COLLEGE OF NURSING AND MIDWIFERY KANO

SCHOOL OF NURSING KANO

GROUP ONE (1) MALE SITE

COURSE : G. I. T. DISORDER'S PRESENTATION

TOPIC : JAUNDICE

TUTOR : MALAM ALIYU LABARAN KAURAN MATA

JAUNDICE

INTRODUCTION

BILURUBIN

Bilirubin (formerly referred to as haematoidin) is the yellow breakdown product of normal heme
catabolism, caused by the body's clearance of aged red blood cells which contain hemoglobin.[1]

Bilirubin is excreted in bile and urine, and elevated levels may indicate certain diseases. It is
responsible for the yellow color of bruises and the yellow discoloration in jaundice. It is also
responsible for the brown color of feces, via its conversion to stercobilin, and the background straw-
yellow color of urine via its breakdown product, urobilin.

It has also been found in plants

JAUNDICE :

When the bilirubin concentration in the blood is abnormally elevated, all the body tissues, including
the sclerae

and the skin, become tinged yellow or greenish-yellow, a

condition called jaundice. Jaundice becomes clinically evident when the serum bilirubin level exceeds
2.5 mg/dL (43

fmol/L). Increased serum bilirubin levels and jaundice may

result from impairment of hepatic uptake, conjugation of

bilirubin, or excretion of bilirubin into the biliary system.

There are several types of jaundice: hemolytic, hepatocellular, and obstructive jaundice, and jaundice
due to hereditary

hyperbilirubinemia. Hepatocellular and obstructive jaundice are the two types commonly associated
with liver disease

DEFINITION

This is the yellowish discoloration of the skin of sclerae and other mucus membrane as a result of
increase core of bilirubin bilurubin concentration in the blood greater than 1.5g /dl

CLASSIFICATION

1. Pre- hepatic jaundice

2. Hepatic jaundice 3. Post hepatic jaundice

1. PRE- HEPATIC JAUNDICE

DEF: is a the type of jaundice occur due to increase hemolysis of the red blood cell, which result in
production of excess bilurubin.

It is also known as hemolytic jaundice

It occur outside of the liver i.e before the bilurubin concentration reaching the liver

It is cause by malaria, sickle cell disease

S/S

It has long duration with revision and exercabation

Spleenomegaly

Hepatomegaly

2. HEPATIC JAUNDICE

Also known as hepato cellular jaundice.

It's a type of jaundice in which the liver fail to clear the amount of bilirubin from the blood

It is cause by :

Hepatitis virus

Epstin bar virus

Yellow fever virus

Certain medications such as aminoglycoside

Chemical toxins eg alcohol, tetrachloride and chloroform

3. POST HEPATIC JAUNDICE

Post-hepatic jaundice, also called obstructive jaundice, is caused by an interruption to the drainage of
bile containing conjugated bilirubin in the biliary system.

The most common causes are gallstones in the common bile duct, and pancreatic cancer in the head
of the pancreas.

Also, a group of parasites known as "liver flukes" can live in the common bile duct, causing obstructive
jaundice.

S/S

- pruritis

- dark urine due the present of increase amount of bilirubin

- pale feaces due to the absence of stercobilin

PATHOPHYSIOLOGY

Jaundice itself is not a disease, but rather a sign of one of many possible underlying pathological
processes that occur at some point along the normal physiological pathway of the metabolism of
bilirubin in blood.

When red blood cells have completed their life span of approximately 120 days, or when they are
damaged, their membranes become fragile and prone to rupture.

Cellular contents, including hemoglobin, are subsequently released into the blood.

The hemoglobin is phagocytosed by macrophages, and split into its heme and globin portions. The
globin portion, a protein, is degraded into amino acids and plays no role in jaundice.

Two reactions then take place with the heme molecule. The first oxidation reaction is catalyzed by the
microsomal enzyme heme oxygenase and results in biliverdin (green color pigment), iron and carbon
monoxide.
The next step is the reduction of biliverdin to a yellow color tetrapyrol pigment called bilirubin by
cytosolic enzyme biliverdin reductase.

This bilirubin is "unconjugated," "free" or "indirect" bilirubin. Approximately 4 mg of bilirubin per kg

of blood is produced each day.

The majority of this bilirubin comes from the breakdown of heme from expired red blood cells in the
process just described

However approximately 20 percent comes from other heme sources, including ineffective
erythropoiesis, and the breakdown of other heme-containing proteins, such as muscle myoglobin and
cytochromes