(A) Right upper quadrant pain associated with progressive worsening of scleral icterus was the presenting complaint of this 10-year-old child with sickle.

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Presentation transcript:

(A) Right upper quadrant pain associated with progressive worsening of scleral icterus was the presenting complaint of this 10-year-old child with sickle cell disease. He had mild elevations of liver enzymes with a total bilirubin of 56 and direct bilirubin of 18 mg/dL. (B) It is useful to examine the urine. Conjugated bilirubin is water soluble and may result in tea colored urine; bilirubinuria implies an elevated serum level of conjugated bilirubin. Urinary urobilinogen is increased in hemolysis and is colorless, though oxidation of urobilinogen may produce urobilins, yellow-brown in color. The presence of bilirubinuria without urobilinogen suggests biliary obstruction. (Photo contributors: Haamid Chamdawala, MD [A] and Binita R. Shah, MD [B].) Source: Chapter 11. Hematology and Oncology, Atlas of Pediatric Emergency Medicine, 2e Citation: Shah BR, Lucchesi M, Amodio J, Silverberg M. Atlas of Pediatric Emergency Medicine, 2e; 2013 Available at: http://accessemergencymedicine.mhmedical.com/DownloadImage.aspx?image=/data/books/shah2/shah2_c011f013a.png&sec=42534563&BookID=577&ChapterSecID=42532497&imagename= Accessed: December 27, 2017 Copyright © 2017 McGraw-Hill Education. All rights reserved