Jaundice: Nursing

Jaundice, also called icterus, is characterized by yellowish discoloration of the skin, mucous membranes, and the sclera, due to the deposition of bilirubin.

Now, let’s go over some physiology. Bilirubin is a yellowish pigment that’s normally found in bile, and is produced in the liver by breaking down hemoglobin from red blood cells.

Normally, red blood cells have an average lifespan of 120 days. When red blood cells get old or damaged, they travel to the spleen, where they are broken down to release hemoglobin. The hemoglobin is degraded into unconjugated or indirect bilirubin, which is then released into the bloodstream.

Unconjugated bilirubin then travels to the liver, where it gets taken up by hepatocytes. These cells bind a molecule called glucuronic acid to the unconjugated bilirubin, forming conjugated or direct bilirubin. Then, the hepatocytes use this conjugated bilirubin, as well as cholesterol and phospholipids, to produce bile. Then, bile is secreted by the liver through the hepatic bile ducts towards the gallbladder, where it’s stored.

Now, when food reaches the stomach, the gallbladder secretes bile through the cystic and common bile duct into the duodenum. The bile then mixes with the food to help digestion while traveling along the intestines.

Ultimately, upon reaching the colon, the colonizing bacteria convert bile’s conjugated bilirubin into urobilinogen. Most of that urobilinogen gets reabsorbed into the blood and travels to the kidneys, where it gets excreted into the urine, giving it its distinct yellow color.

The urobilinogen that remains in the colon gets further converted by colonizing bacteria to stercobilinogen, which is excreted into the feces, giving the distinct brown color.