A 4-Week-Old Boy Is Brought to the Office for a Routine

A 4-week-old boy is brought to the office for a routine well-baby visit.  The boy has been exclusively breastfeeding every 2-3 hours and is making 6 or 7 wet diapers a day.  His urine has appeared dark yellow, and he has had a few pale-colored stools.  His parents also noticed that his skin has appeared yellow for the past 2 weeks, but they were not concerned as they heard from friends that yellow skin is common with breastfeeding.  The patient was born full term without complications by vaginal delivery to a primigravida.  On physical examination, he is well-appearing with icteric sclerae and jaundice of the head and upper chest.  Abdominal examination reveals a mildly enlarged and firm liver.  Liver function results are as follows: Which of the following is the most likely mechanism for the patient's presentation?

A) Extrahepatic obstruction of bile ducts
B) Genetic mutation causing reduced glucuronidation
C) Impaired galactose metabolism
D) Increased enterohepatic circulation of bilirubin
E) Maternal antibody-mediated red blood cell destruction

Correct Answer:

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