JAUNDICE-.ppt_Biochemistry for nursing students

Infant jaundice is yellow discoloration of a newborn baby's skin and eyes. Infant jaundice occurs because the baby's blood contains an excess of bilirubin (bil-ih-ROO-bin), a yellow pigment of red blood cells.

1. JAUNDICE
By,
Mr. Abhijit Bhoyar

2. SPECIFIC OBJECTIVES :-
At the end of class student will be able to-
•Define jaundice.
•Enumerate classification .
•Describe causes.
•Describe diagnostic evaluation.
•List lab investigation of jaundice.

3. INTRODUCTION
•Jaundice is yellowish discoloration of the skin, sclera and
mucous membranes due to hyperbilirubinemia and
deposition of bile pigments.
• It is usually detectable clinically, when the plasma
bilirubin exceeds 50µmol/L(̴3mg/dL) •
•Jaundice is not a disease, but rather a sign that can occur
in many different diseases. 

4. DEFINITION
•A condition in which the skin and the whites of the eyes
become yellow, urine darkens, and the color of stool
becomes lighter than normal. Jaundice occurs when the
liver is not working properly or when a bile duct is
blocked.
•Clinical marker of defect in metabolism /or
excretion of bilirubin.
•Yellow discoloration of sclera, skin, mucous
membranes due to deposition of bile pigment

5. Classification of jaundice

6. 1. Hemolytic jaundice
•This condition is associated with increased hemolysis of
erythrocytes (e.g. incompatible blood transfusion,
malaria, sickle-cell anemia).
•This results in the overproduction of bilirubin beyond
the ability of the liver to conjugate and excrete the same.
• liver possesses a large capacity to conjugate about 3.0 g
of bilirubin per day against the normal bilirubin
production of 0.3 g/day

7. 2. Hepatic jaundice
•Hepatic (hepatocellular) jaundice : This type of jaundice
is caused by dysfunction of the liver due to damage to
the parenchymal cells.
•This may be attributed to viral infection (viral hepatitis),
poisons and toxins (chloroform, carbon tetrachloride,
phosphorus etc.) cirrhosis of liver, cardiac failure etc.
Among these, viral hepatitis is the most common.

8. 3.Obstructive (regurgitation) jaundice
•Obstructive (regurgitation) jaundice : This is due to an
obtruction in the bile duct that prevents the passage of
bile into the intestine. The obstruction may be caused by
gall stones, tumors etc. Due to the blockage in bile duct,
the conjugated bilirubin from the liver enters the
circulation.
•Obstructive jaundice is characterized by Increased
concentration of conjugated bilirubin in serum.

9. Bilirubin
•The breakdown product of Hgb from injured RBCs
and other heme containing proteins.
•Produced by reticuloendothelial system
•Released to plasma bound to albumin
•Hepatocytes conjugate it and extrete through bile
channels into small intestine.

10. Causes of bilirubin

11. Unconjugated vs. Conjugated
•Unconjugated
• production exceeds ability of liver to
conjugate
•Ex. Hemolytic anemias, hemoglobinopathies,
in-born errors of metabolism & transfusion.
•Conjugated
•Can produce but not excrete
•Metabolic defect
•Intra- or extrahepatic obstruction

12. Clinical Features
•Careful history and PE
•Family history (Gilbert, Rotor, Crigler-Najjar,Dubin Johnson,
Sickle Cell)
•Healthy young person with fever, malaise,
myalgias viral hepatitis (try to locate source
•radually develops symptoms hepatic/bile duct
obstruction (consider ETOH liver dz/cirrhosis)
•Develops acutely with abd pain acute
cholangitis 2 to choledocholithiasis

13. •Painless jaundice in older person with epigastric
mass weight loss biliary obstruction from
malignancy
•Hepatomegaly with pedal edema, JVD, and gallop
CHF

14. Laboratory Tests

15. Disposition
•Hemodynamically stable, new-onset jaundice, no
evidence of liver failure or acute biliary
obstruction ?
•discharge with follow up
•If one of above violated ? admission with surgery
consult

16. Causes jaundice
•Acute inflammation of the liver 
•Inflammation of the bile duct - may prevent the secretion
of bile and removal of bilirubin, causing jaundice.
•Obstruction of the bile duct - prevents the liver from
disposing of bilirubin, which results in hyperbilirubinemia.
•Hemolytic anemia - Production of bilirubin increases when
large quantities of erythrocytes are broken down.

17. Diseases or conditions that can
cause jaundice include:
•Internal bleeding (hemorrhage)
•An infection in your baby's blood (sepsis)
•Other viral or bacterial infections
•An incompatibility between the mother's blood and the baby's
blood

18. •An enzyme deficiency
•An abnormality of your baby's red blood cells that causes
them to break down rapidly
•A liver malfunction
•Biliary atresia, a condition in which the baby's bile ducts are
blocked or scarred

19. Risk factors
•Premature birth.
•Significant bruising during birth
•Breast-feeding.

20. Complications
•Acute bilirubin encephalopathy
•Kernicterus

21. Treatment
•Enhanced nutrition. To
prevent weight loss, your doctor
may
recommend more-frequent feeding or
supplementation
to ensure that your baby receives
adequate
nutrition.
•Phototherapy
•Intravenous immunoglobulin (IVIg). 
•Exchange transfusion.

22. Expected Question
•Essay /Situation Question
•Discuss about jaundice classification
•Short question
•Describe the bilirubin ,causes laboratory test

23. THANK YOU