JAUNDICE : REVIEW

Jaundice Disease with Causes, Treatment and Nursing Intervention

Definition of Jaundice:

Jaundice disease (also known as icterus) is a yellowish discoloration of the skin, conjunctival membranes over the sclera and other mucous membranes caused by elevated levels of bilirubin in the blood.

The normal level of bilirubin is below 1.2mg/dl. When the level of bilirubin exceeds more than 2.5-3mg/dl, it leads into jaundice.

 Jaundice – Causes:

The causes of the Jaundice are usually classified on based up the dysfunction of the normal metabolism or execration of bilirubin. The disruption in the metabolism of bilirubin can occur at various stages.

Jaundice disease

Depend upon the stages of dysfunction; the causes of Jaundice are divided into three ways-

Pre-Hepatic,Hepato cellular,Post Hepatic.

Those are described in the following:

1. Pre-Hepatic:

The pathology is occurring outside of liver. An infection or medical condition destruct the red blood cells sooner than usual and increased level of bilirubin such as-

Sick cell anemia,Malaria,Thalassaemia,Hereditary spherocytosis,Drugs or other toxins,Gilbert’s syndrome,Autoimmune disease,Hemolytic uremic syndrome,Glucose-6-Phosphate Dehydrogenase Deficiency (G6PD).

2. Hepato cellular:

The problems are mainly occurred in liver. When the liver is damaged, it losts function in the metabolism and/or excretion of bilirubin.

Acute or chronic hepatitis commonly viral (Hepatitis A, B, C, D, E)Alcoholic liver disease,Liver cirrhosis,Glandular fever,Paracetamol overdose or toxicity (Drug induced hepatitis),Crigler- najjar syndrome,Alcoholic fatty disease,Illegal drug use.

3. Post Hepatic:

The problem is located after the conjunction of bilirubin in the liver caused due to obstruction of biliary passage-

Gallbladder stones,Cancer in the gallbladder, pancreas or bill duct,Biliary atresia,Cholangiocarcinoma,Pancreatitis,Parasites (Like liver flukes),Cholestasis of pregnancy.Pancreatic pseudo cysts,Mirizzi’s syndrome.

Sign and Symptoms of Jaundice Disease:

There are different types of sign and symptoms for jaundice disease, those are mentioned in the below:

Yellow color of skin, sclera of eye and mucous membrane of mouth and nose,Dark colored urine,Skin itching,Nausea and vomiting,Pale colored stool,Fever and chills,Stomach pain,Weight loss,Loss of appetite,Diarrhea,Weakness,Confusion,Headache,Swelling of leg and abdomen.

Risk factors of Jaundice Disease:

There are various types of risk factors for jaundice disease, which are mentioned in the following:

Heavy consumption of alcohol,Pancreatitis,Hepatitis (B,C),Liver cirrhosis,Thalasemia,Hereditary spherocytosis.

Test and Diagnosis for Jaundice Disease:

There are different types of test and diagnosis for jaundice; those are mentioned in the following:

Liver function test,Complete blood test,Physical examination,Urinalysis,Electrolytes panel, conjugated or unconjugated bilirubin,USG of hepatobiliary system,CT Scan or MRI,ERCP (Endoscopic Retrograde Cholangio Pancreatography),Per-cutaneous Tans-hepatic Cholangiography,Liver biopsy.

Treatment for Jaundice Disease:

The treatment depends upon the underlying cause and how serious it is. If the main cause is diagnose, treatment can then be directed to particular condition.

Watchful waiting and home rest.For supportive treatment may need various medications such as painkiller, antibiotics, antiviral, steroids etc.Anti-emetic Medicine for controlling nausea or vomiting.IV fluids in cases of dehydration.Chemotherapy/ radiation therapy.If the cause is genetic such as- sickle cell anemia, a blood transfusion may be needed.If any drugs make toxicity, these must be discontinued.Surgical or various invasive procedures may need to treat Jaundice, such as Laparoscopic Cholecystectomy (Removal of gall bladder stones or bile duck blockage l), Liver transplant, Respectability of neoplastic causes of biliary obstruction.

Complication of Jaundice Disease:

There are different types of complication for jaundice disease; those are mentioned in the below:

Electrolytes imbalance,Anemia,Chronic hepatitis,Cancer,Bleeding,Liver failure,Acute bilirubin encephalopathy,Kernicterus,Kidney failure,Death.

Prevention of Jaundice Disease:

Various types of prevention ways for jaundice disease are described in the below:

Cessation of alcoholism (alcoholic hepatitis, cirrhosis, and pancreatitis).Maintain healthy weight and avoid extra buttery food and fast food.Having a healthy and balanced diet.Avoid coffee, tea, hot spices and red chilli.Avoid stress as much as possible.Avoid potentially road side and contaminated food/water and maintain good hygiene (hepatitis A).Take Vaccines against hepatitis (Hepatitis-A, Hepatitis-B).Aware details information about the country and take medications which prevent malaria before traveling to high-risk regions.Avoid illegal behaviors such as intravenous drug use or unprotected intercourse (Hepatitis-B).Avoid medications that can cause hemolysis in susceptible individuals (Such as-those with G6PD deficiency, a condition that leads to red blood cell breakdown after consumption of certain substances).Avoid medications and toxins which can cause hemolysis or directly damage the liver.

Nursing Intervention for Jaundice Disease:

There are different types of nursing interventions for jaundice disease; those are discussed in the following:

Assess s colour of skin, sclera of eye and mucous membrane of mouth and nose for every 8 hours.
Check for any signs for complication and notify to physician.
Check neurological status 8 hourly to identify complication of bilirubin encephalopathy.Check vital signs every 4 hourly.
Monitor intake output and check urine and stool colour.
Administer medication as order.Control of nausea and vomiting and administer anti-emetic drug as order.
Monitor direct and indirect bilirubin to evaluate treatment efficacy.
Provide healthy diet consult with dietician.Give mouth care to increase appetite and prevent vomiting and provide low fat diet.
Encourage patient to take plenty of fluid at least 6-8 glass daily.
Check weight daily to evaluate weight loss or gain.
Administer IV fluid if diarrhea present.Ensure proper rest and keep everything reaches to patient.
Keep skin clean and dry to prevent itching.
Provide health education to patient and patient party how to prevent jaundice.
Arrange vaccination programme and administer vaccine to patient as order.
Provide psychological support to patient and encourage patient express feeling.