1. Adult Medical- Surgical Nursing Gastro-intestinal Module: Jaundice

2. 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

3. Jaundice: Classification  There are 3 classifications of jaundice:  Obstructive (extra-hepatic or intra- hepatic)  Haemolytic  Hepatocellular

4. 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)

5. 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

6. 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

7. 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

8. 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

9. 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