The question was how do you decide that a 3week old baby has direct
hyperbilirubinemia or not?  I was bemoaning clinical skills deteriorating,
as the medical students say as a first choice "do blood".

The answer is

1. History of the case.  Direct bilirubin is water soluble and appears in
the urine, colouring it brown.

2. Physical examination. Most causes of direct hyperbilirubinemia will give
a large liver and spleen by the time the baby is visibly jaundiced.

Greenish colour?  Yes, but hardly a good sign to hang your hat on. Smell?
No idea.  Green tears? Maybe, never saw that.  Light stool?  Maybe, but most
baby stools look light to adult eyes.

Jack Newman, MD, FRCPC