A 4-week-old exclusively breastfed boy is brought to the emergency department because he is still yellow. He f…

Question

A 4-week-old exclusively breastfed boy is brought to the emergency department because he is still yellow. He feeds hungrily and has gained 900 g since birth. His mother says his nappies stain the pad a dark orange and that over the past fortnight his stools have become the colour of putty. He is alert and afebrile, with a liver edge 2 cm below the costal margin. Total serum bilirubin is 190 micromol/L, of which 96 micromol/L is conjugated. Which one of the following is the most important step to…

Accepted Answer

Refer to a paediatric liver unit.

Answer

Arrange a hepatobiliary scintigraphy scan.

Answer

Arrange a percutaneous liver biopsy.

Answer

Arrange an abdominal ultrasound scan.

Answer

Request a serum alpha-1 antitrypsin phenotype.

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