Ochre
Gastrointestinal System
0
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/P17_F1.jpg"}},{"insert":"\n\n"},{"insert":"After a busy morning, it has been almost a relief to get back to the humdrum duties of your ward.\r\n\r\nSuddenly, your pager beeps. Apparently, you\u0027re wanted in the emergency room.\n"}]}
1
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/P17_F2.jpg"}},{"insert":"\n\n"},{"insert":"In the ER, you are escorted to 25-year-old Melanie and her 14-day-old baby Alyssa, both of whom you\u0027ve met earlier.\u00a0\r\n\r\nYou recall that Alyssa is Melanie\u0027s first child. She was delivered via an elective cesarean section at 39 weeks of gestation. The antenatal period was uncomplicated.\n"}]}
2
{"ops":[{"insert":"\u0022Hello Melanie, it\u0027s good to see you again. How are the two of you doing?\u0022 you say.\r\n\r\n\u0022We\u0027ve been fine doctor, but I\u0027m worried about Alyssa. I thought that she had a yellowish tinge to her skin a couple of days back, and now she\u0027s definitely yellow,\u0022 Melanie responds.\n"}]}
3
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/P17_F4.jpg"}},{"insert":"\n\n"},{"insert":"Alyssa has been asymptomatic otherwise. Both urination and bowel movements were normal, and she has not been lethargic or drowsy. Currently, Melanie breastfeeds her around 10 times a day.\r\n\r\nYou ask Melanie if she is on any medications or herbal supplements, to which the answer is \u0022no\u0022. You also ascertain that she is currently on a normal diet.\r\n\r\nYou then ask her to undress Alyssa for the examination, while you flip through the relevant medical records.\n"}]}
4
{"ops":[{"insert":"Alyssa is of mixed African-American and East-Asian ancestry. Her birth weight was 3600 grams and Apgar score was 9\/10. All neonatal examinations were completely normal.\r\n\r\nBreastfeeding was commenced on the day of birth itself. She was discharged home on the third postnatal day, once her mother had fully recovered from the cesarean section.\r\n\r\nYou note that Alyssa\u0027s blood group is AB+, while Melanie\u0027s blood group is B+.\n"}]}
5
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/P17_F6.jpg"}},{"insert":"\n\n"},{"insert":"Alyssa\u0027s weight is 3800 grams now.\r\n\r\nDuring the examination, you note a yellowish discoloration of Alyssa\u0027s face, chest, abdomen, and upper thighs. The anterior fontanelle is not sunken. Capillary refill time is \u003C3 seconds. There is no hepatomegaly or splenomegaly. No other untoward signs are present.\n"}]}
6
{"ops":[{"insert":"what will you do now?\n"}]}
1. Reassure Melanie and send Alyssa home
2. Order a workup of the jaundice; keep Alyssa until results are available
3. Order a workup of the jaundice; admit Alyssa and start phototherapy in parallel
8
{"ops":{"insert":"\n"}}
10
{"ops":{"insert":"\n"}}
9
{"ops":{"insert":"\n"}}
7
{"ops":{"insert":"\n"}}
