assignement

1. 1
HARAMAYA UNIVERSITY
COLLEGE OF HEALTH AND MEDICAL SCIENCE
DEPARTMENT OF PEDIATRIC AND CHILD HEALTH NURSING
PATHOPHYSIOLOGY COURSE
Assignment presentation on: Jaundice
Presenter: ARAFAD AWIL NOUR
Moderator: Dr. ADDISU

2. Outline
Objective
Introduction
Types of Jaundice
Risk factors
Causes
Pathophysiology
Clinical features
Diagnosis
Reference
2

3. Objectives
At the end of this session the students should be able:
 To define jaundice
 To explain the pathophysiology of jaundice
 To understand types of jaundice
 Identify the risk factors of jaundice
 To understand diagnoses of jaundice
 To understand neonatal jaundice and its related conditions.
 To understand management and prevention of jaundice
3

4. 4

5. Introduction
 Jaundice is a medical condition characterized by a yellowish discoloration in the
skin, sclera, and mucous membranes.
 It is caused by an increase in the concentration of bilirubin in the bloodstream.
 In a clinically, the detection of this condition typically occurs when the plasma
bilirubin level exceeds 50 µmol/L, approximately equivalent to 3 mg/dL.
 It is important to note that jaundice itself is not a disease, but rather an
indication of underlying medical conditions.
.
5

6. important Terms related to bilirubin
• Bilirubin is a yellowish molecule formed by the breakdown of
hemoglobin.
• Hyperbilirubinemia refers to an increase in the concentration of bilirubin
in the blood plasma.
• Hyperbilirubinemia can present itself in two forms:
• Unconjugated hyperbilirubinemia, also known as indirect acting
hyperbilirubinemia, is the most common type
• .Conjugated hyperbilirubinemia, or direct acting hyperbilirubinemia..
6

7. Pathophysiology of jaundice
7
 Jaundice occurs as a result of increased levels of bilirubin in the bloodstream.
 Bilirubin is the normal breakdown of product from the catabolism of heme and thus
is formed from the destruction of red blood cells.
 Under normal circumstances, bilirubin undergoes conjugation within liver, making it
water soluble.
 It is then excreted via the bile into the GI tract especially in the intestines. then
bilirubin is broken down into urobilinogen and stercobilinogen, excreted in feces.
Some urobilinogen is reabsorbed and excreted in urine.
 Jaundice occurs when this pathway is disrupted.

8. 8
Bilirubin Metabolism

9. Types of jaundice
9
• Jaundice is classified into three categories, depending on
which part of the physiological mechanism, the pathology
affects.

10. Three types of jaundice
prehepatic/hemolytic: The pathology occurs prior to hepatic
metabolism, resulting from the rupture of red blood cells.
Hepatic/hepatocellular: The pathology is caused by the dysfunction
of hepatic parenchymal cells.
Post hepatic/cholestatic: The pathology manifests after the
conjugation of bilirubin in the liver, due to the obstruction of the
biliary tract and/or reduced bilirubin excretion.
10

11. 11
Prehepatic jaundice is most commonly caused by a
pathological increased breakdown of red blood cell
(erythrocyte) or hemolysis.
There is excessive red cell breakdown which overwhelms the
liver’s ability to conjugate bilirubin.
This causes an unconjugated hyperbilirubinemia.
Prehepatic/hemolytic

12. Causes of pre-hepatic jaundice
Sickle cell disease
Malaria
Thalassemia
 Autoimmune disorders e.g. primary biliary cholangitis.
Blood transfusion reactions and etc.
12

13. Cont.………

14. 14
Dysfunction of the hepatic cells to metabolize bilirubin.
The major causes of hepatic jaundice are significant damage to
hepatocytes due to infectious, drug/medication-induced,
autoimmune etiology, or less commonly, due to inheritable
genetic diseases.
Hepatic jaundice

15. Causes of hepatic jaundice
Liver cirrhosis
Viral hepatitis
Alcoholic liver disease
Drugs like isoniazid, rifampicin and etc.
15

16. Post hepatic(Obstructive ) jaundice
16
Post hepatic jaundice (obstructive jaundice), is caused by a
blockage of bile ducts that transport bile containing conjugated
bilirubin out of the liver for excretion.
Choledocholithiasis (common bile duct gallstones) is the most
common cause of obstructive jaundice.

17. Causes of post-hepatic jaundice
17
Gallstones
Pancreatic cancer
Bile duct cancer
congenital malformation and etc.

18. 18

19. Signs and symptoms
The most commonly associated symptoms of jaundice are:
 Itchiness,
 Pale feces and dark urine
 Yellowish discoloration of skin, sclera and mucous membrane.
 Fever
 Fatigue
 Vomiting
 Weight loss
 Abdominal pain
 confusion and etc.
19

20. Risk factors
The development of jaundice can be influenced by risk factors
such as
viral hepatitis
 alcohol consumption
non-alcoholic fatty liver disease
 blood incompatibility
 bruising during childbirth,
Breast feeding
20

21. Diagnostic evaluation
The health care provider will perform history taking and physical
examination.
Bilirubin blood test will be done.
Increase conjugated serum bilirubin values (>0.4 mg/100 ml)
Increase unconjugated serum bilirubin values (>0.8 mg/100 ml)
Absence of bilirubin in urine.
21

22. CONT……
• Other tests will vary, but may include
Hepatitis virus panel to look for infection of liver.
Liver function test to determine how the liver is working.
Complete blood test to determine how well liver is working.
Liver biopsy.
Cholesterol level test.
Prolonged prothrombin time.
22

23. Jaundice in newborn
Jaundice in the newborn can be clinically detected when the levels
of serum bilirubin exceed 85 micro mol/L.
This is observed in approximately 60% of term infants and 80% of
preterm infants.
 The first signs of neonatal jaundice are seen on the face and
forehead, and then gradually spread to the trunk and extremities..
23

24. Signs and symptoms of neonatal jaundice
 Newborns, as the bilirubin level rises, jaundice will typically progress from the head
to the trunk, and then to the hands and feet.
 Additional signs and symptoms that may be seen in the newborn include:
 Poor feeding
 Lethargy
 Changes in muscle tone
 High-pitched crying
 Seizures
24

25. Breast milk jaundice
 Breast milk jaundice is postulated to result from the infant's underdeveloped
hepatic and intestinal systems, thereby causing a slowed down elimination
process.
 The act of breastfeeding provides the infant with both nourishment and
hydration.
 The provision of hydration works to decrease the levels of bilirubin in the infant's
physiology.
 Considering this, the failure to breastfeed may trigger the onset of jaundice.
25

26. treatment of jaundice
• The treatment course depends on the cause of the underlying disease,
resulting in the development of jaundice and any associated complications.
Once a diagnosis is made, the treatment can be tailored to address the
specific condition, which may require hospitalization.
• In some cases, medical intervention such as intravenous fluids,
medications, antibiotics, and blood transfusions may be necessary as
prescribed.
• If the cause is a drug or toxin, stopping its use immediately is crucial.
• For neonatal jaundice, phototherapy or blood transfusions may be
necessary to reduce bilirubin levels.
• In cases of obstructive jaundice, surgery may be necessary.
26

27. Prevention of jaundice
• Due to wide range of potential causes, it is not possible to prevent all cases
of jaundice. However, there are four main precautions that you can take to
minimize your risk of developing jaundice. They are:
 Ensure that you stick to the recommended daily amount {RDA} for alcohol
consumption
 Maintaining your health body weight.
 If appropriate, ensuring that you are vaccinated against hepatitis A or B
infection, vaccination would usually be recommended depending on where
in the world you are travelling.
 Minimizing your risk of exposure Hepatitis C because there is currently no
vaccine for this condition.
27

28. References
• Fanaroff and Martine, Neonatal and Perinatal Medicine. 9th edition Page
1443.
• Manual of Neonatology 6th edition.
• Reisman Y, Gips CH, Lavelle SM, Wilson JH. Clinical presentation of jaundice
project in the Netherlands. United Dutch Hospitals and Euricterus Project
Management Group. Hepatogastroenterology 1996; 43:1190.
• Up-to-date version 24.1(Update:2018)
28

29. Cont……..
• Mesele Bezabeh et. al, Lecture note, General pathology for health science
students, University of Gondar,2005
• Robbins and Cotran, Basic.Pathology.8th.Ed
• Tim D. Spector, John S. Axford; An introduction to General pathology, 4th
Ed., 1999
• Goljan, Edward F.,Author.-Rapid Review pathology,5th.Ed (2019).
• Robbins Basic pathology (2020).
• Neonatal Intensive Care Unit (NICU) Training Management Protocol, 2014
29

30. 30