Adult Medical- Surgical Nursing Gastro-intestinal Module: Jaundice
Jaundice Jaundice is a yellow discoloration of the skin and sclera from reabsorption of bile into the circulation → excessive serum bilirubin (may be accompanied by dark, foamy urine, pale stool, itching skin) The excessive total bilirubin may be: Direct (water-soluble, conjugated) or Indirect (fat-soluble, unconjugated) related to the cause of the jaundice
Jaundice: Classification There are 3 classifications of jaundice: Obstructive (extra-hepatic or intra- hepatic) Haemolytic Hepatocellular
Obstructive Jaundice Extra-hepatic: occlusion of the common bile duct by a gall-stone, inflammation, tumour (obstruction may be from within or without the duct) Intra-hepatic: obstruction of bile flow in the canaliculi (cholestasis within the liver) caused by inflammation (oedema and exudate) from: Hepatitis Toxicity (drugs or alcohol)
Haemolytic Jaundice The liver is healthy but unable to cope with the amount of bilirubin from excessive haemolysis (mainly unconjugated bilirubin) Haemolytic disease of the newborn (ABO, Rhesus incompatibility) Haemolytic disorders (haemoglobinopathy, G6PD deficiency) Blood transfusion reaction
Hepatocellular Jaundice Jaundice of liver disease → failure: The damaged hepatocytes cannot clear normal amounts of bilirubin Cell damage, necrosis, mutation and cirrhosis from: Infection (acute and chronic hepatitis) Toxicity of drugs/ alcohol Prolonged obstruction of bile → cell damage develops
Jaundice: Diagnosis of Cause History and clinical picture Abdominal Xray, liver scan (gall stones) Liver biopsy (cirrhosis, cancer, chronic hepatitis to assess cell damage) Serum bilirubin: (total, direct, indirect) LFT, plasma proteins, serum ammonium PT, PTT, INR Antigen/ antibody markers if viral hepatitis
Jaundice: Treatment Jaundice is a clinical manifestation of an underlying problem. Treatment addresses this problem: Hepatitis Cirrhosis Liver cancer Obstruction of bile flow by: Gall stones or tumour
Jaundice: Nursing Considerations Relief of itching with skin lotions and antihistamine medication Dietary education: a low-fat, high glucose, high protein diet with increased high calorie drinks Monitor and teach patient to note bleeding tendency Vitamin supplements, B complex, K