Precautions During Jaundice Despite the fact that jaundice is very commonly regarded as being a condition on its, own, it is actually a common symptom of a number of conditions that affect the liver. The condition causes the affected individual to develop a significant amount of yellow staining of the skin and the whites of the eyes which is primarily the result of high levels of bilirubin in the blood. The intensity of the yellow coloration will depend substantially on the amount of bilirubin present in the bloodstream. Jaundice stems from a malfunction affecting the liver. As a result, almost any condition that seriously affects the liver is likely to cause jaundice.Some of the more common medical conditions that lead to the development of jaundice include malaria, sickle cell crisis, thalassemia and autoimmune disorders. Some of the more common symptoms of jaundice include a yellow coloration of the skin, tongue, whites of the eyes and urine; a loss of appetite as well as the development of a fever, headache and fatigue.
Understanding the various jaundice causes and symptoms is a very important part of being able to diagnose the condition. Because of the fact that there are so many different jaundice causes, there are also a number of different jaundice guidelines that you might want to look up on when you have identified the type of jaundice you are affected by. Understanding and following the various jaundice precautions and jaundice guidelines is the most effective method of ensuring fast recovery. Following a jaundice diet will help reduce the amount of stress that the already unwell liver is under at this point in time. One of the more effective jaundice guideline diets is to eat a single juicy fruit such as an apple, papaya, grapes or a mango in the morning. Follow this up with a single slice of whole wheat bread. Having another orange juice in between your breakfast and lunch is likely to help substantially as well. For lunch, you should have a couple of slices of whole wheat bread followed by a cup of strained vegetable soup and then a steamed leafy vegetable with a glass of buttermilk to help with the digestion.
An afternoon snack can consist of coconut water or juice before moving onto dinner that should comprise of whole wheat bread, steamed vegetables, a baked potato as well as a glass of hot milk with some honey. One of the more important jaundice guidelines is to ensure that you do not consume any foods that contain oils, butter or cream as they should be avoided for at least 2 weeks to prevent excessive stress on the liver. When suffering from jaundice, it is extremely important that you drink a lot of water. Adding a small amount of lemon juice to the concoction will help strengthen the liver substantially. Cold friction is another very useful option and can be performed twice a day while a hot immersion bath for about 10 minutes will help substantially.Jaundice - investigation of prolonged This document is only valid for the day on which it is accessed. Please read our disclaimer. Prolonged jaundice = Jaundice persisting for more than 14 Children with clinically apparent jaundice present after 14 days
Clinical review including examination of stool colour Conjugated and total bilirubin measured Any delay in follow-up for children with neonatal jaundice can lead to poor long term outcomes. Primary investigation of prolonged jaundice will include: feeding history, examination of the baby, examination of stool colour (acholic stools are highly characteristic of cholestasis inInitial laboratory tests should include: Bilirubin (total & direct (conjugated)). fractionation is the most important test in any infant who has more than two weeks of jaundice. Urine (for infection and reducing substances) and possibly a G6PD screen. Total conjugated bilirubin < 20 umol/L and Conjugated bilirubin <20% total bilirubin Children with unconjugated hyperbilirubinaemia require assessment for underlying diagnosis and therapy. Important issues Clinical assessment - sepsis Does the child require phototherapy? Urine for Dipstick +- culture? Consider FBC and film/ G6PD/ Coombs for haemolysis Review maternal blood group for ABO/ rhesus incompatibility Conjugated Hyperbilirubinaemia Total conjugated bilirubin > 20 umol/L or
Conjugated bilirubin >20% total bilirubin Any patient with conjugated hyperbilirubinaemia will be urgently reviewed by the Paediatric Gastroenterology/Hepatology service. Most children with conjugated hyperbilirubinaemia look well but may have important disease. Stool colour - pale stool and dark urine suggests Biliary All children with conjugated hyperbilirubinamia require Disorders in bold are more common or have Spontaneous perforation of bile ducts Bile acid synthesis disorders Congenital disorders of glycosylation Fatty acid oxidation disorders (toxoplasmosis, rubella, CMV, herpes Human Herpes virus-6, Varicella-zoster Trisomy 21, 13, 18 ARC syndrome (Arthrogryposis, renal tubular dysfunction and Adapted from McKiernan 2002 Chart for Investigation of Neonatal Cholestasis Acholic stools are highly characteristic of cholestasis in Bilirubin fractionation is the most important test in any
infant who has more than two weeks of jaundice. Liver enzymes are of limited help to differentiate between hepatocellular and cholestatic liver injury. Synthetic liver function is best assessed by albumin level andUntreated hypothrombinaemia may lead to spontaneous bleeding and intracranial haemorrhage. First line investigations conjugated Hyperbilirubinaemia FBC and blood film Total and conjugated bilirubin AST, ALT, GGT, ALP Blood group and coombs α1 Antitrypsin phenotype (not level) Blood sugar q4 hours first 24hours Guthrie card result review Maternal Hepatitis B status Download printable pdf of First Line Second line investigations conjugated Hyperbilirubinaemia Hepatitis A Virus IgM Epstein Barr Virus serology Urine calcium/Phosphate creatinine ratio Download printable pdf of Second Line Investigations Third line investigations conjugated Hyperbilirubinaemia (repeat if normal & suspect diagnosis)
Very long chain fatty acids White Blood Cell enzymes if indicated Download printable pdf of Third Line All infants with conjugated hyperbilirubinaemia are started on Vit A, D, E, K Early consideration for starting MCT based formula All infants undergoing investigation of conjugated hyperbilirubinaemia should commence fat-soluble vitamin supplementation as soon as possible. Available preparation: Vitadol C® = 2000 micrograms vitamin A per gram = 1 ml =7500 IU Starting dose is 1ml once daily NB: Vitadol C® is only partially subsidised in the community; families should be informed they will be required to pay a part charge for this medicine. Starting dose = 30-50 nanograms/kg once a day rounded to Available preparation = Alfacalcidol (One-Alpha drops®) = 100 nanograms of 1-alpha-OH vitamin D3 per drop. NB: This preparation should be prescribed in drops. Starting dose = 50 mg (68 IU) once a day.