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NURS 2514 > Week 7 - Jaundice > Flashcards

Week 7 - Jaundice Flashcards

1
Q

what is jaundice

A
  • yellow discoloration to the skin & sclera of the eyes
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2
Q

what is another word for jaundice

A
  • icterus
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3
Q

what causes jaundice

A
  • elevated blood bilirubin ( can be unconjugated or conjugated)
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4
Q

what are the 3 types of jaundice

A
  • prehepatic
  • hepatic
  • posthepatic
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5
Q

what is prehepatic jaundice

A
  • jaundice caused by excessive RBC breakdown
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6
Q

list 4 common causes of prehepatic jaundice

A
  • hemolytic transfusion rxn
  • sickle cell anemia
  • autoimmune/acquired hemolysis
  • hemolytic disease of the newborn
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7
Q

what are the 4 characteristics of prehepatic jaundice

A
  • indirect (free) hyperbilirubinemia (high unconj. bilirubin)
  • no excess bilirubin in the urine
  • decreased Hct
  • normal colored stool
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8
Q

why do you get high lvls of uncong. bilirubin in prehepatic jaundice

A
  • the excessive death of RBC causes excessive breakdown Hgb
  • when Hgb is broken down, you get the formation of uncong. bilirubin
  • this large amt of uncong. bilirubin overwhelms the hepatocytes & they cannot work fast enough to conjugate all the bilirubin
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9
Q

why is there no excess bilirubin in the urine during prehepatic jaundice? how will the urine appear?

A
  • uncong. bilirubin is not water soluble = cannot go into the urine
  • therefore, not getting any extra bilirubin in the urine
    = amber urine
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10
Q

why do we have normal colored stools during prehepatic jaundice

A
  • during prehepatic jaundice, your conjugated bilirubin isn’t being effected = still get bilirubin to the intestine
  • bilirubin gives our stool its brown color
    = normal colored stool
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11
Q

what is hyperbilirubinemia in the newborn

A
  • by the 2nd or 3rd day of life, 60% of infants become jaundiced due to the natural breakdown fetal hgb and an immature liver that cannot handle all this uncong. bilirubin
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12
Q

how long does it take for hyperbilirubinemia to resolve in newborns

A

~ a week

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13
Q

how is hyperbilirubinemia of the newborn treated (3)

A
  • fluids
  • using bilitanks that utilize phototherapy
  • exchange transfusions
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14
Q

when is jaundice of the newborn serious

A
  • if it happens at birth or after 1 week or more
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15
Q

what can cause more serious types of newborn jaundice (5)

A
  • breast feeding
  • hemolytic disease (Rh+)
  • hypoxia
  • infection
  • albumin binding drugs
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16
Q

how can breast feeding cause newborn jaundice

A
  • if the milk contains an Ab that destroys RBC
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17
Q

what is hemolytic disease

A
  • when an Rh- mother carries an Rh+ fetus

= mother creates antibodies that attack’s the fetus’ blood cells

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18
Q

what is a potential consequence of hyperbilirubinema of the newborn

A
  • kernicterus

= brain damage r/t bilirubin

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19
Q

how does kernicterus occur?

A
  • bilirubin is v toxic to the - brain
    normally, bilirubin cannot cross the blood brain barrier
  • in newborns, the blood-brain barrier is weak & does not do a good job of keeping bilirubin out
20
Q

what is an exchange transfusion

A
  • removal of blood while that blood is replaced with donor blood
  • blood in to replace RBC
  • blood out to take out bilirubin
21
Q

what is hepatic jaundiceq

A
  • jaundice that involves problems with the liver, specifically the hepatocytes
    1. impaired uptake of bilirubin by the liver
    2. impaired conjugation of bilirubin
22
Q

what are the 2 most common causes of hepatic jaundice

A
  • hepatitis (inflammation or infection)

- cirrhosis

23
Q

how does hepatitis & cirrhosis cause hepatic jaundice

A
  • there is hepatocyte dysunfction r/t inflammation

= impaired conjugation & edema that interferes with bile secretion (intrahepatic cholestasis)

24
Q

what is hepatic jaundice characterized by (4)

A
  • uncong and cong hyperbilirubinemia
  • dark urine
  • N or pale stool
  • elevated liver-specific enzymes in blood
25
Q

why do we get both uncong and cong hyperbilirubinemia in hepatic jaundice

A
  • the increased uncong would be due to impaired conjugation

- increased cong due to edema, which would block bile secretion (intrahepatic cholestasis)

26
Q

why do we get dark urine in hepatic jaundice

A
  • due to the increased cong bilirubin (water soluble)
27
Q

why can we have either N or pale stool in hepatic jaundice

A
  • pale if edema causes blockage of bile secretion

- N if no swelling

28
Q

why do we have increased liver-specific enzymes in the blood during hepatic jaundice

A
  • liver damage & inflammation = hepatocytes lyse or become permeable = release of enzymes
29
Q

what genetic (inherited) disease can cause hepatic jaundice

A
  • Gilbert’s disease
30
Q

what is Gilbert’s disease

A
  • a genetic disease that results in diminished activity in the enzyme responsible for conjugating bilirubin
  • considered mostly harmless
31
Q

what does Gilbert’s disease cause and how does this contribute to hepatic jaundice

A

= slowed conjugation = slight elevation in unconjugated bilirubin

32
Q

what is posthepatic jaundice

A
  • jaundice that occurs when bile flow is obstructed at any point between the liver & duodenom
33
Q

describe how bile is excreted from the liver

A
  • bile gets conjugated and leaves the liver via the bile duct
  • it then goes to the gall bladder where it is stored
  • then, bile is excreted from the gall bladder into the small intestine
34
Q

what is bilirubin converted into in the intestine

A
  • urobilinogen

- stercobilin

35
Q

what is the fnxn stercobilin

A
  • gives stool its color
36
Q

what are 3 common causes of post hepatic jaundice

A
  • bile duct strictures
  • gall stones
  • tumors
37
Q

what is post hepatic jaundice characterized by (10)

A
  • elevated conj bilirubin
  • elevated or normal unconj bilirubin
  • elevated blood cholestrol
  • dark urine
  • pale feces
  • decreased urobilinogen & stercobilin
  • steatorrhea
  • accumulation of bile salts in the blood & depositing in the skin
  • vitamin K defic
  • elevated liver enzymes ( may or may not happen)
38
Q

why do we get elevated conjugated & unconj bilirubin in post hepatic jaundice

A
  • conj = due to backflow, can’t get rid of conj bilirubin in the
  • unconj = ???
39
Q

what is the function of urobilinogen

A
  • some reabsorbed back into portal circulation & returned liver
  • small amt released in urine
40
Q

why do we get dark colored urine in post hepatic jaundice

A
  • increased conjugated bilirubin

- since the bilirubin cannot leave the bile duct, it is excreted thru the kidneys instead (???)

41
Q

why do we get pale colored feces in post hepatic jaundice

A
  • due to decreased stercobilin
42
Q

why do we get steatorrhea in post hepatic jaundice

A
  • bile is responsible for emulsifying fat which allows fat to be absorbed
  • if fat cannot be emsulified, we wont absorb it & it is lost in the feces
43
Q

what does the depositing of bile salts in the skin during post hepatic jaundice cause

A
  • puritis
44
Q

why do we get vitamin K deficiency during post hepatic jaundice

A
  • it is a fat soluble vitamin

- therefore, no bile = cannot emsulfy & absorb

45
Q

what are types of fat soluble vitamins

A

A, D, E, K

46
Q

what does vitamin K deficiency cause

A

= decreased clotting factor production

= abnormal bleeding

NURS 2514 (75 decks)

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