Jaundice Health Article

Prognosis

Prognosis is based on the underlying cause of jaundice. The liver is a very resilient organ, and many patients do well after supportive therapy or surgical intervention for acute causes of jaundice. High bilirubin levels themselves are not dangerous to patients other than neonates, so all symptoms of high bilirubin levels are reversible if the underlying condition is treatable.

Health care team roles

Good supportive care of the jaundiced patient, regardless of the underlying disorder, is important. If alcohol abuse has been an acute or long-standing problem, nursing staff can contribute much in educating the patient about the importance of avoiding alcohol.

Prevention

Many of the numerous causes of jaundice cannot be anticipated or avoided. Alcohol abuse in patients should be identified and support provided to aid in recovery. Erythroblastosis fetalis can be prevented by giving an Rh-negative mother a gamma globulin solution called RhoGAM as a routine part of prenatal care. This will decrease the chances her antibody titer will rise against her baby's blood. Liver problems due to medications can be minimized with appropriate screening blood tests and cessation of the drug if necessary. One cause of liver failure not mentioned previously is anorexia nervosa, in which patients intentionally starve themselves, disabling the body's immune-defense system and overwhelming the liver's ability to detoxify the blood. Patients with this condition need specific psychiatric therapy in addition to adequate nutritional supplementation therapy to prevent liver failure. If it occurs, transplantation may be the only recourse. Malaria may be prevented by taking certain precautions when traveling in tropical or subtropical countries and climates.

KEY TERMS

Ampulla of Vater—A valve at the distal end of the widened portion of the common bile duct, through which the bile and pancreatic juices enter the duodenum.

Anemia—A condition in which the blood does not contain enough hemoglobin. There are many causes of anemia, including hemolysis, bleeding, and problems producing red blood cells (RBCs).

Biliary system/bile ducts—The gallbladder and the system of tubes that carries bile from the liver into the intestines.

Bilirubin—A breakdown product of hemoglobin that is potentially toxic. The liver collects bilirubin from the bloodstream, alters it, and secretes it into bile.

Hemoglobin—The red pigment in red blood cells that carries oxygen.

Hemolysis—The premature destruction of red blood cells.

Hepatic jaundice—A cause of jaundice; jaundice that occurs while the liver is performing its task of making bilirubin soluble.

Icteric—An adjective, based on the Greek word for jaundice, used to describe a jaundiced patient.

Liver—A large, solid organ in the right upper quadrant of the abdomen that is the body's premier "chemical processing plant" of drugs, nutrients, and toxins.

Neonatal jaundice—Jaundice in a newborn baby, resulting from various conditions.

Pancreas—The organ adjacent to the stomach that produces digestive juices, insulin, and other hormones.

Posthepatic jaundice—A cause of jaundice; jaundice that occurs after the liver has performed its task of making bilirubin soluble.

Prehepatic jaundice—A cause of jaundice; jaundice that occurs before the liver has performed its task of making bilirubin soluble.

Rh incompatibility—When a baby and mother have different Rh factors; a common cause of jaundice in newborns.

Splenectomy—Surgical removal of the spleen, sometimes necessary to control certain types of hemolytic anemia.

BOOKS

Braunwald, E., et al. Harrison's Principles of Internal Medicine, 15th ed. New York: McGraw-Hill, 2001; pp. 255-259, 1715-1720.

Fischbach, F. A Manual of Laboratory and Diagnostic Tests. Philadelphia: Lippincott, 2000; pp. 385-389.

Tierney, L. M., S. J. McPhee, and M. A. Papadakis. Current Medical Diagnosis and Treatment 2001; New York: Lange Medical Books/McGraw-Hill, 2000; pp.662-667.

PERIODICALS

Furuta, S., et al. "Anorexia Nervosa with Severe Liver Dysfunction and Subsequent Critical Complications." Internal Medicine 38, no. 7 (July 1999): 575-579.

Himal, H. S. "Common Bile Duct Stones: The Role of Preoperative, Intraoperative, and Postoperative ERCP." Seminars in Laparoscopic Surgery 7, no. 4 (December 2000): 237-245.

Madlon-Kay, D. J. "Health Nurse Clinical Assessment of Neonatal Jaundice: Comparison of Three Methods." Archives of Pediatric and Adolescent Medicine 155, no. 5 (May 2001): 583-586.

Narang, A., P. Kumar, and R. Kumar. "Neonatal Jaundice in Very Low Birth Weight Babies." Indian Journal of Pedatrics 68, no. 4 (April 2001): 307-309.

Erika J. Norris