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    Jaundice Presentation

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    mbishara2010
    This document defines jaundice and hyperbilirubinemia as an excessive level of bilirubin in the blood characterized by yellowing of the skin. It differentiates between physiological and pathological jaundice. The most dangerous complication is kernicterus, where unconjugated bilirubin deposits in the brain. Causes of high bilirubin include excessive production or impaired processing and excretion by the liver. Treatment depends on severity but may include increased feeding, phototherapy, or exchange transfusion in severe cases.

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    Jaundice Presentation

    Uploaded by

    mbishara2010
    308 views33 pages
    This document defines jaundice and hyperbilirubinemia as an excessive level of bilirubin in the blood characterized by yellowing of the skin. It differentiates between physiological and pathological jaundice. The most dangerous complication is kernicterus, where unconjugated bilirubin deposits in the brain. Causes of high bilirubin include excessive production or impaired processing and excretion by the liver. Treatment depends on severity but may include increased feeding, phototherapy, or exchange transfusion in severe cases.

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    This document defines jaundice and hyperbilirubinemia as an excessive level of bilirubin in the blood characterized by yellowing of the skin. It differentiates between physiological and pathological jaundice. The most dangerous complication is kernicterus, where unconjugated bilirubin deposits in the brain. Causes of high bilirubin include excessive production or impaired processing and excretion by the liver. Treatment depends on severity but may include increased feeding, phototherapy, or exchange transfusion in severe cases.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    308 views33 pages

    Jaundice Presentation

    Uploaded by

    mbishara2010
    This document defines jaundice and hyperbilirubinemia as an excessive level of bilirubin in the blood characterized by yellowing of the skin. It differentiates between physiological and pathological jaundice. The most dangerous complication is kernicterus, where unconjugated bilirubin deposits in the brain. Causes of high bilirubin include excessive production or impaired processing and excretion by the liver. Treatment depends on severity but may include increased feeding, phototherapy, or exchange transfusion in severe cases.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 33

    JAUNDICE

    By Bish

    Objectives
    Define hyperbilirubinemia (Jaundice). Differentiate between physiological and

    pathological jaundice. State causes of hyperbilirubinemia. Describe the most dangerous complication of hyperbilirubinemia. Discuss the management of hyperbilirubinemia

    Definition: Hyperbilirubinemia
    Hyperbilirubinemia:
    excessive level bilirubin in the blood characterized by jaundice, a yellowish
    Typically seen at bili levels of: 85-120

    discoloration of the skin, sclerae, mucous membranes and nails

    Unconjugated bilirubin = Indirect

    bilirubin. Conjugated bilirubin = Direct bilirubin.

    Why am I learning this?


    Is it important?

    Why?
    Jaundice is quite common Full term infants: at least 60% Preterm infants: over 80%

    Most Importantly

    Most Importantly
    Kernicterus: unconjugated bilirubin deposits in the brain yellow staining + degenerative lesions Phase 1: decreased alertness Hypotonia Poor feeding

    Phase 2: Hypertonia,
    Retrocollis, opisthotonus Phase 3: Hypotonia

    Source Of Bilirubin
    85% from old RBC , the rest

    from non haem proteins Hb is degraded to Haem and Globin Iron is extracted from Haem Rest is converted to bilirubin Bilirubin travels to liver bound to albumin

    Journey through the liver


    Bilirubin taken up Conjugated to form water soluble conjugate Conjugate secreted into bile

    In The Gut
    Bilirubin diglucuronide may be
    Deconjugated or Metabolised by bacteria to urobilinogen

    partially reabsorbed (remainder makes the stool brown)

    So where can things go wrong?

    Pathophysiology Of Jaundice
    Hyperbilirubinemia is due to: Excess bilirubin production

    Haemolytic Impaired uptake by hepatocyte Hep/cellular. Failure of Conjugation Hep/cellular. Impaired secretion of conj.bil. Hep/cellular. Impaired bile flow. Obst.Jaundice

    Classifications

    Classifications
    Physiological Jaundice Pathological Jaundice

    Physiological jaundice :
    1. General state of baby is well 2. Appears 2-3days 3. Disappears <2 week (term infants) <4 weeks (preterm infants)
    Pathophysiology increased hematocrit and decreased RBC lifespan immature glucuronyl transferase enzyme system

    (slow conjugation of bilirubin) increased enterohepatic circulation

    Pathological Jaundice
    1. Appears earlier (first 24 hours of life) 2. Fades >2 weeks (term infants) >4 weeks (preterm infants)

    Back to our table..lets break things down into basics..

    Hint

    Good Job!

    Now that youre a pro..


    Youre called by a nurse for a new admission

    regarding a baby with elevated bili..what do you want to know

    Approach to jaundiced baby


    Get age of baby (hours), gestational age,

    pregnancy hx, septic risk factors, complications with delivery Assess clinical condition (well or ill) Decide whether jaundice is physiological or pathological Look for evidence of kernicterus* in deeply jaundiced NB
    *review..what do you look for?

    Approach to jaundiced baby


    Get age of baby (hours), gestational age,

    pregnancy hx, septic risk factors, complications with delivery Assess clinical condition (well or ill) Decide whether jaundice is physiological or pathological Look for evidence of kernicterus* in deeply jaundiced NB
    *Lethargy and poor feeding, poor or absent Moro's, opisthotonus or convulsions

    Why does the age (hours) of baby matter?

    Causes of jaundice
    Appearing within 24 hours of age Hemolytic disease of NB : Rh, ABO Infections: TORCH, malaria, bacterial Appearing between 24-72 hours of life Physiological G6PD deficiency Dehydration (breast feeding jaundice) Sepsis Polycythemia Concealed hemorrhage Intraventricular hemorrhage Increased entero-hepatic circulation Appearing beyond 1 week Breast milk jaundice Prolonged physiologic jaundice in preterm Hypothyroidism Neonatal hepatitis Conjugation dysfunction - e.g. Gilbert syndrome, Crigler-Najjar syndrome Inborn errors of metabolism - e.g. galactosemia Biliary tract obstruction - e.g. biliary atresia

    What workup/labs do you order

    Workup
    Initial laboratory tests

    Total & direct bilirubin Blood group and Rh for mother and baby CBC/d, retic count and peripheral smear Coomb test TSH, G6PD screen Conjugated hyperbilirubinemia:
    AST, ALT, PT, PTT, serum albumin, ammonia, TSH, TORCH screen, septic work-up

    Treatment?

    Treatment
    During pregnancy (if severe)

    Intrauterine blood transfusion Early delivery

    After pregnancy
    Increase feeds (especially in breast feeding

    jaundice) Phototherapy Exchange transfusion (if severe)

    Bilirubin chart

    Side effects of phototherapy


    Increased insensible water loss Loose stools Skin rash Bronze baby syndrome Hyperthermia Upsets maternal baby interaction

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