Jaundice is caused by high levels of bilirubin in the blood and results in yellowing of the skin and eyes. It can be categorized as pre-hepatic, hepatic, or post-hepatic depending on where the underlying condition occurs. Pre-hepatic jaundice is caused by increased breakdown of red blood cells while hepatic jaundice results from liver damage and post-hepatic from bile duct blockage. Treatment depends on the type but may include phototherapy, medications, or procedures to relieve bile duct obstructions.

3. CONTENTS:-
DEFINITION
CLASSIFICATION
SYMPTOMS
CAUSES
DIET
TREATMENT
MANAGEMENT

4. Jaundice is a term used to describe a yellowish
tinge to the skin and the whites of the eye. Body
fluids may also be yellow.

5.  The color of the skin and whites of the eyes will vary depending
on levels of bilirubin.
 Moderate levels lead to a yellow color, while very high levels will
appear brown.
About 60 percent of all infants born in the United States have
jaundice.
 However, jaundice can happen to people of all ages and is
normally the result of an underlying condition.
 Jaundice normally indicates a problem with the liver or bile duct.

6. Risk factors:-
Acute inflammation of the liver: This may impair the ability of
the liver to conjugate and secrete bilirubin, resulting in a
buildup.
Inflammation of the bile duct: This can prevent the secretion
of bile and removal of bilirubin, causing jaundice.
Obstruction of the bile duct: This prevents the liver from
disposing of bilirubin.

7. Hemolytic anemia: The production of bilirubin
increases when large quantities of red blood cells are
broken down.
Gilbert's syndrome: This is an inherited condition that
impairs the ability of enzymes to process the excretion
of bile.
Cholestasis: This interrupts the flow of bile from the
liver. The bile containing conjugated bilirubin remains
in the liver instead of being excreted.

8. Common symptoms of jaundice include:
a yellow tinge to the skin and the whites
of the eyes, normally starting at the head
and spreading down the body
pale stools
dark urine
itchiness

9. Fatigue
•abdominal pain
•weight loss
•Vomiting
Fever
•pale stools
•dark urine
Accompanying symptoms of jaundice resulting from low bilirubin levels
include:

10. The level of bilirubin is defined in a blood test called a bilirubin test.
This measures unconjugated, or indirect, bilirubin levels. These are
responsible for the onset of jaundice.
Bilirubin levels are measured in milligrams per decilitre (mg/dL).
Adults and older children should have a level of between 0.3 and 0.6
mg/dL.Around 97 percent of infants born after 9 months of
pregnancy have levels lower than 13 mg/dL. If they show higher
levels than this, they are usually referred for further investigation.

12. Differential diagnosis

14. Pre-hepatic/
hemolytic
• The pathology is occurring prior to the liver due to
either:A. Intrinsic defects in RB cells B. Extrinsic
causes external to RB cells
Hepatic/
hepatocellular
• The pathology is located within the liver caused due
to disease of parenchymal cells of liver.
Post-Hepatic/
cholestatic
• The pathology is located after the conjugation of
bilirubin in the liver caused due to obstruction of
biliary passage.

16. Pre-hepatic jaundice
Pre-hepatic jaundice is caused by conditions that heighten your blood’s
rate of hemolysis. This is the process through which red blood cells are
broken down, releasing hemoglobin and converting into bilirubin.
Because the liver can only process so much bilirubin at once, bilirubin
overflows into bodily tissues.

17. The most common causes of pre-hepatic jaundice are:
malaria, a
blood
infection
caused by
a parasite
sickle cell
anemia, a
genetic
condition in
which red
blood cells
become
crescent-
shaped rather
than the typical
disc shape
spherocytosis, a
genetic
condition of the
red blood cell
membrane that
causes them to
be sphere-
shaped rather
than disc-
shaped
thalassemia, a
genetic condition
that causes your
body to make an
irregular type of
hemoglobin that
limits the
number of
healthy red
blood cells in
your
bloodstream

18. abdominal pain
fever, including chills or cold sweats
abnormal weight loss
feeling itchy
dark urine or pale stool
Common symptoms of pre-hepatic jaundice include:

19. Hepatic jaundice happens when the liver tissue is
scarred (known as cirrhosis), damaged, or
dysfunctional. This makes it less effective at filtering
out bilirubin from your blood.
Since it can’t be filtered into the digestive system for
removal, bilirubin builds up to high levels in your
blood.
Hepatic jaundice

20. 1.
• liver cirrhosis, which means that liver tissues are scarred by long-term exposure to
infections or toxic substances, such as high levels of alcohol
2.
• viral hepatitis, an inflammation of the liver caused by one of several viruses that can get
into your body through infected food, water, blood, stool, or sexual contact
3.
• primary biliary cirrhosis, which happens when bile ducts are damaged and can’t
process bile, causing it to build up in your liver and damage liver tissue
The most common causes of hepatic jaundice are:

21. 4.
• alcoholic hepatitis, in which your liver tissues are
scarred by the heavy, long-term drinking of alcohol
5.
• leptospirosis, is a bacterial infection that can be spread
by infected animals or infected animal urine or feces
6.
• liver cancer, in which cancerous cells develop and
multiply within liver tissues

22. loss of appetite
bloody nose
skin itching
weakness
abnormal weight loss
swelling of your abdomen or legs
dark urine or pale stool
pain in your muscles or joints
darkening skin
fever
feeling sick
throwing up
Common
symptoms
of hepatic
jaundice
include:

23. Post-hepatic, or obstructive jaundice,
happens when bilirubin can’t be drained
properly into the bile ducts or digestive
tract because of a blockage.
Post-hepatic jaundice

24. gallstones, hard calcium deposits in the gallbladder that can
block bile ducts
pancreatic cancer, the development and spread of cancer cells in
the pancreas, an organ that helps produce digestive substances
bile duct cancer, the development and spread of cancer cells in
your bile ducts
The most common causes of post-hepatic jaundice are:

25. biliary atresia, a genetic condition in which
patient having narrow or missing bile ducts
pancreatitis, an inflammation or infection of
the pancreas

26. feeling sick
throwing up
dark urine
or pale
stool
abdominal
pain
diarrhea
abnormal
weight loss
skin itching
Common symptoms of post-hepatic jaundice include:

27. being overweight
eating a high-fat, low-fiber
diet
having diabetes mellitus
having a family history of
gallstones
being female
Some risk factors for this type of jaundice include:
Aging
smoking tobacco products
drinking a lot of alcohol
having a previous pancreas
inflammation or infection
being exposed to industrial
chemicals

28. Neonatal jaundice
Neonatal jaundice is a common type of jaundice
that happens to newborn babies.
Most babies are born with a lot of red blood cells,
and because the liver isn’t fully developed yet,
bilirubin can’t be processed quickly. As a result,
child may have jaundice symptoms a few days
after they’re born.

29. Physiological. This happens because the
liver isn’t fully formed yet.
Prematurity. This results from a baby being
born too early and being unable to poop out
bilirubin properly.
Types of neonatal jaundice include:

30. Breastfeeding. Breast milk jaundice occurs from a baby
having trouble breastfeeding or not getting enough breast
milk.
Incompatible blood type. This results from a baby and
mother having different blood types, which can cause the
mother to make antibodies that break down her baby’s
red blood cells.

31. long periods of high-pitched crying
arching of their neck and back
Fever
throwing up
having trouble feeding
Seek emergency medical attention if you notice that your
child has any of the following symptoms:

32. Therapeutic approaches and managements
•Infusion of immunoglobulins is used as primary treatment for
pre-hepatic jaundice.
• Phototherapy is considered as an effective treatment of high
levels of bilirubin in pre-hepatic jaundice.
• Bilirubin rapidly decreases within two hours of onset of
phototherapy.
Pre-hepatic jaundice

33. • However the duration of therapy and the strength of
light treatment depend upon the severity of
hyperbilirubinemia.
•Metaloporphyrins are also considered as a treatment
possibility of pre-hepatic jaundice, because these
metaloporphyrins target the hemeoxygenase enzyme to
limit the production of bilirubin.

34. • Phototherapy - for neonatal jaundice.
• Phenobarbital can be used for treatment of neonatal
physiological jaundice however it is not frequently used due to
certain drawbacks involving somnolence and febrile seizures.
• Supportive therapy - fluids, rest, pain relief - for Hepatitis A.
• Abstinence from alcohol and cessation of medications
contributing to liver dysfunction.
Hepatic jaundice

35. • Steroids - for autoimmune hepatitis.
• Immunosuppressant - for autoimmune
hepatitis.
• Interferon - for chronic hepatitis B and C.
• Liver transplantation for fulminant hepatitis and
end stage liver failure.

36. Low fat diet should be given to patient suffering
from post-hepatic jaundice to minimize the
discomfort due to fat ingestion and diarrhea.
 The treatment of the post hepatic obstructive
jaundice is mechanical decompression however the
complications and other symptoms are also
necessarily treated.
Post hepatic jaundice

37. Decompression can be done by surgical bypass,
percutaneous insertion of stents, removal of lesions
and endoscopic insertion of stents.
 Dexchlorophenramine, Hydroxyzine,
Cholestyramine, Ursodeoxycholic acid and
Naltrexone are used as a therapeutic approach in
treatment and management of post hepatic
jaundice.