Catanduanes State University

COLLEGE OF HEALTH SCIENCES

Department Of Nursing
Virac, Catanduanes

Case Presentation
(Bleeding Biliary
Atresia)
Submitted by:
Jhosua F. Paytan
Dan Albert T. Timajo
Jelly E. Eustaquio
Claudine C. Villamor
RLP-BSN 4A

Submitted to:
Prof Janet B. Lim
I. Introduction
 Background of the Study
 Significance of the Study
 Scope and Limitation
 Goal
 Objectives
 Overview of the Disease
 Signs and Symptoms
 Anatomy of the Affected System
 Physiology of the Affected System

Background of the Study

Biliary Atresia is a rare disorder who about one of 15,000 to
20,000 infants do not have complete bile ducts. This disorder seems to
affect a majority of girls more than boys. In this case, in the same family,
only one child will be positive or in a pair of twin one child only will be
affected.
 Experts say that babies with biliary atresia do not have the chance
to release the liquid bile and it is in the liver alone. Since the liquid is
inside only it destroys the liver cells causing cirrhosis. The liquid will
damage the whole liver and will result in having scars.

Frequently affected by this disorder are more Asian and African-

American than Caucasian race

We chose to study further about this disease because:

 It was the students’ first encounter with this kind of disease
especially during the whole duration of having their RLE
experience in the Pediatric Ward.

Significance of the Study

This case study is essential primarily to the following:
 Patients with the same condition
 Nursing students
 Other professional Health Care providers

Scope and Limitation

The subject of this case study is a single individual only, not a
group of people with bleeding biliary atresia.

All of the information gathered and used here are individualized

and may not be the same for all patients with the same condition.

The interventions included in the nursing care plan were also

limited as to the client’s signs and symptoms and availability of
equipment at the institution wherein the client is admitted.

Goal
To generate an organized and effective nursing care plan for the
management of clients with bleeding biliary atresia.

Through its implementation, the client will be free from unwanted

signs and symptoms, prevent further complications, and achieve an
optimal level of health and well-being.

Objectives
This case study has the following objectives:
 To provide an in-depth study regarding to bleeding biliary
atresia considering the entire disease process,
pathophysiology, signs and symptoms and anatomy and
physiology of involved body system.
 To come up a relevant nursing diagnosis that is suitable for
the client’s condition and presenting manifestations.
  To assist the client towards relief of signs and symptoms,
prevention of complications, and especially to achieve
quality of life.

Overview of the Disease

Biliary atresia is a serious liver disorder that occurs before or

shortly after birth when a baby's bile ducts (the tubes that carry bile
from the liver) become blocked. The body needs bile to aid digestion and
carry wastes from the liver out of the body. When blocked ducts
prevent bile from being excreted, the liver becomes damaged.

Signs and Symptoms

Frequently, the first sign of Biliary Atresia is having a yellowing
of skin and white part of the eyes which called jaundice. Jaundice is a
situation where excessive bilirubin in your blood that results in
becoming yellow of skins color and white part of the eyes. Many
possible types of disorder jaundice can be and not only biliary atresia
disease.

Often babies develop jaundice in the first two weeks after birth.
In this case, Biliary atresia is very difficult to identify with newborn
babies. And since jaundice is a sign not only for Biliary Atresia disorder.

Other signs of jaundice are a darkening of the urine and a

lightening in the color of bowel movements. The urine darkens from the
high levels of bilirubin in the blood spilling over into the urine, while
stool lightens from a lack of bilirubin reaching the intestines. Pale,
grey, or white bowel movements after 2 weeks of age are clear signs of
a liver problem.

Anatomy of the Affected System

The liver, the largest organ in the body, is located on the right
side of the abdomen, underneath the ribs and diaphragm and on top of
the stomach, right kidney and intestines. It is reddish-brown, weighs
about 1½ to 2 pounds in a child (depending on age), and holds about 13
percent of the body's blood supply at any given moment. It receives
oxygenated blood from the hepatic artery and nutrient-rich blood from
the hepatic portal vein.

The liver has two main lobes, both of which are made up of
thousands of lobules. These lobules are connected to small ducts,
which connect with larger ducts to ultimately form the hepatic duct.
The hepatic duct transports bile produced by the liver cells to the
gallbladder and duodenum (the first part of the small intestine).

Physiology of the Affected System

One of the liver's primary functions is to filter the blood of
toxins and other harmful substances, which are then excreted into bile
or blood. Bile byproducts enter the intestine and leave the body in the
feces; the kidneys filter out the blood byproducts, which leave the body
in urine.

The liver carries out many other important jobs, including:

 Converting food into chemicals necessary for life and
growth.
 Making the proteins needed for normal blood clotting.
 Processing medications we take into forms the body can use.
 Manufacturing bile, which helps the body digest and absorb
fat, vitamins A, D, E and K, and medications. Bile is stored in
the gallbladder and released into the intestines as needed.
 Producing cholesterol and special proteins to help carry
fats through the body.
 Converting excess glucose (sugar) into glycogen for
storage; this glycogen can later be converted back to
glucose for energy.
 Regulating the level of amino acids, which form the building
blocks of proteins, in the blood.
 Resisting infections by producing immune factors and
removing bacteria from the bloodstream.
 Bile is the nasty greenish-brown liquid which helps for digestive
process and excreted by the liver cells and preserved in the
gallbladder. This discharged liquid is composed of cholesterol, bile
salts, and other waste or bad compounds.

II. Demographic Data

Name: Baby Girl G
Address: Capilihan, Virac, Catanduanes
Age: 1 y/o
Birthday: August 30, 2016
Civil Status: Child
Sex: Female
Religion: Catholic
Nationality: Filipino
Admission Diagnosis: Bleeding Biliary Atresia
Final Diagnosis: Bleeding Biliary Atresia
Data Admitted: July 02, 2018 / 04:30 AM
Attending Physician: Cecile A. Zuniega, M.D.

Admission Diagnosis: Biliary Atresia

Final Diagnosis: Upper G.I. Bleeding sec to Portal Hypertension sec to
Biliary Atresia
Data Admitted: July 27, 2018 / 12:30 PM
Attending Physician: Jenevy T. Lizaso, M.D.

III. Nursing Health History

Past Health History
Patient’s mother claimed that “Di pa nagka ibang hilang si Baby Girl
G bukod sa Biliary Atresia.”

Present Health History

Few days PTA, patient had several episodes of vomiting of blood.
Her mother further stated that “Nangluluya buda dai gakaon ning
marinas kaya dinala na sa hospital para ipaadmit.”

Chief Complaint
Severe vomiting of blood
Family Health History
Mother stated that “Dai man ning hilang na alog kaini sa pamilya
nimi maski man sa pamilya ning agom ko. Siya lang talaga ang inot na nagka
igwa ning alog kaining hilang samo.”

IV. Activities of Daily Living

V. Physical Assessment

General Appearance
Vital Signs

Measurements

Affected Body Area

VI. Laboratory Results

Hematology (July 02, 2018)

Hematology (August 01, 2018)

VII. Nursing Care Plan

 Breathing Pattern related to an increase in abdominal distension

Hyperthermia related to progressive inflammation due to damaged

extrahepatic biliary duct

Deficient fluid volume related to nausea and vomiting

Imbalanced Nutrition: less than body requirements related to anorexia

and impaired absorption of fat

Risk for Infection related to inadequate secondary defences

VIII. Drug Study

Ranitidine (July 02, 2018) / (July 27, 2018)

Tranexamic Acid (July 02, 2018)

Vit K (July 27, 2018)

Phenobarbital (July 27, 2018)

Zinc Sulfate syrup (July 27, 2018)

Metoclopramide (July 27, 2018)

Paracetamol (July 27, 2018)

Cefuroxime (July 27, 2018)

Furosemide (July 30, 2018)

IX. Medical Management

X. Discharge Plan
M – Medication to take
 Emphasize the importance of adhering to the prescribed
therapeutic regimen.
 Explain the action, how to take the medication, possible side
effects, management of such side effects and adverse
reactions that needs to be reported immediately.

E – Exercise
 Advise to maintain a healthy and normal weight.

T – Treatment
 Advised on supportive treatments depending on the
manifestations.

H – Health Teachings
 Health teachings with emphasis on child’s body and oral
hygiene, nutritious diet, exercise and environmental
sanitation.

O – Out patient follow-up

  Instructed the mother to return to the Out Patient
Department one week after discharge, specifying the date
and time.


D – Diet
 BF with SAP
 No iron intake and avoid fresh fruits as indicated by the
physician.

XI. Conclusion
As the result of this study, the following conclusions were
drawn:
 Biliary atresia is a condition in infants in which the bile
ducts outside and inside the liver are scarred and blocked.
 Early surgical intervention to treat biliary atresia is
critical to prevent irreversible liver damage.