A

PROJECT REPORT
On
Title of the Project
Submitted in the partial fulfillment for award of thedegree in

B.Voc in MLT

(Deemed to be University u/s 3 UGC Act 1956)

Name of the Student: pooja Prajapati Name of the guide:

Roll No: 19BVMLT179

School of Vocational Studies

Lingaya’s Vidyapeeth
(Deemed to be University u/s 3 UGC Act 1956)

NACHAULI, FARIDABAD

Year
 DECLARATION

The project titled Study Of Jaundice is my original work and has not been presented for award of
degree in any other University/Institution.

Students Name : pooja Prajapati Sign Date

I confirm that the project titled Study Of Jaundice was carried out by the candidate under my
supervision.

Name of Guide: Sign Date

(Stamp of the Hospital/ Institution )

 CERTIFICATE

This is to certify that pooja Prajapati has carried out the project work entitled Study Of Jaundice

under my supervision for the fulfilment of the B.Voc MLT

from Lingaya’s Vidyapeeth. The project is the original work and studies carried out by the student

and the content of the project do not form the basis for the award of any other degree to the
candidate or to anyone else

Signature of Student Signature of the Supervisor

Name of Student Name of Supervisor

Roll No. Designation

3
 ACKNOWLEDGEMENT
Firstly, I sincerely thank the Almighty for His glorious blessings and infinite mercy, abundant
love and spiritual guidance all the way through my life. Then I extend my sincere thanks to
my family for their valuable encouragement.

I would appreciate and convey my sincere thanks to Mr. Yogesh Sagotia and teacher Mrs.
Pooja Jadhav for all their support and ideas they have given me for the successful
accomplishment of the project. am indebted to Mrs. Pooja Jadhav for having spared her
valuable time and effort in assisting me with this project and giving me valuable inputs
whenever required.

Words could have missed some personalities who have helped me to accomplish my task and
my hearty gratitude will always be with them.

4
 ABSTRACT

Aim of Project is to study Jaundice and the factors associated with the risk of developing
Jaundice in children and adults. objective of the study of the clinical history and Presentation
of Jaundice. Methodology used in the study are finding history related to patient studying
their LFT report and finding the causes of Jaundice. The study was carried out within 20
patients and their LFT reports were studied we observed that resolution of jaundice in malaria
took 1-2 weeks in contrast 6 to 8 weeks in viral hepatitis.This difference in duration was
statistically significant. (thus jaundice not resolving in 1-2 weeks time in a patient of malaria
requires serious can sideration for presence of other con comitant diseases including viral
hepatitis.

5
 LIST OF ABBREVIATIONS

ABBREVIATIONS STANDS FOR

CBC Complete blood count

HB Hemoglobin
RBC Red blood cells
SGOT Serum glutamic oxaloacetic transaminase
SGPT Serum glu
ALP Alkaline phosphates
HIDA SCAN Hepatobiliary iminodiacetic acid scan
MRI Magnetic resonance imaging
IV Intravenous
TSB Total serum bilirubin
TCB Transcutaneous bilirubin
ICU Intensive care unit
IVIG Intravenous immunoglobin

6
Sr.no Topic name Page name
1 CHAPTER – 1
1.1 Introduction
2 CHAPTER – 2
2.1 Objective
3 CHAPTER – 3
3.1 History
4 CHAPTER – 4
4.1 Methodology
5 CHAPTER – 5
5.1 bilirubin
6 CHAPTER – 6

7
 CHAPTER - 1

1.1 INTRODUCTION
Jaundice, also known as icterus is a yellowish. or greenish pigmentation of the
skin. and whites of the eyes due to high bilirubin levels. Jaundice in adults is typically a sign
indicating the presence of underlying disease involving abnormal haem. Metabolism liver
dysfunction or biliary tract obstruction. The Prevalence of jaundice in adults is rare while
jaundice in babies is common with an estimated 80% affected, during their first week of life.
the most commonly associated Symptoms of jaundice are itchiness pale face and dark urine.

The term jaundice is derived from the French word jaune which means yellow
Tissue deposition of bilirubin occurs only in the Presence of Serum hyperbilirubinemia and is
a Sign of either liver or less often a hemolytic disorder.

Jaundice Frequently indicate a problem with the liver or bile ducts when the
liver is not working properly .it can cause a waste material Called bilirubin to build up in the
blood.

8
 CHAPTER – 2

2.1 OBJECTIVE

i. Review bilirubin pathway or metabolism

ii. Explore risk factor for neonatal jaundice

iii. Outline causes of indirect hyperbilirubinemia

iv. Outline causes of jaundice in 1st 24 hr of life and that persist more than 2-3 week

v. Distinguish between physiological vs pathological jaundice

vi. Distinguish between breast milk vs breast feeding jaundice

vii. Be able to diagnose kernicterus, discover risk factor and make prevention

9
 CHAPTER – 3

3.1 HISTORY

Jaundice comes from the French word ‘ jaunis in cirea ’ 1300 AD meaning yellow and the word
‘jaunis’ itself is derived from an earlier french word ‘jalnice’ in 1885 luhrman noted jaundice
as on adverse effect of vaccination neonatal jaundice may have first been described in a Chinese
textbook 1000 years ago.

This treatment for new born babies was invented in the 1950s by a clever nurse named sister
jean word who was in charge of the premature unit at rochford general hospital in Essex
England. She realized sunlight reduced jaundice in new borne and premature infant. Bilirubin
metabolism takes place in three phase’s pre-hepatic intrahepatic and post-hepatic.

To check for infant jaundice press gently on your baby’s forehead or nose. In the skin looks
yellow where you pressed its likely your baby has mild jaundice the skin color should simply
look slightly lighter than its normal color for a moment.

Jaundice is often a sign of problem with the liver gallbladder or pancreas. Jaundice can occur
when too much bilirubin up in the body during production of bilirubin jaundice can be caused
by viruses including hepatitis A chronic hepatitis B and C and Epstein barr virus infection.

10
 CHAPTER – 4
Methodology

Q. How common is jaundice?

Ans :- Jaundice is rare in adults by you can get it for many reasons some of the time these
include: - hepatitis: most of the time, this infection is caused by a virus.it may be short lived
(acute) or chronic which means it lasts for at least 6 months. Jaundice is one of the most
common conditions that can effect new born babies it’s estimated 6 out of every 10 babies
develop jaundice but only around 1 in 10 babies has a blood bilirubin level high enough to
need treatment.

Q. What causes you are having during jaundice?

Ans :- Jaundice is often a singn of a problem with the liver, gallbladder or pancreas. Jaundice
can occur when two much bilirubin builds up in the body these are too many red blood cells
during or breaking down (hemolysis) and going to the liver.
What difficulty faces during jaundice?
Patients having family history of jaundice and patient mother for babies also has jaundice.
patient also having complication associated with her previous pregnancy such as baby is big a
delivery.

Q.How you learn that you jaundice?

Ans :- Sometimes, you may have jaundice occurring with liver disease if you have : chronic
hepatitis or inflammation of the liver.
• Fever
• Chills
• Abdominal pain
• Flu-like symptoms
• Change in skin colour
• Dark coloured urine and pale coloured stool

Q. How you diagnosed is at jaundice ?

Ans :-Doctors diagnose jaundice by checking for signs of liver disease it most cases a
bilirubinometer is used for check for jaundice in babies blood tests are usually only necessary

11
if your baby developed is particularly high. The level of bilirubin detected in your baby’s
blood is used to decide whether any treatment is needed.

Q. What are risk factor you observed during jaundice?

Ans :- patients observed several risks in jaundice both for adults and children of having
jaundice patient has higher bilirubin level ; it leader to the higher bilirubin level in the
children.

Q. Should J explain you how jaundice will affect your child and adults?
Ans :- jaundice is rare in adults but you can get it for many reason hepatitis most of the time
this infection. if not properly treated jaundice can lead to serious health issues when bilirubin
level rise dangerously high it can harm cells throughout the body.

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 DATA COLLECTION TABLE

PRE HEPATIC JAUNDICE :-

Sr.no Patient Age Sex History T.B D.B I.B

name
1. XYZ 9 days F Yellow skin,yellow 14.42 0.48 13.94
discolouration of nails
bedes , mucus membrane
2. XYZ 5days M Ineffective 20.26 0.80 19.46
breastfeeding,
yellowish urination,
yellowish
discolouration of skin
3. XYZ 4days F Excessive crying 7.57 0.99 6.58
yellowish
discolouration of the
eye. yellow of the
skin.
4. XYZ 6days M Yellow discolouration 14.2 0.5 13.7
of the skin, yellow
discoloration nails,
pale stool
5. XYZ 3days M Yellow discolouration 13.17 0.57 14.0
of the skin, pale stool
dark, urine
6. XYZ 68years M Abdominal pain, fever 1.68 0.17 1.29
dark

13
7. XYZ 53years M Abdominal pain fever, 2.78 0.29 1.97
abdominal weight loss
dark
8. XYZ 48years M Hemolytic anaemia, 2.91 0.42 1.86
fever including ails
9. XYZ 23years F Fever feeling 3.21 0.59 2.29
weakness abdominal
pain
10. XYZ 36years M Abdominal pain fever, 2.57 0.27 1.47
cold sweats abnormal
weight loss.

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 HEPATIC JAUNDICE :-

Sr. Patient A S History T.B D.B I.B SG SG ALP Bile Bile

no name OT PT salt pigment
1. XYZ 54 M Yellow of the 12.7 7.6 5.1 420 660 358 - present
skin loss
appetite
feeling sick
fever pain in
your muscles
2. XYZ 14 F Loss of 3.4 2.97 0.12 57 68 52 - -
weight,
anaemia, dark
urine
3. XYZ 48 M Weight loss 3.5 2.5 0.25 - 85 70 - present
fever,
yellowish if
nails
4. XYZ 35 M Weakness 1.92 1.28 0.64 267 369 103 - present
darkening
skin swelling
abdomen
fever
5. XYZ 6 F Fever dark 2.09 1.02 0.57 644 379 453 present present
urine, fever
loss of weight
feeling sick
6. XYZ 45 M Yellow of the 13.7 7.92 1.2 540 310 375 - present
skin fever

15
 loss of weight
appetite viral
infection
vomiting
tireless drink
alcohol
7. XYZ 41 M Hemolystic 2.7 1.7 0.35 88 63 - - present
anaemia fever
pain
abdomen,
skin itching
feeling sick
8. XYZ 29 M Fever weight 3.2 2.1 1.0 - 210 187 - -
loss, not eat
properly dark
urine pale
stool
9. XYZ 15 F Yellow of the 8.2 3.9 1.2 92 88 150 - present
skin fever
swelling of
the abdoment
dark urine
10. XYZ 32 M Fever, feeling 2.9 1.87 0.30 - 290 310 - -
sick, white of
the eyes
itchiness

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POST HEPATIC JAUNDICE :-

Sr. Patient A S History T.B D.B I.B ALP URINE

no name BILIRUBINE
1. XYZ 32 F Feeling sick, 11.2 8.7 0.5 221 present
dark urine
abdominal pain
diarrhoea, fever
2. XYZ 25 M Abnormal weight 6.0 2.1 0.4 157 -
loss skin itching
abdominal pain,
dark urine, fever
3. XYZ 34 M Gall stone 22.3 16.2 0.30 270 present
abdominal pain
dark urine pale
stool , diarrhea
4. XYZ 42 M Yellow eye and 9.2 3.1 0.27 120 -
skin abdominal
pain fever
5. XYZ 36 M Abdominal 8.2 4.1 1.0 201 -
pain fever,
nausea and
vomiting
infection
6. XYZ 18 F Abdominal pain , 13.1 6.9 1.2 187 -
dark urine fever
itchy skin fatigue

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7. XYZ 24 F Fever infection 18.0 12.9 0.39 235 present
dark urine pale
stool, swelling
abdomen yellow
of the skin and
nails.
8. XYZ 38 M Drink alcohol 6.9 3.2 0.22 157 present
during 2 month,
loss of weight
diarrhea dark
urine
9. XYZ 42 M Abdominal 12.1 5.9 0.47 205 present
pain,loss of
weight skin
itching, gall
bladder, stone
10. XYZ 49 M Fever abdominal 3.9 2.2 0.30 192 present
pain diarhea,loss
of weight ,
feeling sick

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 CHAPTER – 5

5.1 BILIRUBIN

Bilirubin is produce by normal break down haemoglobin and other is protein

in reticuloendothelial system. The haemoglobin is broken. down into heam and globin. There
is a formation of green Pigment which is known as “biliverdin” which is for these reduce
bilirubin which is also called as unconjugated bilirubin and it is attach to albumin.

The albumin part of the bilirubin is removed and the bilirubin enter into the
liver. where it is conjugated with the help of gluconic acid. This conjugated bilirubin Further
excreted unto the bile duct Form there it passes into the and found in Stool in the form of
"stercobilinogen" and is found in the urine in the form of urobilinogen.

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 CHAPTER – 6

TYPES OF JAUNDICE. :-

6.1. PRE-HEPATIS JAUNDICE: -

It is also known as haemolytic Jaundice where RBCS break fake place Where total bilirubin in
increased and indirect bilirubin increased.
It occurs due to excessive destruction of red blood cell resulting in increased bilirubin
formation Jaundice may be due to the increased formation of Indirect bilirubin than the normal
liver Can Convert it into direct bilirubin and excrete. There is no hepatic damage.

i. Inside the red blood cells.

• Thalassemia major
• Sickle cell disease

ii. In the wall of the red blood cells:

• Hereditary spherocytosis glucose 6 phosphate dehydrogenase (G6PD)
deficiency associated with drugs such as aspirin sulfonamides and anti-
malarials.
iii. Out side the red blood cells
• Acquired haemolytic anaemia associated with autoimmune disorder and other
disease Such as leukemias Carcinoma, etc.
• Infections - malaria Septicemia , etc.
• Physical agents:- burns

6.1.2 CAUSES

• MALARIA :- a blood infection caused by a parasite.

• STCKIE CELL ANEMIA :- genetic Condition in which red blood cells become
Crescent shaped rather than the typical disc Shape.

• SPHEROCYTOSIS: - a genetic condition of the red blood Cell membrane that

Causes them to be Sphere -Shaped rather than disc-shaped.

20
 • THALASSEMIA: - a genetic condition that causes your body to make an irregular
type of haemoglobin that limits blad Cell the number of healthy red blood cell in your
blood stream.

6.1.3 SYMPTOMS
• abdominal pain
• fever, including chills or cold sweats
• abnormal weight loss.
• feeling itchy
• dark urine or pale Stool

6.1.4 DIAGNOSE

• A Urinalysis to Measure the Amount of Certain Substance in Your Urine.

• Blood tests, Such as Complete blood count (CBC) Or liver function test to measure
bilirubin and Other Substance in the blood."

• imaging test such as an MRI or ultrasound to examine your liver gallbladder and bile
ducts to rule out other form of Jaundice.
• A HIDA scan to help find blockage or other issue in the liver gallbladder bile duct
other form of jaundice.

6.1.5 TREATMENT

1) For malaria:

• medications to help destroy the parasite and prevent parasites from re-infecting your
liver again

2) For sickle cell anaemia:

• blood transfusions from a healthy donor

21
• rehydrating with intravenous (IV) fluid

• medications for any infections that can cause a sickle cell crisis

3) For spherocytosis:

• folic acid supplements

• blood transfusions for anaemia.

• spleen removal surgery to help increase red blood cell life and lower the chance
of gallstones

4) For thalassemia:

• blood transfusions

• bone marrow transplants

• spleen or gallbladder removal surgery

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6.2 HEPATIC JAUNDICE

It is also Known as hepatocellular Jaundice. It occurs in the liver damage due to toxic virus
infection in this total bilirubin increased direct bilirubin increased and SGOT, GGPT increased.
There is some disorder of the liver cell or the bile passage within the liver this include the
following subgroup: -

• Jaundice caused by impaired uptake of bilirubin by the liver Cells

There is ineffective transport of bilirubin within the Cell or defective
conjugation at the microsome. As with prehepatic Jaundice there is retention of indirect
bilirubin Action of drug such as rifampicin affecting cellular uptake of bilirubin.

• Jaundice caused by infective Hepatitis: -

In infective hepatitis there is a varying degree of liver cell necrosis. Due to
The badly damaged hepatis calls, there is disordered uptake bilirubin there and
conjugation of bilirubin.

INFECTION

Viral: - viruses that causes hepatitis include hepatitis A virus. hepatitis B Virus, hepatitis
virus hepatitis D Virus, hepatitis E virus, hepatitis G virus, herpes simplex virus
Epstein-Barr Virus etc.

i. MODE OF SPREAD OF HEPATITIS A VIRUS:

a. Contamination of water.
b. personal Contact: - Direct personal contact with persons suffering from
disease or with the Carriers.
c. Insects like tiles bedbugs, mosquitoes are Vectors.
d. Contamination of food milk or by ingestion of Shell fish obtained from
Polluted water.

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 ii. MODE OF SPREAD OF HEPATITIS B VIRUS.

a) Infected blood transfusion

b) Use of infected blood products like plasma albumin and may be injection of
infected
c) gamma globulin.
d) contamination of needle and syringe.
e) Infected razor.
f) Infected needles used during tattooing.

iii. MODE OF SPREAD OF HEPATITIS C VIRUS.

a) The spread of Hepatitis C virus is mainly by blood and products by the

parenteral route.
b) Hospital and laboratory Staff can occasionally acquire hepatitis c after
needlestick injuries.

iv. MODE OF SPREAD OF HEPATITIS D VIRUS

a) It is more prevalent among intravenous drug abusers. It is a defective RNA

Virus which Can replicate only in association with Hepatitis B Virus.

v. MODE OF SPREAD OF HEPATITIS E VIRUS

a) Clinically, hepatitis E Virus is Similar to Hepatitis A and virus also spreads by

the fecal - oral route.

JAUNDICE COUSED BY DRUG INDUCED HEPATITIS

Drug-induced hepatitis is rare. It is Caused When you have a harmful or toxic amount of
some medicines, Vitamins, herbal. remedies, or Food Supplements.
many widely used and generally well tolerated therapeutic agents occasionally case hepatic
injury. Mild hepatis damage manifested by increased, in Serum Transaminase enzymes is
Common after exposure to numerous such drugs. Drug induced hepatitis often resembles

24
viral hepatitis clinically, biochemically and on liver biopsy, but appears to have increased
incidence of severe necrosis.

MANY TYPES OF MEDICINES MAY CAUSE DRUG INDUCED

HEPATITIS. THESE INCLUDE:
• pain and fever medicines that have acetaminophen.
• Anabolic steroids, man-made medicine that are like the male sex hormone
testosterone.
• Some medicines used to treat bacterial infections (antibiotics).
• Birth Control pills Coral Contraceptives)
• Statins, used to lower Cholesterol.
• Sulfa medicines, a type of antibiotic.
• Anti-epileptic medicines.

JAUNDICE CAUSED BY IMPAIRED MANSPORT OF BILIRUBIN

Although processes up to conjugation may be normal the transport of conjugated bilirubin

into the bile capillaries may be impaired in the following Conditions:

i. Congenital disorders such as Dubin johnson and Rotor syndromes.

ii. In cirrhotic nodules. where the disorderly regeneration of hepatic cells
prevents proper closely organized association with normal bile Capillaries.

JAUNDICE CAUSED BY OTHER FORMS OF INTRAHEPATIC

CHOLESTASIS.

Other forms of intrahepatic cholestasis include –

1. Primary biliary cirrhosis

2. Intrahepatic atresia
3. Sclerosing cholangitis.
4. Bile duct carcinoma

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6.2.1. THE MOST COMMON CAUSES OF HEPATIC JAUNDICE ARE

1. liver cirrhosis, which means. that liver tissues are Scarred by long-term. exposure to
infection ΟR toxic Substance, such as high level of alcohol.

2. Viral hepatitis, an inflammation of the liver caused by one of several viruses that can
get into your body thorough infected food, water, blood, Stool or sexual contact.

3. primary biliary cirrhosis, which happens when bile ducts are damaged and can't
Process bile causing it to build up in your liver and damage liver tissue.

4. Alcoholic hepatitis, in which your liver tissue is Scarred by the heavy, long-term
drinking of alcohol.

5. Leptospirosis, is a bacterial infection that Can be spread by infected animals or

infected animal urine or faces.

6. Liver Cancer, in which cancerous cells develop and multiply within liver tissues.
6.2.2 COMMON SYMPTOMS OF HEPATIC JAUNDICE INCLUDE.

• loss of appetite.
• bloody nose.
• Skin itching.
• Weakness.
• abnormal weight loss.
• Swelling of your abdomen or legs
• dark urine or pale stool
• Pain in your muscles or joints
• Darkening skin
• Fever
• Feeling sick

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6.2.3 SOME RISK FACTORS FOR THIS TYPE OF JAUNDICE
INCLUDE: -

• Drug Use.
• Drinking A Lot of Alcohol Over A Long Period Of Time.
• Use Of Medications That Can Cause Liver Damage, Such As Acetaminophen Or
Heart Medication.
• Previous infection that affected your liver.

6.2.4 TO DIAGNOSE HEPATIC JAUNDICE, YOUR DOCTOR WILL

LIKELY ORDER THE FOLLOWING TESTS:
• a urinalysis to measure levels of substances in your wine related to your liver
function.
• blood tests such as a Complete blood count (CBC) and antibody tests, or liver
function tests to measure bilirubin in the blood and levels of Substances that indicate
that your liver may not be processing bilirubin properly.
• imaging tests, such as an MRI Ultrasound, to examine your liver. For damage or for
the presence of Can Cerous Cells.
• An endoscopy which involves insetting a thin lighted tube into small incision to look
at your liver and take tissue sample (biopsy) if necessary for analysis for Cancer or
other condition.

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6.3 POST- HEPATIC JAUNDICE

Post hepatic, or obstructive Jaundice happens when bilirubin can't be drained Properly
into the bite ducts digestive tract because of A blockage. The most Common Causes of
post-hepatic Jaundice are: - gallstones, hard calcium deposits in the gallbladder that Can
blocks bile ducts.
In Complete obstruction of the bile duct no urobilinogen is Found in urine Since, bilirubin
has no access to the intestine and it is in the intestine that bilirubin gets Converted to
urobilinogen to be later released into the general circulation.in this case presence of
bilirubin (conjugated) in the urine without urine - urobilinogen suggests obstructive
Jaundice, either intra-hepatic or post-hepatic.

6.3.1 THE MOST COMMON CAUSES OF POST -HEPATIC JAUNDICE

ARE :

• gallstones, hard calcium deposits in the gall bladder that Can blocks bile ducts.

• Pancreatic Cancer the development and spread of cancer cell in the pancreas an
organ that helps produce digestive Substances.
• Bile duct Cancer the development and spread of Cancer cell in your bile ducts.
• Pancreatitis an inflammation Οr infection of your pancreas.
• biliary atresia a genetic condition in which you have narrow or missing bile ducts.

6.3.2 COMMON SYMPTOMS INCLUDE 8 OF POST-HEPATIC

JAUNDICE INCLUDE :-
• Feeling Sick
• throwing up
• dark urine or pale stool.
• abdominal pain
• diarrhea
• abnormal weight loss
• Skin itching

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 • abdominal swelling
• Fever

6.3.3 SOME RISK FACTORS FOR THIS TYPE OF JAUNDICE

INCLUDE: -
• Being overweight
• Eating a high fat, low fiber diet
• Having diabetes mellitus.
• Smoking tobacco product
• Drinking a lot of alcohol
• Being exposed to industrial chemical.

6.3.4 TO DIAGNOSE POST - HEPATIC JAUNDICE: -

• A urinalysis to measure levels of Substance in your urine.

• Blood test such as a complete blood count (CBC) and antibody tests for cancer, or
liver function test to rule out hepatic Jaundice.
• Imaging tests, such as an MRI or ultrasound to examine your liver, gallbladder, and
bile ducts for obstructions or tumors.
• An endoscopy, which involves inserting a thin lighted tube down the esophagus look
at your liver gallbladder or bile ducts and take tissue sample if necessary for analysis
for Cancer or Other Condition.

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 LABORATORY TESTS OF JAUNDICE.

Prehepatic Post hepatic

Hepatic jaundice
jaundice jaundice

Normal /
Total serum bilirubin Increased Increased
increased

Conjugated bilirubin Normal Increased Increased

Normal /
Unconjugated bilirubin Increased Normal
increased

Normal / Decreased /
Urobilinogen Decreased
increased negative

Dark (urobilinogen, Dark (conjugated

Urine colour Normal
conjugated bilirubin) bilirubin)

Stool colour Brown Slightly pale Pale, white

Alkaline phosphatase levels Increased Highly increased

Normal
Alanine transferase and aspartate
Highly increased Increased
transferase levels

Conjugated bilirubin in urine Not present Present Present

30
 CHAPTER -7

7.1 What’s new born jaundice?

New born jaundice is a yellowing of a baby’s skin and eyes. New born jaundice is very
common and can occur when babies have a high level of bilirubin, a yellow pigment
produced during normal breakdown of red blood cells.

In older babies and adults, the liver processes bilirubin, which then passes it through the
intestinal tract. However, a new-born’ still-developing liver may not be mature enough to
remove bilirubin.

The good news is that in most cases, new born jaundice goes away on its own as a baby’s
liver develops and as the baby begins to feed, which helps bilirubin pass through the body.

In most cases, jaundice will disappear within 2 to 3 weeks. Jaundice that persists longer than
3 weeks may be a symptom of an underlying condition.

Additionally, high levels of bilirubin can put a baby at risk for deafness, cerebral palsy, or
other forms of brain damage.

The American Academy of Pediatrics (AAP) recommends that all new born babies be
examined for jaundice before discharge from the hospital and again when the baby is between
3 and 5 days old.

7.2 There are a few different types of jaundice in new-borns.

i. Physiological jaundice

The most common type of jaundice in new-borns is physiological jaundice. This type
of jaundice is normal. Physiological jaundice develops in most new-borns by their
second or third day of life. After your baby’s liver develops, it will start to get rid of
excess bilirubin. Physiological jaundice usually isn’t serious and goes away on its
own within two weeks.

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 ii. Breastfeeding jaundice

Jaundice is more common in breastfed babies than formula-fed

babies. Breastfeeding jaundice frequently occurs during your baby’s first week of life.
It happens when your baby doesn’t get enough breast milk. It can occur due to nursing
difficulties or because your milk hasn’t come in yet. Breastfeeding jaundice may take
longer to go away.

iii. Breast milk jaundice

Breast milk jaundice is different than breastfeeding jaundice. Substances in your

breast milk can affect how your baby’s liver breaks down bilirubin. This can cause a
bilirubin build up. Breast milk jaundice may appear after your baby’s first week of
life and may take a month or more to disappear. Other types of jaundice can occur if
your baby has an unrelated medication condition.

7.2.1 CAUSES

Jaundice happens when your baby’s blood has too much bilirubin. Bilirubin is a chemical
your body makes when it breaks down old red blood cells. Your liver normally filters
bilirubin from your blood. Your body gets rid of it when you poop.

If your baby’s liver hasn’t developed enough to get rid of bilirubin, it can start to build up.
This build up of bilirubin causes your baby’s skin to look yellow. Most babies develop
jaundice in their first few days of life. This is because it takes a few days for your baby's liver
to develop and get better at removing bilirubin.

Severe jaundice can occur if your baby has:

• A blood infection (sepsis).

• A different blood type than you.
• Bruising from a difficult birth.
• Too many red blood cells.
• A low oxygen level (hypoxia).
• A liver condition such as biliary atresia.

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7.2.2 SYMPTOMS

The main sign of jaundice is the yellowing of your baby’s skin. You can see it best in natural
lighting, such as in front of a window. It usually appears in your baby’s face first. The whites
of your baby’s eyes and under their tongue may look yellow. As the level of bilirubin
increases, the yellowing may move to your baby’s chest, belly (abdomen), arms and legs.

Jaundice may be difficult to see if your baby has darker skin. But you should still be able to
tell if your baby has jaundice by the colour of their eyes and under their tongue.

33
7.2.3 DIAGNOSE

Your baby’s healthcare provider will check for signs of jaundice while you’re still in the
hospital. Your baby’s bilirubin level will be highest when they’re three to five days old. It’s
important that your baby’s healthcare provider checks them again within this time frame.

Your baby’s healthcare provider can estimate your baby’s bilirubin level by placing a probe
on your baby’s head. This test shows the transcutaneous bilirubin (TcB) level. If this level is
high, your baby’s healthcare provider will order a blood test to confirm the results. They’ll
prick your baby’s heel to collect a small sample of blood. The blood test shows the total
serum bilirubin (TSB) level.

The American Academy of Pediatrics uses a new born jaundice level chart to determine if a
baby needs treatment. The chart is based on your baby’s total serum bilirubin level and age.

Total serum bilirubin (TSB) level Age of new born

• Above 10 milligrams Less than 24 hours old

• Above 15 milligrams 24 to 48 hours old

• Above 18 milligrams 49 to 72 hours old

• Above 20 milligrams Older than 72 hours.

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7.2.4 TREATMENT

Typically, treatment for mild jaundice in infants is unnecessary, as it tends to disappear on its
own within 2 weeks.If the infant has severe jaundice, they may need to be readmitted to the
hospital for treatment to lower levels of bilirubin in the bloodstream. In some less severe
cases, treatment may be done at home.

Some treatment options for severe jaundice include:

• Phototherapy (light therapy) – treatment by light rays. The baby is put under a
special light, covered by a plastic shield to filter out ultraviolet light. The light
manipulates the structure of bilirubin molecules so they can be excreted.

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 • Exchange blood transfusion – the baby’s blood is repeatedly withdrawn and then
replaced (exchanged) with donor blood. This procedure will only be considered if
phototherapy does not work because the baby would need to be in an intensive care
unit (ICU) for newborns.

• Intravenous immunoglobulin (IVIg) – in cases of rhesus or ABO incompatibility,

the infant may have a transfusion of immunoglobulin; this is a protein in the blood
that lowers the levels of antibodies from the mother, which are attacking the infant’s
red blood cells.

If jaundice is caused by something else, surgery or drug treatment may be required.

7.2.5 OTHER TREATMENTS

If jaundice is caused by an underlying health problem, such as an infection, this usually needs
to be treated.

If the jaundice is caused by rhesus disease (when the mother has rhesus-negative blood and
the baby has rhesus-positive blood), intravenous immunoglobulin (IVIG) may be used.

IVIG is usually only used if phototherapy alone has not worked and the level of
bilirubin in the blood is continuing to rise.

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 CHAPTER - 8

8.1 PREVENTION OF JAUNDICE

Due to the wide range of potential causes, it's not possible to prevent all cases of Jaundice.
However, there are four main precautions that you can take to minimize your risk of developing
jaundice. They are:

• Ensuring that you stick to the Recommended Daily Amount (RDA) for alcohol
consumption
• Maintaining a healthy weight for your height and build
• If appropriate, ensuring that you're vaccinated against a Hepatitis A or B
infection,vaccination would usually only be recommended depending on where in the
world you're travelling.
• Minimizing your risk of exposure to Hepatitis C because there's currently no vaccine
for the condition.

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8.2 SUMMARY
I briefly explain about introduction definition, history, causes, symptoms, sign types, fisk
factors, treatment. I explain about prevention of jaundice clinical features and treatment of
jaundice I investigation jaundice, Excess bile pigments (bilirubin) in the bloodstream and
tissues, causing a yellow to orange-even greenish-colour in the skin, the whites of the eyes, and
the mucous membranes. Bilirubin may be overproduced or inadequately removed by the liver
or leak into the bloodstream after removal; jaundice may also be due to impaired bile flow.
Causes include anaemia, pneumonia, and liver disorders (e.g., infection or cirrhosis). While
bilirubin excess usually does no harm, retention jaundice signals severe liver malfunction.

8.3 CONCLUSION

Jaundice is very common disease yellowing of skin sclera and mucus membrane are common
manifestation of jaundice due to defect in production metabolism and excretion of bilirubin.
I have studied total 30 patients for my projects. I came to conclude that in 10 patients total
bilirubin and indirect bilirubin was high this states that these patients are of prehepatic jaundice
total bilirubin direct bilirubin, SGOT and SGPT was high in 10 patients this states that these
patients are of hepatic jaundice that in 10 patients total bilirubin, direct bilirubin, and ALP and
urine bilirubin was high this states that these patients are of post hepatic jaundice.

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