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JAUNDICE
Introduction
What is Jaundice?
A yellow discolouration of the skin, sclera and mucous membrane
due to an increase in the serum bilirubin level. This becomes
clinically evident when serum bilirubin reaches about
80-100 mol/l.

It is sometimes called icterus from a greek word for the condition.

when red blood cells break down naturally in a 120 day cycle,
bilirubin is produnced as a waste by-product.

Jaundice frequently indicates a problem with the liver or bile ducts.

When the liver is not working properly, it can cause a waste
material called bilirubin to build up in the blood.
 Continuation..
• With moderate bilirubin levels, a person’s skin, eyes, and
mucous membranes can turn yellow. As it progresses, the
color can also change from yellow to green. The green color
occurs due to Trusted Source biliverdin, the green pigment
present in bile.
 Jaundice can develop in people of all ages and is normally the
result of an underlying condition. Newborns and older adults
have the highest likelihood Trusted Source of developing
jaundice
 Causes of jaundice
• When red blood cells break down naturally in a 120-day cycle
• Bilirubin is produced as a waste by-product
• The liver filters waste out from the blood
• When bilirubin reaches the liver, other chemicals attach to it.
A substance called conjugated bilirubin results
• The liver produces bile, a digestive juice
• Conjugated bilirubin enters the bile then it leaves the body. It
is this type of bilirubin that gives feaces its brown colour
• If there is too much bilirubin , it can leak into the surrounding
tissues. This is known as hyperbilirubimmia and it causes the
yellow color in the skin and eyes
Types of jaundice
 Physiological jaundice
 Pathological jaundice
Physiological jaundice usually
Peaks 48-72hours
Disappears by 1 week
Does not present before 24 hours.
Incidence:
• Preterm infants – 80%
• 30 – 50 % of term infants in first week of life
 Predisposing factors to physiological jaundice

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

The skin on the baby's the abdomen, arms or legs looks yellow
•The whites of the baby's eyes look yellow
•The baby seems restless or sick or is difficult to awaken
•The baby isn't gaining weight or is feeding poorly
•The baby makes high-pitched cries
 Aetiology of Physiological Jaundice
• Hb in neonate =18-19g/dl and in adult =11-14g/dl
• Breakdown of excess RBCs (Haemoglobin is a constituent of
RBC) 
• Hb broken into:
(i) globin - a protein that is conserved and utilised
(ii) haem - cannot be used
•  degraded and excreted
• Bilirubin is a product of this degradation
• It causes yellow staining of the tissues
 Physiological Factors Associated with Physiological Jaundice
1) Hb level is higher than required
2) RBC have shorter life
3) Hepatic Immaturity
- reduced glucuronyl transferase activity
- reduced active uptake of UB
- reduced intracellular transport system
- reduced active secretion of CB
- large enterohepatic circulation of bilirubin to add to
the load of UB in the hepatocyte
Other Factors That Can Contribute To
Physiological Jaundice

Drugs eg antibiotics (penicillin)

Bruises
Caput
Cephalhaematoma
Hypoxia /asphyxia

Hypoglycaemia

Hypothermia
 Pathological jaundice

• Sometime jaundice maybe due to other underlying conditions

like hypothyroidism, liver disease ( hepatitis).
• However, jaundice can be considered pathological when
presents within 24hours of birth, which suggest serious illness
or blood incompatibility
Types of pathological jaundice
• Pre-hepatic; here there's excess production of bilirubin that
overtakes the ability of liver to conjugate and excrete into the
gut. This is predominantly unconjugated hyperbilirubinemia.
The most common cause of prehepatic jaundice is hemolytic
anemia
• Hemolytic jaundice:
• This occurs when there is excessive red blood cell breakdown
called haemolysis. Usually, there is a perfect balance between
the breakdown of existing red blood cells and the
manufacturing of new red blood cells. If for some reason the
breakdown is more than the manufacturing, the liver is not
able to remove the excess amount of bilirubin. A classic
example is Malaria, where the parasites live within red blood
cells and finally kill them.
• The new red blood cells are not formed in time to take the
place of the old ones. Therefore, people with malaria have a
high risk of contracting jaundice
 continuation
• The new red blood cells are not formed in time to take the
place of the old ones. Therefore, people with malaria have a
high risk of contracting jaundice.
• Hepatic jaundice; here there is dysfunction of the hepatic
cells. The liver loses the ability to conjugate bilirubin, but
incases where it also become cirrhotic, it compresses the inta-
hepatic portions of the biliary tree to cause a degree of
obstruction.
• Post hepatic jaundice/ obstructive; there is an impediment to
the flow of bile due to partial or complete obstruction of the
extrahepatic biliary passage between the liver and the
duodenum due to biliary cholangitis, gall stone etc.
Obstruction can occur within the biliary duct themselves or
more distal within the pancreas
 Risk factors include

Some possible underlying conditions and causes of jaundice

include:
•side effects of certain medications
•Gallstone disease
•excessive alcohol consumption
•gallbladder or pancreatic cancer
•cirrhosis, which is a disease that causes scar tissue to replace
healthy tissue in the liver
•hepatitis or other liver infections
•hemolytic anemia
 Signs and symptoms of jaundice
The severity of the signs and symptoms depends on the underlying
cause and how quickly or slowly the disease develops.
These include;
•Skin , white of the eyes and mucous membranes turn yellow because
of the high levels of bilirubin and a yellow -orange pigment
•Dark colored urine due to blockage of bilirubin from being eliminated
in stool causing more to be eliminated in urine
•Pale stool due to failure of bile pigments to pass into the intestine
•Nausea and vomiting
•Itching of the skin when there is build up of bile salts in the blood due
to blockage of bile ducts and failure of the liver to work properly.
 Signs and symptoms continuation

• Abdominal pain if the jaundice is caused by pancreatic or

biliary tract cancers
• Fever especially when the jaundice is caused by infections
leading to excessive plasm bilirubin
• Swelling of the lower limbs due to compression of the hepatic
vein and inferior vena cover by the bile duct causing
congestion.
• The underlying disease process may result in additional signs
and symptoms, these may include; abdominal pain, fevers,
weakness, loss of appetite and headache, confusion, swelling
of the legs and abdomen
 Diagnosis of jaundice
• History of the patient
• Physical examination to diagnose jaundice and confirm
bilirubin levels, close attention to the abdomen, feel for tumors
and check the firmness of the liver, Bruising of the skin,
Spider angiomas (abnormal collection of blood vessels near
the surface of the skin), Palmar erythema (red coloration of the
palms and fingertips).
• Clinical history of mother/family, history of labor/ birth
trauma, blood group, feeding pattern, infection and G6PD.
• History of Drugs, Serum bilirubin ? conjugated/unconjugated
(Icterometer), Hb and Reticulocyte count ( raised levels in
cases of haemolysis) 
 Diagnosis continuation
Lab tests to help determine the underlying cause of jaundice include:
• Liver functioning test to find out whether the liver is functioning
well
• Bilirubin test; a high level of unconjugated compared to levels of
conjugated bilirubin suggest hemolytic jaundice
• Full blood count; this measures levels of red blood cells, white
blood cells and platelets
• Hepatitis A, B, and C tests. This tests for a range of liver
infections
• Examination of the structure of the liver if suspect an obstruction
may include MRI, CT and ultrasound scans
• Also carry out an endoscopic retrograde
cholangiopancreatography(ERCP) this is a procedure combining
endoscopy and x-ray imaging
Continuation..

•Liver biopsy can check for inflammation, cirrhosis, cancer,

and fatty liver.
•In addition, they may carry out an endoscopic retrograde
cholangiopancreatography (ERCP). This is a procedure
combining endoscopy and X-ray imaging
 Treatment/ management
It will depend on the underlying cause, jaundice treatment
targets the cause rather than the jaundice symptoms. The
following treatments are used;
•Hepatocellular jaundice is treated with anti-viral medications
and steroids
•Hemolytic jaundice is treated with iron supplements
•Obstructive jaundice is treated with surgery to remove the
obstruction followed by medication
•There is also medication induced jaundice, in other words,
jaundice which occurs as a side effect to consuming certain
medicines. In such cases the medicines are discontinued and
alternative medicines are prescribed
•As jaundice may sometimes indicate damage to the liver, a
liver transplant may be necessary in some cases, depending on
the severity of the injury.
 Treatment/ management of
jaundice
• Fluid-loss of fluids will cause bilirubin level to rise
• phototherapy for babies with physiological jaundice- baby lie
under lights with little clothing so their skin is exposed to the
rays.
• exchange blood transfusion- slowly removing the patient
blood and replacing it with the fresh donor blood/ plasma.
• Intravenous immunoglobin
• Jaundice can lead to itching, or pruritis. A warm baths
containing oatmeal and take antihistamines for mild pruritis.
• A healthcare professional may prescribe medications for those
experiencing moderate to severe pruritis, such as
cholestyramine or colestipol
 Treatment contin….
For infants with jaundice the treatments include:
•Phototherapy
•Blood transfusion
Care includes;
•Early feeding/ Nutrition/ Hydration
•Increase frequency of breast feeding
•Neutral thermal environment
•Prevent hypoglycaemia and hypoxia
•Avoid constipation
continuation
• Feeding
• SBR levels- invasive!! (? icterometer)
• - pain
• - infection
• Phototherapy
• - to maintain levels below 340 mmols/l
• (others argue 500mmol/l)
 Complications of jaundice
• Brain damage caused by high levels of bilirubin(bilirubin encephalopathy).
• The underlying conditions causing jaundice can also lead to their own
complications. These may include;
• Infections - Flatulence
• abdominal bloating - Diarrhoea
• swelling of legs - Constipation
• liver failiure
• kidney failure
• Bleeding
• anemia
• stomach pain
References
Al-Alaiyan (1996) Fiberoptic, conventional and combination phototherapy
for treatment of nonhaemolytic hyperbilirubinemia in neonates
http://www.kfshrc.edu.sa/annals/166/96-036.html Date accessed 20/10/2000
Blackburn (1995) Hyperbilinemia & Neonatal Jaundice. Neonatal
Network (October) 14: 7 15
Coe L (1999) Pathology & physiology of neonatal jaundice BJM April
p 240-243
College of Family Physicians of Canada (1999) Approach to the
management of hyperbilirubinemia in term newborn infants paeditrics &
Child Health 4(2); 161-164
http://www.cps.ca/english/statements/FN/fn98-02.htm date accessed 20/10/00
Hey (1995) Phototherapy: fresh light on a murky subject.Midirs
Midwifery Digest (Sept ) 5:3; 256-
Hey (1995)Neonatal jaundice-how much do we really know? Midirs
Midwifery Digest (March) 5: 1;4-
Robertson (1993) Neonatal jaundice. Mechanisms & diagnosis.
Modern Midwife. Sept/Oct: p28