Pediatric Annals

Firm Rounds 

A 10-month-old Boy with Jaundice and Abdominal Pain

Robert Listernick, MD

  • Pediatric Annals. 2007;36(6)
  • Posted June 1, 2007

Abstract

This 10-month-old boy was admitted to the hospital for evaluation of jaundice and abdominal pain. He was in his usual state of good health until three weeks prior to admission when his mother noted the development of bilateral cervical adenopathy. Over the ensuing two weeks, he developed increasing irritability and vague abdominal pain. One week prior to admission, his mother noted that his eyes turned yellow. On review of systems, he had decreased appetite for the past two weeks and had been constipated. He had been drinking only cow’s milk recently, and his solid food intake had decreased. There was no history of vomiting, diarrhea, or other symptoms; there were no recent sick contacts. The past medical history, birth history, and family history were unremarkable.

Key Learning Points

  1. An elevated direct bilirubin and alkaline phosphatase are indicative of an obstructive process.
  2. Young children who have hepatitis A usually develop a mild gastroenteritis with anicteric hepatitis. Adults are more likely to develop severe transaminase elevation, jaundice, and occasionally liver failure.
  3. The classic triad of presenting symptoms of a choledochal cyst is jaundice, right upper quadrant pain, and an abdominal mass.
  4. Choledochal cysts may be associated with malignancy, including adenocarcinoma and cholangiocarcinoma.

ABOUT THE AUTHOR

Dr. Listernick is professor of pediatrics at Feinberg School of Medicine, Northwestern University, and director of the Diagnostic and Consultation Service, Division of General Academic Pediatrics, Children’s Memorial Hospital, Chicago, IL.

Abstract

This 10-month-old boy was admitted to the hospital for evaluation of jaundice and abdominal pain. He was in his usual state of good health until three weeks prior to admission when his mother noted the development of bilateral cervical adenopathy. Over the ensuing two weeks, he developed increasing irritability and vague abdominal pain. One week prior to admission, his mother noted that his eyes turned yellow. On review of systems, he had decreased appetite for the past two weeks and had been constipated. He had been drinking only cow’s milk recently, and his solid food intake had decreased. There was no history of vomiting, diarrhea, or other symptoms; there were no recent sick contacts. The past medical history, birth history, and family history were unremarkable.

Key Learning Points

  1. An elevated direct bilirubin and alkaline phosphatase are indicative of an obstructive process.
  2. Young children who have hepatitis A usually develop a mild gastroenteritis with anicteric hepatitis. Adults are more likely to develop severe transaminase elevation, jaundice, and occasionally liver failure.
  3. The classic triad of presenting symptoms of a choledochal cyst is jaundice, right upper quadrant pain, and an abdominal mass.
  4. Choledochal cysts may be associated with malignancy, including adenocarcinoma and cholangiocarcinoma.

ABOUT THE AUTHOR

Dr. Listernick is professor of pediatrics at Feinberg School of Medicine, Northwestern University, and director of the Diagnostic and Consultation Service, Division of General Academic Pediatrics, Children’s Memorial Hospital, Chicago, IL.

This 10-month-old boy was admitted to the hospital for evaluation of jaundice and abdominal pain. He was in his usual state of good health until three weeks prior to admission when his mother noted the development of bilateral cervical adenopathy. Over the ensuing two weeks, he developed increasing irritability and vague abdominal pain. One week prior to admission, his mother noted that his eyes turned yellow. On review of systems, he had decreased appetite for the past two weeks and had been constipated. He had been drinking only cow’s milk recently, and his solid food intake had decreased. There was no history of vomiting, diarrhea, or other symptoms; there were no recent sick contacts. The past medical history, birth history, and family history were unremarkable.

Key Learning Points

  1. An elevated direct bilirubin and alkaline phosphatase are indicative of an obstructive process.
  2. Young children who have hepatitis A usually develop a mild gastroenteritis with anicteric hepatitis. Adults are more likely to develop severe transaminase elevation, jaundice, and occasionally liver failure.
  3. The classic triad of presenting symptoms of a choledochal cyst is jaundice, right upper quadrant pain, and an abdominal mass.
  4. Choledochal cysts may be associated with malignancy, including adenocarcinoma and cholangiocarcinoma.

ABOUT THE AUTHOR

Dr. Listernick is professor of pediatrics at Feinberg School of Medicine, Northwestern University, and director of the Diagnostic and Consultation Service, Division of General Academic Pediatrics, Children’s Memorial Hospital, Chicago, IL.

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