This is usually due to the malfunction of bile salts to arrive at the intestinal tract.
The bleeding that transpires in the intestines is openly connected to the lack of bile salts, for without them the body cannot immerse the fat-soluble vitamin K correctly.
Without this vitamin, blood clotting is very weak, so there is a better tendency for bleeding to take place.
Treatment of jaundice
In hepatocellular jaundice, its dark amber urine and normal stools categorize it.
Hepatocellular jaundice, since much of the bilirubin in the blood already has been conjugated by the endoplasmic reticulum of the hepatocyte, it is water-soluble and can be filtered by the kidney.
Stools are typically normal because some bile pigment also manages to be excreted into the biliary tract and intestine.
Cholestatic jaundice is also categorized by amber-coloured urine, but the colour of the stools is very pale.
Itching of the skin is frequently linked with this condition.
Cholestatic occurs in numerous types especially those caused by certain drugs, and in diseases that largely damage small bile passages in the liver.
Cholestatic jaundice also occurs in patients with disruptive disorders of the biliary tract in the exterior of the liver.
It is often unfeasible to decide the level of obstruction by means of examination alone, and more sophisticated testing is required to situate the location of harm.
Diagnoses
I am going to test a 6-month-old male baby, whose blood test showed hints of bile.
I have taken an ultrasound image to check what sort of jaundice my patient has, obstructive or non-obstructive.
An ultrasound image was used because; it shows the organs that we want in detail. It gives a better imaging of organs than x-rays and also harmless, doesn’t require radiation.
No uses of dye are needed, no contrast media.
To ensure the patient’s dignity a male staff will carry out the imaging and the baby’s parents can be present.
The ultrasound image shows that my patient has jaundice. It shows the build-up of bilirubin, which is produced naturally by the body.
[Refer to page five for the image]
You can see from the picture that the gall bladder is swollen because it has no control on the bile it’s storing and the bile ducts keep releasing bile.
This expands faster than a newborn liver can break it down and get rid of it in the baby's stool.
The picture shows the build-up of bilirubin round the gall bladder right under the skin. This gives the skin a yellow colour.
The image signifies that my patient has obstructive jaundice, which is when the gall bladder blocks the flow of bile. This makes the bile flow out of control.
This happens because of the following reasons:
- A baby's liver is not yet capable of eliminating the bilirubin from the blood
- More bilirubin is being made than the liver can handle
- A great deal of bilirubin is reabsorbed starting from the intestines before the baby clears it in the stool
Too much bilirubin will make a baby’s skin look yellow. This yellow colour will show on the face first, after that on the chest and stomach, and finally, on the legs.
How we shall treat our patient
Mild to average levels of jaundice don’t need any treatment. Because these usually clear up after a while after the baby develops more.
I have tested my patient and it seems like he does have jaundice judging by the ultrasound image.
My patient was lying on his back he was fully covered his parents were present. I uncovered the part that I needed to produce an image of which is the liver.
There are no health hazards to the patient, because I am not using any radiation. The patient may feel a bit of heat but it’s for short-term.
The patient doesn’t need any preparation but if possible it would be better if he fasted beforehand.
This is so a little amount of bile can be produced to help focus on the gall bladder and liver. The liver is the essential organ we’re looking at which is meant to clean up the blood from bile and impurities.
Instantly an ultrasound picture of the liver will show up on a screen, which can be printed out.
The picture that I have gained has been printed out from my patient’s examination. It shows that the patient has obstructive jaundice.
After the examination I have decided that the patient should be breast-fed. I have told his mother to breast-feed him until his liver develops appropriately.
Plentiful feedings of breast milk help pass the bilirubin out in the stools.
Increasing the quantity of water given to the patient isn’t sufficient to pass the bilirubin because it must be passed in the stools.
Rarely, babies may require treatment of their blood to remove bilirubin.
An example of this is the very high levels bilirubin; a blood exchange is given of fresh blood and removes the bilirubin.
Once the patient’s bilirubin level decreases, it is not likely that it will increase again.
Nevertheless, if the patient carries on looking yellow after 3 weeks of life then other tests have to be done.
Generally a lot of breastfed babies don’t have jaundice that requires disruption of breastfeeding.
Nonetheless, if the patient builds up jaundice that lasts a week or further, I may have to diagnose that the patient temporarily stops being breastfed for a day or two.
If the mother temporarily stops breastfeeding, she can be offered breast pumping so she can keep producing breast milk and can resume nursing straight away.
If there are high levels of bilirubin that don’t clearout, then my patient may be treated with special lights (light therapy).
These special lights help get rid of the bilirubin by altering it, this is to make it easier for my patients liver to get rid of the bilirubin.
The treatment may involve that the patient stays in hospital for a couple of days. Some pediatricians treat babies with these lights at home.
The treatment in this case will be carried out in the hospital and how long my patient will be tested for depends on his recovery.
If the baby still has jaundice, then the parent shouldn’t be too frightened. Remember that jaundice in a healthy newborn isn’t severe and typically clears up with no trouble.
If my patient has a very severe case of jaundice and other health problems, there will always be many other treatments.