May 7, 2022

1400H - 1500H
Health Disorder Empowerment Via Zoom
Course– objective - for
Fundamentals laypeople to have an
and understanding of the
Generalities in FUNDAMENTALS
Medical and GENERALITIES in
Management the MEDICAL
of JAUNDICE MANAGEMENT of
[OVERVIEW] JAUNDICE.
Health Disorder Empowerment ROJoson PEP Talk
Course– objective - for
Fundamentals laypeople to have an I have a Patient
and Empowerment
understanding of the
Program in which I
Generalities in FUNDAMENTALS like to empower the
Medical and GENERALITIES in lay people or
Management the MEDICAL patients to take
of JAUNDICE MANAGEMENT of control in the
[OVERVIEW] JAUNDICE. management of
their health.
 There are 3 courses
in the PEP Talk.
I completed the Core
Course on October 9,
2021.
 From October 23,
2021 onwards, I have
been tackling Health
Disorder and Health
Issue Courses. This
may take 3 years or
longer.
 Fundamentals Contents of ABDOMINAL DISORDERS March 19, 2022
1400H - 1500H
and Generalities [OVERVIEW] Via Zoom
in Medical • What is an abdominal disorder?
Management of • What are the different types of abdominal
JAUNDICE disorders?
• What are the causes of abdominal disorders?
• How common are the abdominal disorders?
• Clinical diagnosis of abdominal disorders?
• Paraclinical diagnostic procedures for • Abdominal Pain
abdominal disorders? • Abdominal Mass
• Basic treatment modalities for abdominal • Abdominal Obstruction
disorders? • Abdominal Bleeding
• Jaundice
 My PEP TALK today
is entitled:
Health Disorder Empowerment
Fundamentals and
Course– objective - for
Generalities in
Fundamentals laypeople to have an Medical
and understanding of the Management of
Generalities in FUNDAMENTALS JAUNDICE [AN
Medical and GENERALITIES in OVERVIEW]. This is
Management the MEDICAL part of the Health
of JAUNDICE MANAGEMENT of Disorder Course.
[OVERVIEW] JAUNDICE.
 Definition of Terms in Title AND Delimitation of
Fundamentals
Coverage of Talk:
and Generalities
in Medical
Fundamentals – simplest and essential facts and
Management of
theories which can serve as a basis or foundation
JAUNDICE
and support for advanced information

Generalities – general statements of info, not

covering specifics and details

Medical Management – diagnosis and treatment

by physicians
 Fundamentals Contents of PEP TALK on JAUNDICE
and Generalities • What is JAUNDICE?
in Medical • What are the different types of JAUNDICE?
Management of • What are the causes of JAUNDICE?
JAUNDICE • How common is JAUNDICE?
• Clinical diagnosis of JAUNDICE
• Paraclinical diagnostic procedures for
JAUNDICE
• Basic treatment modalities for JAUNDICE
 • What is JAUNDICE?
Fundamentals
and Generalities
in Medical
Management of
JAUNDICE
 • What is JAUNDICE?
Fundamentals
and Generalities
in Medical Jaundice is the yellowing of the skin,
Management of mucous membranes, and whites of the
JAUNDICE eyes because of a high level of bilirubin, a
yellow-orange bile pigment.

Jaundice is usually first noted in the whites

of the eyes.
 • What are the different types of JAUNDICE?
Fundamentals
and Generalities
in Medical
Management of
JAUNDICE
 • What are the different types of JAUNDICE?
Fundamentals
and Generalities In this PEP Talk:
There are so many ways of categorizing the
in Medical Limited to:
Management of types of jaundice.
JAUNDICE One categorization: Another categorization: Adult jaundice
• Adult jaundice • Surgical jaundice
• Neonatal jaundice • Medical jaundice Obstructive jaundice
(usually surgical
Another categorization: Another categorization: jaundice)
• Pre-hepatic jaundice • Obstructive jaundice Non-obstructive
• Hepatic jaundice • Non-obstructive jaundice (medical
• Post-hepatic jaundice jaundice jaundice)
 • What are the different types of JAUNDICE?
Fundamentals
and Generalities In this PEP Talk:
in Medical Adult jaundice – occurring in adults
Limit to:
Management of
JAUNDICE Surgical jaundice – jaundice whose cause Adult jaundice
needs an operation for treatment
Surgical Jaundice
Medical jaundice – jaundice whose cause Medical Jaundice
is usually not treated by an operation
 • What are the causes of JAUNDICE?
Fundamentals
and Generalities
in Medical
Management of
JAUNDICE
 • What are the causes of JAUNDICE?
Fundamentals
and Generalities
Jaundice is the yellowing of the skin, mucous
in Medical
membranes, and whites of the eyes because of a
Management of
high level of bilirubin, a yellow-orange bile
JAUNDICE
pigment.

Bilirubin is made during the normal breakdown of

red blood cells.
 • What are the causes of JAUNDICE?
Fundamentals
and Generalities
Reasons for bilirubin build-up: One categorization of
in Medical
Management of jaundice:
•There are too many red blood cells dying or • Pre-hepatic
JAUNDICE
breaking down and going to the liver. jaundice

•The liver is overloaded or damaged. • Hepatic jaundice

•The bilirubin from the liver is not able to • Post-hepatic

properly move into the digestive tract. jaundice
 • What are the causes of JAUNDICE?
Fundamentals
and Generalities
Reasons for bilirubin build-up: One categorization of
in Medical
Management of jaundice:
•There are too many red blood cells dying or • Hemolytic
JAUNDICE
breaking down and going to the liver. jaundice

•The liver is overloaded or damaged. • Hepatocellular

jaundice
•The bilirubin from the liver is not able to
properly move into the digestive tract. • Obstructive
jaundice
 • What are the causes of JAUNDICE?
Fundamentals
and Generalities
Reasons for bilirubin build-up: One categorization of
in Medical
Management of jaundice:
•There are too many red blood cells dying or • Medical jaundice
JAUNDICE
breaking down and going to the liver.

•The liver is overloaded or damaged. • Medical jaundice

•The bilirubin from the liver is not able to • Surgical jaundice

properly move into the digestive tract. • Obstructive
jaundice
 • What are the causes of JAUNDICE?
Fundamentals
and Generalities Causes:
Reasons for bilirubin build-up:
in Medical
Management of • Blood disorders
•There are too many red blood cells dying or
JAUNDICE
breaking down and going to the liver.
• Hepatitis
• Drugs
•The liver is overloaded or damaged.
• Cirrhosis
•The bilirubin from the liver is not able to
• Stones and tumors
properly move into the digestive tract.
in the common
bile duct; tumors
in the pancreas
 • How common is JAUNDICE?
Fundamentals
and Generalities
in Medical
Management of
JAUNDICE
 • How common is JAUNDICE?
Fundamentals
and Generalities
COMMON
in Medical
Management of
• Hepatitis
JAUNDICE
• Cirrhosis
• Drug-induced
• Gallstones
• Pancreatic tumor
 • Clinical diagnosis of JAUNDICE
Fundamentals
and Generalities
in Medical
Management of
JAUNDICE
 • Clinical diagnosis of JAUNDICE
Fundamentals
and Generalities
Starting point:
in Medical
Management of
Adult patient has jaundice.
JAUNDICE
 • Clinical diagnosis of JAUNDICE
Fundamentals
and Generalities TIPS:
in Medical
Management of BASIC EVALUATION METHODS:
JAUNDICE
• HISTORY TAKING – TO GET SYMPTOMS
• PHYSICAL EXAMINATION – TO GET SIGNS

CLINICAL DIAGNOSIS
 • Clinical diagnosis of JAUNDICE
Fundamentals
and Generalities TIPS:
in Medical Basic data needed in
Management of BASIC EVALUATION METHODS: HISTORY:
JAUNDICE • When initial
• HISTORY TAKING – TO GET SYMPTOMS symptoms noted
• PHYSICAL EXAMINATION – TO GET SIGNS • Subsequent
course
• Associated
symptoms
CLINICAL DIAGNOSIS
 Basic data needed in
• Clinical diagnosis of JAUNDICE EXAMINATION:
Fundamentals
and Generalities TIPS:
in Medical LOOK and PALPATE
Management of BASIC EVALUATION METHODS: • Look for bulge
JAUNDICE • Look for
• HISTORY TAKING – TO GET SYMPTOMS distention
• PHYSICAL EXAMINATION – TO GET SIGNS • Palpate for mass
• Palpate for
tenderness

CLINICAL DIAGNOSIS
 • Clinical diagnosis of JAUNDICE
Fundamentals
and Generalities TIPS:
in Medical Look for cues for a SPECIFIC CAUSE or DISEASE DISORDER
Management of causing the JAUNDICE.
JAUNDICE
Use PATTERN RECOGNITION of a particular SPECIFIC CAUSE
disease and PREVALENCE process in those with
similar presentation of symptoms and signs.
 • Clinical diagnosis of JAUNDICE
Fundamentals
and Generalities TIPS:
in Medical JAUNDICE
Management of
JAUNDICE • Palpate for a MASS in the RUQ and epigastric
region as a possible cause.
• If no mass, look for symptoms suggestive of
hepatitis, gallbladder disease (with stones in
the biliary passage) or pancreatic disease.
 • Clinical diagnosis of JAUNDICE
Fundamentals
and Generalities TIPS:
in Medical JAUNDICE
Management of
JAUNDICE • Determine whether the jaundice is obstructive
or non-obstructive.
• Non-obstructive (usually medical jaundice) –
hepatitis, cirrhosis
• Obstructive (usually surgical jaundice) –
stones, tumors – common bile duct / pancreas
 • Clinical diagnosis of JAUNDICE
Fundamentals
and Generalities
in Medical CASE ILLUSTRATIONS
Management of
JAUNDICE Starting point in evaluation:
Presence of Jaundice
 • Clinical diagnosis of JAUNDICE Analyze further
Fundamentals through more data
and Generalities Case Illustration: gathering –
in Medical A patient has JAUNDICE. symptoms, signs
Management of and repeated
JAUNDICE START THINKING WHAT IS THE SPECIFIC CAUSE! questioning and
physical
Is it an obstructive jaundice or not? examination until
the specific cause of
the JAUNDICE is
obtained.
 • Clinical diagnosis of JAUNDICE
Fundamentals
and Generalities Case Illustration:
in Medical A patient has JAUNDICE.
Management of
JAUNDICE START THINKING WHAT IS THE SPECIFIC CAUSE!
Is it an obstructive jaundice or not?
If there is a palpable epigastric or RUQ mass, most
likely it is the cause of the JAUNDICE. Most likely,
there is an obstructive jaundice. Obstructive
jaundice is usually a surgical jaundice – needing
operation.
The mass can a pancreatic or liver tumor.
 • Clinical diagnosis of JAUNDICE
Fundamentals
and Generalities Case Illustration:
in Medical A patient has JAUNDICE.
Management of
JAUNDICE START THINKING WHAT IS THE SPECIFIC CAUSE!
Is it an obstructive jaundice or not?
If there is NO palpable epigastric or RUQ mass, a
non-palpable tumor is still possible as a cause.
Likewise, think of gallstone also as this is
common. Non-obstructive cause like hepatitis
and cirrhosis are also possible. Diagnostic
procedure is needed, usually an ultrasound.
 • Clinical diagnosis of JAUNDICE
Fundamentals
and Generalities Case Illustration:
in Medical A patient has JAUNDICE.
Management of
JAUNDICE START THINKING WHAT IS THE SPECIFIC CAUSE!
Is it an obstructive jaundice or not?
Viral hepatitis should be considered if there is a
history of fever before the onset of jaundice.

Drug-induced hepatitis should be considered if

there is a history of intake of drug/s that are
notorius for development of jaundice.
 • Clinical
Paraclinical
diagnosis
diagnostic
of abdominal
procedures
pain?
for
Fundamentals
JAUNDICE
and Generalities
in Medical
Management of
JAUNDICE
 • Clinical
Paraclinical
diagnosis
diagnostic
of abdominal
procedures
pain?
for
Fundamentals FOR JAUNDICE
JAUNDICE
and Generalities
in Medical Common instrumental and laboratory diagnostic ULTRASOUND OF
Management of procedures for JAUNDICE: THE HEPATOBILIARY
JAUNDICE TREE IS USUALLY
• Imaging procedures (x-rays – plain / with THE INITIAL
barium dye; ultrasound; CT scan; MRI; PET DIAGNOSTIC
scan; etc.) PROCEDURE.
• Endoscopy (upper – esophagogastroscopy,
retrograde cholangiopancreatography)
• Blood tests (CBC; liver function tests; tumor
markers; etc.)
 • Clinical
Paraclinical
diagnosis
diagnostic
of abdominal
procedures
pain?
for
Fundamentals FOR JAUNDICE
JAUNDICE
and Generalities
in Medical ULTRASOUND of the hepatobiliary tree can give ULTRASOUND OF
Management of the following information: THE HEPATOBILIARY
JAUNDICE • Presence or absence of tumors in the liver, TREE IS USUALLY
gallbladder, and pancreas (which are THE INITIAL
commonly affected in Jaundice). DIAGNOSTIC
• Presence or absence of stones in gallbladder PROCEDURE.
and common bile duct and hepatic ducts.
• Presence or absence of unusual or abnormal
dilatation of the common bile duct.
Obstructive jaundice is suspected if there is
tumor, stone or dilatation of bile ducts.
 • Clinical
Paraclinical
diagnosis
diagnostic
of abdominal
procedures
pain?
for
Fundamentals
JAUNDICE
and Generalities
in Medical
Management of The foremost indication for a paraclinical
JAUNDICE diagnostic procedure can be stated this
way:

if you are not certain on the primary

clinical diagnosis and you need to be
certain or be more certain before
treatment, then go for a paraclinical
diagnostic procedure.
 • Clinical
Paraclinical
diagnosis
diagnostic
of abdominal
procedures
pain?
for
Fundamentals As a rule, there is no need
JAUNDICE
and Generalities for a paraclinical
in Medical diagnostic procedure if:
Management of
To decide on indication of the paraclinical
• you are quite
JAUNDICE diagnostic procedure,
certain of your
the physician uses two processes – primary clinical
- degree of certainty on the primary diagnosis.
clinical diagnosis and • treatment plans for
primary and
- comparison of the treatment plans for secondary
the primary and secondary clinical diagnoses are the
diagnoses. same.
 • Clinical
Paraclinical
diagnosis
diagnostic
of abdominal
procedures
pain?
for
Fundamentals
JAUNDICE
and Generalities
in Medical
Competencies required of physicians managing
Management of
JAUNDICE:
JAUNDICE
• Know the uses and indications of all known
instrumental and laboratory diagnostic
procedures for JAUNDICE.
• Use as needed and indicated.
• Select the most cost-effective one using the
BRCA process.
• Know how to interpret the results.
 • Clinical
Paraclinical
diagnosis
diagnostic
of abdominal
procedures
pain?
for
Fundamentals
JAUNDICE
and Generalities
in Medical
BRCA Process in selecting diagnostic procedures
Management of
JAUNDICE Procedures Benefit Risk Cost Availability
(goal – to
be more
definite on
the
diagnosis)

Option1        
Option2        
Option3        
 • Basic
Clinical
treatment
diagnosismodalities
of abdominal
for JAUNDICE
pain?
Fundamentals
and Generalities
in Medical
Management of
JAUNDICE
 • Basic
Clinical
treatment
diagnosismodalities
of abdominal
for JAUNDICE
pain?
Fundamentals
and Generalities
in Medical SPECIFIC DISEASE SURGICAL / POTENTIALLY SURGICAL / NON-SURGICAL
Management of
JAUNDICE W
X
Y
Z

• Surgical – outright surgical

• Non-surgical – non-surgical at all times (no OPERATION)
• Potentially surgical – surgical only when needed
 • Basic
Clinical
treatment
diagnosismodalities
of abdominal
for JAUNDICE
pain? Surgical Treatment:
Fundamentals
• Removable of
and Generalities
cause of
in Medical Examples of OUTRIGHT SURGICAL TREATMENT obstructive
Management of • Presence of obstructive jaundice caused by jaundice (stone /
JAUNDICE stone tumor)
• Presence of obstructive jaundice caused by • By-pass or detour
resectable tumors such as in pancreas procedure
• Drainage of
obstruction
• Surgical – outright surgical
• Non-surgical – non-surgical at all times (no OPERATION)
• Potentially surgical – surgical only when needed
 • Basic
Clinical
treatment
diagnosismodalities
of abdominal
for JAUNDICE
pain? Surgical Treatment:
Fundamentals
• Removable of
and Generalities Examples of POTENTIALLY SURGICAL TREATMENT cause of
in Medical in which a WATCH & WAIT stance is a better obstructive
Management of option and in which a medical management can jaundice (stone /
JAUNDICE be tried tumor)
• Inflammation / infection causing the • By-pass or detour
obstructive jaundice procedure
• Asymptomatic gallbladder stones treated with • Drainage of
watch and wait but which cause obstruction obstruction
• Surgical – outright surgical
• Non-surgical – non-surgical at all times (no OPERATION)
• Potentially surgical – surgical only when needed
 • Basic
Clinical
treatment
diagnosismodalities
of abdominal
for JAUNDICE
pain? Non-Surgical
Fundamentals
and Generalities Treatment:
in Medical Examples of OUTRIGHT NON-SURGICAL • Medicines
Management of TREATMENT • NO medicines
JAUNDICE The so-called MEDICAL JAUNDICE (watchful waiting;
• Drug-induced hepatitis natural support
• Viral hepatitis management;
• Cirrhosis etc.)

• Surgical – outright surgical

• Non-surgical – non-surgical at all times (no OPERATION)
• Potentially surgical – surgical only when needed
 • Basic
Clinical
treatment
diagnosismodalities
of abdominal
for JAUNDICE
pain?
Fundamentals
and Generalities
in Medical
BRCA Process in selecting cost-effective treatment
Management of
modality.
JAUNDICE
 Fundamentals Contents of PEP TALK on JAUNDICE Summary
and Generalities • What is JAUNDICE?
• What are the different types of JAUNDICE?
Take Away
in Medical
Management of • What are the causes of JAUNDICE?
JAUNDICE • How common is JAUNDICE?
• Clinical diagnosis of JAUNDICE
• Paraclinical diagnostic procedures for
JAUNDICE
• Basic treatment modalities for JAUNDICE
 Fundamentals Be always in touch with reliable medical Take Away in
and Generalities information on fundamentals and relation to
in Medical generalities in medical management of Patient
Management of JAUNDICE. Empowerment
JAUNDICE
Knowledge is power; it gives power.
Use the 4Ks of Patient Empowerment:
Kaalaman, Kakayanan, Karapatan and
Kapangyarihan
to gain greater control over decisions in
medical management of JAUNDICE.
 May 7, 2022
1400H - 1500H
Health Disorder Empowerment Via Zoom
Course– objective - for
Fundamentals laypeople to have an
and understanding of the
Generalities in FUNDAMENTALS
Medical and GENERALITIES in
Management the MEDICAL
of JAUNDICE MANAGEMENT of
[OVERVIEW] JAUNDICE.