JAUNDICE By G Sadasiva - PowerPoint Presentation

Slide1

JAUNDICE

By

G

Sadasiva

Rao

M.Pharm

, (

Ph.D

)

Asst.

Professor

& HOD

Dept.

of Pharmacy Practice

Hindu college of pharmacy,

Gnt

, A.P.

Slide2

Jaundice definition and facts

Jaundice

is a yellowish discoloration of the skin, mucous membranes and of the white of the eyes caused by elevated levels of the chemical 

bilirubin

 in the blood (

hyperbilirubinemia

).

The term jaundice is derived from the French word

jaune

, which means yellow. Jaundice is not a disease , but rather a visible sign of an underlying disease process.

Jaundice is typically seen when the level of

bilirubin

in the blood exceeds 2.5-3 mg/

dL

.

Slide3

Jaundice in adults can be caused by a variety of medical conditions, some of which are serious and potentially life-threatening.

Any adult who develops jaundice needs to undergo a comprehensive medical evaluation in order to determine its cause.

Neonatal jaundice,

a condition seen in newborns, is most often a benign condition that improves without serious effects.

Slide4

What causes jaundice in adults?

Jaundice in adults is caused by various medical conditions that affect the normal metabolism or excretion of

bilirubin

.

Bilirubin

is mostly formed from the daily breakdown and destruction of 

red blood cells

 in the bloodstream, which release 

hemoglobin

 as they rupture.

The

heme

portion of this

hemoglobin

molecule is then converted into

bilirubin

, which is transported in the bloodstream to the liver for further metabolism and excretion.

Slide5

In the liver, the

bilirubin

is conjugated (made more water soluble), and is excreted into the gallbladder (where it is stored) and then into the intestines.

In the intestines, a portion of the

bilirubin

is excreted in the

feces

, while some is metabolized by the intestinal bacteria and excreted in the urine.

Slide6

Jaundice occurs if there is a dysfunction of the normal metabolism or excretion of

bilirubin

.

This disruption in the metabolism or excretion of

bilirubin

can occur at various stages, and it is therefore useful to classify the different causes of jaundice based on where the dysfunction occurs.

The causes of jaundice are generally classified as

pre-hepatic (the problem arises before secretion to the liver),

hepatic (the problem arises within the liver), and

post-hepatic (the problem arises after

bilirubin

is excreted from the liver).

Slide7

What are pre-hepatic (liver) causes of jaundice?

Jaundice caused during the pre-hepatic phase is due to the excessive destruction (

hemolysis

) of red blood cells from various conditions.

This rapid increase in

bilirubin

levels in the bloodstream overwhelms the liver's capability to properly metabolize the

bilirubin

, and consequently the levels of

unconjugated

bilirubin

increase.

Slide8

Conditions which can lead to an increase in the

hemolysis

of red blood cells include:

Malaria,

Sickle cell disease,

Hereditary

spherocytosis

,

Thalassemia

,

Glucose-6-phosphate

dehydrogenase

deficiency (G6PD),

Drugs or other toxins, and

Autoimmune disorders

Slide9

What are hepatic (liver) causes of jaundice?

Jaundice caused during the hepatic phase can arise from abnormalities in the metabolism and/or excretion of

bilirubin

. This can lead to an increase in both

unconjugated

and/or conjugated

bilirubin

levels. Conditions with a hepatic cause of jaundice include:

Acute or chronic hepatitis (commonly viral [Hepatitis A, B, C, D, E] or alcohol related),

Cirrhosis (caused by various conditions),

Drugs or other toxins,

Crigler-Najjar

syndrome,

Autoimmune disorders,

Gilbert's syndrome, and

Liver cancer.

Slide10

What are post-hepatic (liver) causes of jaundice?

Jaundice from a post-hepatic cause arises from a disruption (an obstruction) in the normal drainage and excretion of conjugated

bilirubin

in the form of bile from the liver into the intestine.

This leads to increased levels of conjugated

bilirubin

in the bloodstream.

Conditions that can cause post-hepatic jaundice include

Gallstones,

Cancer (pancreatic cancer, gallbladder cancer and bile duct cancer),

Strictures of the bile ducts,

Cholangitis

,

Pancreatitis, and

Parasites (for example, liver flukes).

Slide11

What are the signs and symptoms of jaundice in adults?

As already mentioned, jaundice is not a disease, but it is a visible sign of an underlying disease process.

Individuals with jaundice will have a yellow discoloration of the skin to varying degrees, and may also exhibit yellowing of the mucous membranes and white of the eyes.

However, depending on the underlying cause of jaundice, individuals may experience different symptoms.

Some individuals may have very few, while others may experience more severe and pronounced symptoms.

Slide12

Individuals with jaundice may experience any of the following signs and symptoms

Pale-

colored

stools, Dark-

colored

urine,

Skin itching, Nausea and vomiting,

Rectal bleeding,

Diarrhea

,

Fever  and chills, Weakness,

Weight loss, Loss of appetite,

Confusion, Abdominal pain,

Headache, Swelling of the legs, and

Swelling and distension of the abdomen due to the accumulation of fluid (

ascites

).

Slide13

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What are the risk factors for jaundice in adults?

The risk factors for developing jaundice vary based upon the underlying cause.

Certain individuals with hereditary conditions (for example,

thalassemia

or hereditary

spherocytosis

) are at an increased risk of developing jaundice from

hemolysis

.

Individuals who consume alcohol heavily are at an increased risk of developing a

lcoholic hepatitis

, pancreatitis, and cirrhosis leading to jaundice.

People who are at an increased risk of exposure to the different types of 

viral hepatitis

(for example, 

hepatitis B

 and 

hepatitis C) are also at risk of developing jaundice at the time of infection or subsequently if liver disease occurs or if 

liver cancer

 develops later.

Slide15

What are the complications of jaundice in adults?

The type of complication and the severity of complications vary with the underlying cause leading to jaundice.

Certain individuals will not suffer any long-term after effects and will have a full recovery,

while for others the appearance of jaundice will be the first indication of a life-threatening condition.

A few of the potential complications include:

Slide16

Electrolyte abnormalities

Anemia

Bleeding

Infection/sepsis

Chronic hepatitis

Cancer

Liver failure

Kidney failure

Hepatic encephalopathy (brain dysfunction)

Death

Slide17

What exams and tests diagnose jaundice in adults?

The presence of jaundice requires a comprehensive medical evaluation to determine the cause.

Initially, your health-care professional will take a detailed history of your illness and perform a physical exam, which can sometimes determine the cause of the jaundice.

Initial blood testing will also be undertaken, with special attention being given to your 

liver function

 tests, 

complete blood count

 (CBC), electrolyte panel and lipase levels

.

Blood testing for exposure to hepatitis may also be ordered.

Additional blood testing may be ordered based on the initial results.

A 

urinalysis

will likely also be ordered.

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Depending on the results of initial blood tests, further studies may be needed to help diagnose the underlying disease process.

In certain cases, imaging studies will need to be obtained in order to evaluate for any abnormalities of the liver, gallbladder and pancreas.

These imaging studies may include abdominal

 

ultrasound

, 

computerized tomography

(CT) scan, 

magnetic resonance imaging

(MRI), and 

cholescintigraphy

 (HIDA scan).

Occasionally, individuals will need further invasive testing to determine the cause of the jaundice.

Procedures that may be ordered include endoscopic retrograde

cholangiopancreatography

(

ERCP

) or a 

liver biopsy

. 

Slide19

What is the treatment for jaundice in adults?

The treatment for jaundice depends entirely on the underlying cause.

Once a diagnosis has been established, the appropriate course of treatment can then be initiated.

Certain patients will require hospitalization, whereas others may be managed as outpatients at home.

In certain individuals with jaundice, the treatment will consist of supportive care and can be managed at home.

For example, most cases of mild viral hepatitis can be managed at home with watchful waiting and close monitoring by your doctor.

Novel medications for hepatitis C now can offer a cure for this condition

Slide20

Alcohol cessation is necessary in patients with cirrhosis, alcoholic hepatitis, or  acute pancreatitis secondary to alcohol use.

Jaundice caused by drugs/medications/toxins requires discontinuation of the offending agent.

In cases of intentional or unintentional  acetaminophen (Tylenol) overdose, the antidote N-

acetylcysteine

(

Mucomyst

) may be required.

Various medications may be used to treat the conditions leading to jaundice, such as steroids in the treatment of some autoimmune disorders.

Certain patients with cirrhosis, for example, may require treatment with diuretics and 

lactulose

.

Antibiotics may be required for infectious causes of jaundice,

Slide21

Blood transfusions may be required in individuals with 

anemia

 from

hemolysis

or as a result of bleeding.

Individuals with cancer leading to jaundice will require consultation with an oncologist, and the treatment will vary depending on the type and extent (staging) of the cancer.

Surgery and various invasive procedures may be required for certain patients with jaundice.

For example, certain patients with gallstones may require surgery. Other individuals with liver failure/cirrhosis may require a liver transplant.

Slide22

Can jaundice in adults be prevented?

Certain conditions leading to jaundice can be prevented, whereas others may be less preventable. However, there are certain measures that can be taken in order to decrease the risk of developing jaundice.

Take medications as instructed in order to prevent potential liver damage or unintentional overdose.

Individuals with certain medical conditions (for example, G6PD deficiency or cirrhosis) should avoid certain medications altogether.

Discuss medications with your health care professional.

Avoid high-risk

behaviors

such as unprotected intercourse or intravenous drug use, and implement universal precautions when working with blood products and needles. This can decrease your risk of developing hepatitis B or hepatitis C.

Slide23

Consider being vaccinated against hepatitis A and hepatitis B. There is currently no available vaccine against hepatitis C.

Avoid potentially contaminated food products or unsanitary water, as this may decrease your risk of developing hepatitis A.

When travelling to areas where malaria is endemic, take the recommended precautions and prophylactic medications in order to prevent the development of malaria.

Consume alcohol responsibly and only in moderation. This can prevent alcoholic hepatitis, alcoholic cirrhosis and pancreatitis, among other conditions. Certain individuals will need to avoid alcohol altogether.

Avoid smoking, as it is a risk factor for the development of pancreatic cancer, as well as many other malignancies.

Slide24

What is the prognosis for an adult with jaundice?

The prognosis for individuals with jaundice depends on the underlying cause of the condition.

There are certain conditions that carry an excellent prognosis with individuals making a full recovery.

However, more serious causes of jaundice can sometimes be fatal despite medical or surgical intervention.

The development and severity of complications will also determine an individual's prognosis, as will a patient's underlying health and

comorbidities

(presence of other diseases).

Therefore, a case-by-case assessment by your health care professional is necessary in order to determine a more accurate prognosis