol/L | <5 umol/L |
| GGT | 640 U/L | 15-200 U/L |
| ALP | 590 U/L | 100-500 U/L |
| ALT | 84 U/L | 5-45 U/L |
| AST | 118 U/L | 20-80 U/L |
| Albumin | 34 g/L | 28-44 g/L |
| INR | 1.1 | 0.9-1.3 |
| Haemoglobin | 126 g/L | 100-180 g/L |
| White cell count | 10.4 x10^9/L | 5.0-19.5 x10^9/L |
| Platelets | 365 x10^9/L | 150-450 x10^9/L |
| TSH | 3.1 mIU/L | 1.0-9.0 mIU/L |
This morning's nappy, checked against a stool colour chart
| Item | Value | Reference range |
|---|---|---|
| Stool colour | Pale, putty-coloured; matches the palest shades on the chart | Yellow, mustard or green shades |
| Urine on the nappy | Dark yellow; stains the nappy lining | Colourless or pale yellow |