CASE PRESENTATION OF JAUNDICE INCLUDES PATIENT DEMOGRAPHICS, PAST MEDICAL AND MEDICATION HISTORY, FAMILY HISTORY, SURGICAL HISTORY, PERSONAL HISTORY, ON EXAMINATION, LABORATORY INVESTIGATIONS, DIAGNOSIS, SOAP NOTES, TREATMENT, DISEASE INFORMATION, PATIENT COUNSELLING, LIFE STYLE MODIFICATIONS.

1. CASE PRESENTATION
ON
JAUNDICE
Presented By :
M . DurgaRohitha
174T1T0005
Pharm D VI Year

2. PATIENT DETAILS
A male patient with 51 years of age was admitted in the general Medical Ward with chief
complaints –
 Fever with chills since 1 day
 Swollen foot, after one day a black patch and water bubbles are appeared
 Vomtings since 1 day
HISTORY OF PRESENT ILLNESS:
 Vomtings with food particles is seen
 Fever and chills are observed with on & off
 Edema is pitting type
 Decreased fluid and food intake
 Decreased sleep from past 1 day
 Yellowish colour of eyes are seen

3. PAST MEDICAL HISTORY
• Known case of Hypertension since 12 years and using Bisoprolol Fumerate 5mg
• Known case of Diabetes Mellitus since 1 year and using Metformin Hydrochloride
Prolonged-Release And Glimepiride Tablets 1mg.
FAMILY HISTORY
Diabetes Mellitus – present to his father
SURGICAL THERAPY
Nill significant
PERSONAL HISTORY
Habits – smoking ; -
alcoholic ; -
Food ; VEG
Appetite & sleep – Decreased
Bowel & Bladder - Normal

4. ON EXAMINATION
VITALS OBSERVED VALUE NORMAL VALUE
Temperature 99.6 F 98.6 F
Pulse rate 78bpm 72bpm
SPO2 95% 98%
BP 120/80mm of Hg 120/90mm of Hg
pallor -- -
Icterus + -
Edema
extremities
+ pitting type
Edema seen in lower right
foot
-

5. LABORATORY EXAMINATIONS
PARAMETERS OBSERVED VALUES NORMAL VALUES
Hemoglobin 10.4 gm/dl 13 – 16 gm/dl
RBC 4.5 m/cumm 4.75 – 6.0 m/cumm
Packed cell volume 35.8 % 38 – 50 %
MCV 79.2 fl 74 – 95 fl
MCH 22.6 Pg 27 – 32 Pg
MCHC 28.8 gm/dl 31.8 – 36.3 gm/dl
Platelet count 1,39,000cells/cumm 1.4 – 4.5lakh cells/cumm
ESR 15mm/hr 0 – 10mm/hr
Total Leucocyte count 21,200/cumm 4000 – 10,000/cumm
Conjugated Bilirubin 0.6 mg/dl 0.0 – 0.2 mg/dl
Unconjugated Bilirubin 2.4 mg/dl 0.2 – 0.8 mg/dl
Total Bilirubin 3.0 mg/dl 0.2 – 1.0 mg/dl

6. FBS 76 mg/dl 70 – 110 mg/dl
PPBS 92 mg/dl 80 – 150 mg/dl
URINE ANALYSIS ;
Appearance Turbid
Colour Red
pus cells + -
Epithelial cells + -
RBC + -
Continued….,
Serology Report:
Specimen: Serum for salmonella Typhi antibody screening test
Result: salmonella Typhi “0” 1:160dil,
salmonella “H” 1:160dil,
salmonella paratyphi “AH” 1:20dil
salmonella paratyphi “BH” 1:20 dil
Normal range is upto 1: 80dil.

7. DIAGNOSIS
By observing chief complaints and laboratory investigations the patient was
diagnosed to have CELLULITIS WITH JAUNDICE

8. SOAP NOTES
SUBJECTIVE ;
 Fever with chills since 1 day
 Swollen foot, after one day a black patch and water bubbles are appeared
 Vomiting's since 1 day
OBJECTIVE ;
• Vomiting's with food particles
• Fever on and off
• Edema is pitting type
• Hemoglobin : 10.4 gm/dl
• ESR : 15
• Unconjugated bilirubin : 2.4 mg/dl
• Total bilirubin : 3.0 mg/dl
• Urine Analysis – color ; red
pus cells ; +
Epithelial cells ; +
RBCs ; +

9. ASSESSMENT
JAUNDICE

10. PLAN
BRAND
NAME
GENERIC
NAME
DOSE ROA FREQ DAYS OF
TMT
Ursokem T.Ursodeoxy
cholic acid
300mg oral BD 5 days
Pacimol T.
Paracetomol
650mg oral TID 5 days
Rantac T. Ranitidine 40mg oral OD 3 days
Zerodol - SP Aceclofenac 325mg oral BD 4 days
Megazolid Linezolid 300ml IV BD 4 days
Metrogyl Metronidazol
e
100ml IV BD 4 days
Periset Ondansetron 4mg IV OD 4 days

11. DEFINITION
Jaundice is also called as a hyperbilirubinemia. It is a yellow discoloration of the body tissue
resulting from the accumulation of an excess of bilirubin.
 Excess of bilirubin indicates increased production or impaired excretion.
 Normal serum bilirubin ; 1.2 mg/dl.
 Further increase in serum bilirubin levels , skin will progressively discolour ranging from
lemon yellow to apple green especially if the process is long standing the green colour is due
to bilirubin.
 Bilirubin contains unconjugated bilirubin ( Indirect )
conjugated bilirubin ( Direct ).
ETIOLOGY
1. CONJUGATED HYPERBILIRUBINEMIA
• Dubin Johnson syndrome
• Rotor syndrome
• Hepatocellular disease – viral hepatitis, alcoholic hepatitis, cirrhosis, Wilson autoimmune
disease
• Infiltrative disease – Amyloidosis, lymphoma, sarcoidosis.
• TPN
• Drugs and toxins – oral contraceptives, rifampicin, probenecid, steroids, chlorpromazine,
herbal medications.
DISEASE INFORMATION

12. 2. BILIARY OBSTRUCTION
• Choledocholithiasis
• Tumors
• Acute and chronic pancreatitis
• Parasitic infections ( Ascaris )
3. UNCONJUGATED
• Hemolytic anemia – Gilbert syndrome
• Crigler – Najjar syndrome
SIGNS AND SYMPTOMS
Common signs and symptoms seen in individuals with jaundice include :
 Yellow discoloration of *Abdominal pain
The skin *Fever
Mucous membranes *Weakness
The whites of the eyes *Loss of appetite
 Light – colored stools *headache
 Dark-colored urine
 Itching of the skin
 Nausea & vomiting

14. TYPES
1. Prehepatic ;
o Arising from the blood, before it enters the liver
o Excess production of bilirubin due to excess breakdown of hemoglobin
o Indirect bilirubin ( insoluble in water since unconjugated)
2. Intrahepatic ;
o Due to disease of liver parenchyma
o Liver ability to conjugate or excrete bilirubin is affected
o Increased level of conjugated and unconjugated bilirubin present.
3. Post hepatic ;
o Result of obstruction of biliary tract outside the liver.
o Bilirubin formation rate is normal

15. DIAGNOSIS
 Physical Examination
 Complete blood count
 Bilirubin tests
 Hepatitis A,B & C tests – This tests for a range of liver infections.

16. TREATMENT
 Goals
 The goal of treating jaundice is to efficiently and safely reduce the level of bilirubin.
 Minimizing development or severity of associated complications
 NON pharmacological therapy
 Drink at least eight glasses of fluids per day .
 Consider adding milk thistle to your routine .
 Eat at least 2 & 1/2 cups of veggies and 2 cups of fruit per day.
 Look for high-fiber foods, such as oatmeal, berries, and almonds.
 Pharmacological therapy
 Jaundice treatment targets the cause rather than the jaundice symptoms
The following treatments are used
 Anemia-induced jaundice may be treated by boosting the amount of iron in the blood by either
taking iron supplements or eating more iron-rich foods.
 Hepatitis-induced jaundice requires antiviral ( Acyclovir) or steroid medications (
methylprednisolone , prednisolone)
 Obstruction-induced jaundice by surgically removing the obstruction.
 If the jaundice has been caused by use of the medication, treatment involves changing to an
alternative medications.

17.  Ursodeoxycholic acid is mainly given for jaundice and it is a hepatoprotectant.
 Paracetomol is mainly given to reduce body temperature
 Ranitidine is mainly neutralizes the acid secretion in stomach.
 Aceclofenac is given mainly for the pain of punchered cellulitis.
 Linizolide is an antibiotic.
 Metronidazole is a antibacterial agent.
 Ondansetron is to reduce / stop vomtings.

18. CRITICAL EVALUATION
• Clinical condition : Jaundice with cellulitis
• Drug of choice : Ursodesoxycholic acid
• Drugs : All are appropriate
• Doses : All are appropriate
• Dosage form : All are appropriate
• Frequency : All are appropriate
• Duration : All are appropriate
• Guidelines : clinicalestablishments.gov.in
• Drug interactions ; no drug interactions

19. PATIENT COUNSELLING
Drink 6 – 8 glasses of water per day
Eat lots of vegetables like leafy vegetables
Liquid (Juices)intake is necessary for speed recovery.
Do not dink coffee, alcohol , soda and other junk food
and drinks.
Brown rice and millets are good.
Avoid red meet and animal fats.
Get sleep and do some exercise for health( walking for
digestion).
And take medicines as Doctor suggests as regular.

20. Reference
https://WWW.ncbi.nlm.nih.gov/books/NBK544252/