Endocrine System

{"ops":[{"insert":"Diagnosis and reasoning"},{"insert":"\n","attributes":{"header":1}},{"insert":"Neonatal jaundice is extremely common, and very often, physiological in origin. However, it may also herald the presence of severe pathology - thus a careful examination should be performed in all patients.\n\nExamination of this neonate shows one sign out of the ordinary - the presence of abnormally wide fontanelles. This alone is sufficient to encourage further evaluation (note that the liver is usually palpable at this age - thus the 1 cm subcostal expanse is not significant).\n\nAt this point, estimation of serum bilirubin levels is the investigation of greatest value. This will allow determination of whether the jaundice is direct or indirect, significantly narrowing down the differential diagnosis.\n\nIn this patient, the direct bilirubin f"}]}

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