Case Presentation Jaundice
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adarshjadav6Case Presentation Jaundice
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adarshjadav6CASE PRESENTATION
ON JAUNDICE
BY P.GOUTHAMI REDDY
22EF1T0022
PHARM.D 3rd YEAR
JAUNDICE
Definition:Jaundice is a clinical condition characterized
by yellowish discoloration of the skin, sclera (whites of
the eyes), and mucous membranes due to elevated
levels of bilirubin in the blood (hyperbilirubinemia).
• Normal total serum bilirubin: 0.3–1.2 mg/dL
• Jaundice usually becomes visible when bilirubin >2.5–3 mg/dL
ETIOLOGY
Jaundice is classified based on the location of the dysfunction
1. Pre-hepatic (Hemolytic)
• Increased RBC breakdown
• Examples: Hemolytic anemia, Sickle cell anemia, Malaria
2. Hepatic (Hepatocellular)
• Liver unable to process bilirubin
• Examples: Hepatitis (A, B, C), Alcoholic liver disease, Cirrhosis, Liver cancer
3. Post-hepatic (Obstructive/Cholestatic)
• Obstruction in bile flow
• Examples: Gallstones, Pancreatic cancer, Bile duct strictures
CLINICAL MANIFESTATIONS
• Yellowing of skin and sclera
• Dark urine
• Pale (clay-colored) stools
• Itching (pruritus)
• Fatigue and malaise
• Abdominal pain or discomfort (especially RUQ)
• Nausea and vomiting
• Weight loss (in chronic liver disease)
• Fever (in infectious or obstructive jaundice)
PATHOPHYSIOLOGY
Underlying Cause (Hemolysis / Liver Cell Injury / Biliary Obstruction)
↓
Imbalance in Bilirubin Metabolism (Excess Production / Impaired Conjugation /
Obstructed Excretion)
↓
Accumulation of Bilirubin in Blood (Unconjugated or Conjugated)
↓
Deposition of Bilirubin in Tissues (Skin, Sclera, Mucosa)
↓
Clinical Sign: Yellow Discoloration = Jaundice
↓
Further Complications (If Untreated: Pruritus, Pale Stools, Dark Urine, Hepatic
Pre-Hepatic Jaundice (Hemolytic)
Hepatic Jaundice (Hepatocellular)
Encephalopathy) Post-Hepatic Jaundice (Obstr
↑ RBC breakdown Liver damage (e.g., hepatitis)Bile duct obstruction
↑ Unconjugated bilirubin Impaired conjugation & excretion
↑ Conjugated bilirubin
Normal liver function Mixed bilirubinemia Pale stools, dark urine
PATIENT PROFILE FORM
• Date: 02/1/2025
• Age: 23
• Gender: Female
• Address: xyz
• Final Diagnosis: Hepatocellular Jaundice (e.g., due to Hepatitis A)
• Discharge: 05/1/20245
CHIEF COMPLAINTS
• Yellow discoloration of eyes and skin
• Fatigue
• Dark urine
• Abdominal pain (RUQ)
• Low-grade fever
HISTORY OF PRESENT ILLNESS
The patient was asymptomatic until 02/12/2024. She gradually developed yellowish
discoloration of sclera and skin, followed by fatigue, nausea, dark-colored urine, and
mild RUQ abdominal pain. No history of alcohol or hepatotoxic drug use.
PAST MEDICAL HISTORY
• N/K/C/O DM, HTN, Epilepsy, Asthma
• No addictions
VITALS
Vitals Day 1 (12:30 PM) Day 1 (4:00 PM) Day 2
BP 110/60 mmHg 110/70 mmHg 110/80 mmHg
Pulse Rate 106 bpm 75 bpm 85 bpm
Temp 101.8°F 99.2°F 98.4°F
SpO₂ 98% 97% 98%
RBS 110 mg/dL — —
LAB INVESTIGATIONS
Investigation Obtained Value Normal Range
Total Bilirubin 6.4 mg/dL 0.3–1.2 mg/dL
Direct Bilirubin 3.8 mg/dL 0.1–0.3 mg/dL
ALT (SGPT) 225 U/L 7–56 U/L
AST (SGOT) 195 U/L 10–40 U/L
ALP 210 U/L 44–147 U/L
Hb 11.8 g/dL 12–16 g/dL
WBC 9500 /cumm 4000–11000 /cumm
Platelet Count 1.8 lakh/cumm 1.5–4.5 lakh/cumm
Hepatitis A IgM Positive Negative
USG Abdomen Mild hepatomegaly with diffuse liver echotexture
FINAL DIAGNOSIS
Hepatocellular Jaundice – likely due to acute Hepatitis A
TREATMENT CHART
BRAND NAME GENERIC NAME CLASS ROA DOSE
Inj. Hepamerz L-ornithine L- HepatoprotectiveIV 10ml in 100ml NS
aspartate
Inj. PAN 40 Pantoprazole PPI IV 40 mg
Inj. Zofer Ondansetron Antiemetic IV 4 mg
IV Fluids NS + OptineuronElectrolytes + IV 100ml/hr
Vitamins
LIV 52 DS Herbal (Ayurvedic)
Liver Tonic PO 1 tab BID
DOLO 650 Paracetamol Antipyretic PO 650 mg
DISCHARGE SUMMARY
• Date of Admission: 02/1/25
• Date of Discharge: 05/1/25
• Diagnosis: Hepatocellular Jaundice (Acute Hepatitis A)
• Discharge Medications:
BRAND NAME GENERIC NAMECLASS ROA DOSE
LIV 52 DS Herbal Liver tonic
Hepatoprotective
PO 1 tab BID
Zofer Ondansetron Antiemetic PO 4 mg SOS
Dolo 650 Paracetamol Antipyretic PO 650 mg TID
All medications for 5 days.
SOAP NOTES
• S (Subjective): 23-year-old female presented with complaints of
fatigue, yellowish skin discoloration, dark urine, and abdominal
discomfort.
• O (Objective):
• Total bilirubin: 6.4 mg/dL
• ALT/AST: Elevated
• Hepatitis A IgM: Positive
• Mild hepatomegaly on USG
• A (Assessment): Hepatocellular jaundice due to acute Hepatitis A
• P (Plan):
• IV fluids with supportive therapy
• Monitor LFTs
• Oral hepatoprotective medications
• Symptomatic treatment with antipyretics and antiemetics
STANDARD THERAPY
Class Drugs Mechanism Side Effects
IV Fluids NS, Dextrose Maintain hydration Local irritation,
& support liver fluid overload
Hepatoprotecti Silymarin, L- Enhance liver cell GI upset, rare
ves ornithine recovery allergic reaction
Antiemetics Ondansetron Block serotonin Headache,
receptors (5-HT3) constipation
Antipyretics Paracetamol Inhibit prostaglandins Liver toxicity at
high doses
ON-PHARMACOLOGICAL THERAP
• Adequate bed rest
• High-carbohydrate, low-fat diet
• Avoid alcohol completely
• Regular follow-up of LFTs
• Maintain hygiene to avoid transmission (especially in hepatitis A)
PATIENT COUNSELING
1. Liv 52 DS
• Use: Improves liver function
• Advice: Take after meals; herbal—report any side effects like nausea or rash
2. Paracetamol (Dolo 650)
• Use: Reduces fever and pain
• Advice: Do not exceed 3g/day to avoid liver damage
3. Ondansetron (Zofer)
• Use: Prevents nausea
• Advice: Take before meals if feeling nauseous
FESTYLE MODIFICATIONS FOR JAUNDIC
Nutrition & Hydration
• Eat easily digestible food like boiled vegetables, fruits, rice, toast
• Avoid fatty, oily, spicy, or fried foods
• Drink plenty of water, coconut water, ORS
Rest & Recovery
• Get adequate sleep and physical rest
• Avoid strenuous activities
Hygiene Practices
• Wash hands thoroughly
• Avoid sharing food, drinks, and utensils
• Maintain sanitary conditions in kitchen/toilets
Avoid Alcohol & OTC medications
• Do not consume alcohol
• Avoid self-medicating with hepatotoxic drugs
THANK YOU
