Professional Documents
Culture Documents
• 4 Causes of Jaundice are destruction of RBC (hemolytic jaundice), impaired uptake of bilirubin by liver cells (Hepatocellular
jaundice), Decreased conjugation of bilirubin (hepatocellular jaundice), Obstruction of bile flow (obstructive jaundice)
• Signs and symptoms of jaundice are the following 4. 1. Yellow skin, sclera and mucus membranes b/c bilirubin diffuses into
the tissue and stains it. 2. Dark urine b/c excess bilirubin is excreted by kidneys. 3. Light clay colored stool if bile ducts are
obstructed or inflamed and bile can’t flow to intestines. 4. Itching b/c bile salts accumulate under the skin
• Facts about jaundice – 1. Yellow is from the flow of bile into hepatic or billary ducts. 2. Bilirubin must be 3 xs normal for
jaundice to occur. 3. It is a symptom not a disease 4. Abnormal increase in bilirubin concentration occurs 5. It is first detected
in the sclera and skin
Type of Jaundice Commonly caused by Bilirubin
Hemolytic (prehepatic) what causes it happens • Blood transfusion reactions Increased breakdown of rbc causes increased
before the liver gets involved • Hereditary disorders of RBC’s such as amounts of unconjugated bilirubin in the blood
sickle cell anemia, thalasemia, (liver cannot handle the load.)
spherocytosis
• Acquired hemolytic disorder
Hepatocellular (hepatic) it happens w/I the liver, • Hepatitis Hepatocytes cant convert so bilirubin increases.
the liver cells cant convert bili or leaks bili or both • Cirrhosis Both direct and indirect increase. Conjugated
• Hepatic carcinomas (direct) bilirubin is secreted through urine since
they are water soluble. (impaired uptake of
bilirubin by the liver
Obstructive intrahepatic (post hepatic) it is an • Swelling or fibrosis of the canalculi and Increased direct and indirect bilirubin and increased
obstructive flow of bile in the liver bowel ducts inside the liver urine bilirubin
s/s clay colored stool • Tumors
• Hepatitis
• Cirrhosis
Obstructive extrahepatic (post hepatic) it is an • d/t whatever keeps bile from getting into Increased direct and indirect bilirubin and increased
obstructive blow if bile in the biliary system the intestines urine bilirubin
s/s clay colored stool • stones caught in the CBD, biliary
strictures, schlerosing cholangitis,
carcinoma of the head of the pancreas
Hepatitis Phases
Phase Time Signs and Symptoms Misc. Facts
Acute phase Lasts 1-4 months * anorexia * nausea *fatigue * headache * • fever usually subsides
Acute infection, infected Hepatocytes are (incubation) occasional vomiting * ruq discomfort * low when jaundice occurs
lysed by cytotoxic cytokines and killer
cells, kupffer cells enlarge and proliferate grade fever * joint pain* rashes* • anorexia nausea &
this causes periportal inflammation that hepatomegaly * lymphoidenopathy * fatigue continues after
can interrupt bile flow (cholestasis splenomegaly * Jaundice * fever * enlarged jaundice sets in
tender liver • time of maximal
infectivity for hep A
patients
Convelescent Phase Lasts 2-4 months *malaise * fatigue * hepatomegaly may • begins as jaundice
Follows acute phase continue for several weeks after disappears
(relapse may occur) • splenomegaly subsides
• disappearance of
jaundice does not mean
pt is fully recovered
Fulminant hepatitis
Fulminant Hep: rare,frequently fatal form of acute hepatitis more often with hbv, F. Hepatitis nsg care: : may progress rapidly, condition can change by the hr.
esp. w/ hdv co infection. Less often w/ hcv. toxic reactions to drugs & (assess frequently. Monitor labs (lft’s and kidney function). Plan for early transfer
cogentenital metabolic disorders can also cause this liver failure. Usually causes to ICU or transplant center. (keep paper work updated), assess for renal failure
death unless liver transplant is done. Rapidly deteriorates w/ liver failure, hep secondary to liver failure
encephalopathy, necrosis of hep parenchyma, cougu –lopathy, renal failure, coma
Diagnostic Findings: specific hep virus antigens/antibody panels. AST increase in acute, ALT increase in acute, GGT increase,
Alkaline phosphatase moderately increased, globulin wnl or increased, albumin wnl or decreased, serum bilirubin increased to approx
8-15mg/dl, urinary bilirubin increase, urine urobilinogen increased 2-3 days before jaundice, prothrombin time is prolonged.
CARE:
• goal is to reduce metabolic demands on liver
• managed at home
• rest
• high calorie, high protein, high carb, low fat diet
• vitamin supplements
• avoid alcohol and drugs detoxified by liver
• counseling if needed
Entecavir Can be used with lamivudine, *taken for 1 year * do not give to pregnant *reduces viral load,
(Baraclude) resistant hbv women * decreases liver damage
*decreases liver
enzymes in 2/3 of pt.
*seroconversion
*inflammation returns
when drug is stopped