CA - Jaundice (NOT TESTED) Flashcards
Whats jaundice?
yellow skin, mucous membranes & sclera due to deposition of bilirubin
What are the causes of jaundice?
hemolytic or prehepatic,
hepatocellular or intrahepatic,
and obstructive or posthepatic.
Whats Hemolytic, Hepatocellular & Obstructive jaundice?
Hemolytic jaundice
- hemolysis or breakdown of RBCs
- eg hemolytic anemia, sickle cell disease
hepatocellular jaundice
- conditions that damage the liver
- certain medications that may cause hepatotoxicity, such as acetaminophen or rifampin
- inherited disorders affecting liver function
Obstructive jaundice
- conditions that block the bile ducts, causing cholestasis / obstructed bile flow -> cant be excreted
What are the risk factors for jaundice?
- newborn and elderly clients
- hepatic disease
- alcohol use
- certain medications
- pregnancy
Whats the pathology of hemolytic jaundice?
- Excessive breakdown of RBCs -> release all their haemoglobin into the blood
- excess hemoglobin is degraded into unconjugated bilirubin
- but the large amount of bilirubin exceeds the liver’s ability to conjugate it.
- excess unconjugated bilirubin will start to build up in blood
Whats the pathology of hepatocellular jaundice?
- liver damage decreases its ability to conjugate the unconjugated bilirubin -> build up in blood
- liver damage impairs its ability to secrete the conjugated bile that’s produced into bile -> build-up of conjugated bilirubin in blood
Whats the pathology of obstructive jaundice?
- Caused by cholestasis -> causes bile build up in gallbladder
- The conjugated bilirubin in it leaks into the blood
- Regardless of the underlying cause -> excess bilirubin in blood can’t be processed and removed from the body
- Deposited in the skin, mucous membranes, and sclera
What are the clinical manifestations of jaundice?
- yellowish discoloration of the sclera -> skin & mucous membranes
- pruritus / itching
- In liver dysfunction (e.g., cholestasis, hepatitis, cirrhosis), bile cannot flow properly -> buildup of bile salts in blood -> deposited in skin -> irritates nerve endings & causes itching
Additional signs and symptoms vary depending on the underlying cause of jaundice:
What are the clinical manifestations of Hemolytic anaemia?
- fatigue
- hepatosplenomegaly
Splenomegaly
- spleen removes damaged RBCs -> in hemolysis, increased destruction of RBCs -> splenic congestion and hypertrophy -> splenomegaly
Hepatomegaly
- liver processes excess bilirubin from RBC breakdown
- Chronic hemolysis -> increased bilirubin deposition and iron overload -> hepatomegaly
What are the clinical manifestations of Hepatitis?
- fever
- muscle and joint pain
- Hepatitis (inflammation of the liver) -> liver cell swelling & congestion -> hepatomegaly
What are the clinical manifestations of Cirrhosis and liver failure?
- gynecomastia / breast tissue enlargement in clients assigned male at birth
- ascites / accumulation of fluid in the abdomen
- caput medusae or engorged veins in the abdomen, radiating from the umbilicus
- In cirrhosis, scar tissue replaces normal liver tissue, blocking normal blood flow through the liver -> portal hypertension -> blood diverts through smaller veins -> normally collapsed veins in adults become engorged -> caput medusae
What are the clinical manifestations of
Cholestasis?
- RUQ tenderness
- dark urine or pale stools
- Conjugated bilirubin is water-soluble and is excreted in urine when it cannot reach the intestines -> dark-colored urine
- bile pigments cant rch the intestines, stools lose their brown colour -> pale (clay-colored).
How do you diagnose jaundice? (5)
- blood tests
- revealing hyperbilirubinemia
- detect if bilirubin is unconjugated or conjugated
> CBC
- decreased RBC for pts with hemolytic causes
- blood smear can reveal appearance of the RBCs
- liver function tests
- albumin, PT, and PTT
- can be abnormal in clients with liver damage. - urinalysis
- presence of bilirubin in urine - CT scan, MRI, endoscopic retrograde cholangiopancreatography ERCP
- gallstones or cancer - liver biopsy
- to confirm hepatocellular causes
