Name : Sheren Alexis

NIM : 01071180186

Jaundice, also known as icterus, is a yellowish or greenish pigmentation

of the skin and whites of the eyes due to high bilirubin levels.[ Jaundice
normally indicates a problem with the liver or bile duct. Bilirubin is a yellow
pigment formed from red blood cells that die in the liver. Usually, jaundice
is experienced by babies.

Accompanying symptoms of jaundice resulting from low bilirubin levels

include:
 fatigue.
 abdominal pain.
 weight loss.
 vomiting.
 fever.
 pale stools.
 dark urine.

If contacted with kernicterus

Kernicterus is a type of brain damage most often seen in babies.
It’s caused by an extreme buildup of bilirubin in the brain.
Kernicterus is much rarer. It involves dangerously high bilirubin
levels.
Kernicterus is a medical emergency. Babies with this condition
need to be treated right away to bring down their bilirubin levels
and prevent further brain damage. Kernicterus symptoms are
more severe. Kernicterus is caused by severe jaundice that isn’t
treated.

VITAMIN -> M = Metabolic

why it leads to metabolic disorders?

->Jaundice is divided into three types, namely pre-hepatic, intra-hepatic, and post-
hepatic.
 Pre-hepatic jaundice occurs when red blood cells break down too quickly
before the time so that bilirubin levels increase rapidly.
 Intra-hepatic jaundice occurs when the liver is damaged so that the organ's
ability to process bilirubin becomes disrupted.
 Post-hepatic, occurs due to a disturbance in the bile duct so that bilirubin
is not completely wasted into the digestive tract.
 Tender ( Medical
Definition )
Costal margin
Sensitive or painful as a
result of pressure or contact that is not sufficient to
cause discomfort in normal tissues. Pain or

 The presence of the liver 2 cm

or more below the costal margin
was considered abnormal, since
this organ was found no more
than 1 cm in a few normal
subjects only by auscultatory
percussion.

discomfort when an affected area is touched.

Diagnosis
Your doctor will do a physical exam to see if your liver is larger than it should be. He
may also order some blood tests to help figure out what's causing it.

In children and adults, the normal value of direct bilirubin is 0 - 0.4 mg

per deciliter (mg / dL). The normal total bilirubin value is 0.3 - 1.0 mg /
dL. Normal bilirubin in newborns will be below 5 mg / dL, but many
newborns have several types of jaundice and bilirubin above 5 mg / dL.

In my opinion it is more suitable to be examined through USG because usually used

to detect stones, cysts, tumors, deformities, infections, excess fluid
collection, obstruction / obstruction of organs, block / clot in blood vessels
etc. (related mainly to the liver).
Inflammation or fatty liver. This could be from:

 Obesity
 An infection
 Some medications or alcohol
 Toxins
 Autoimmune disease (your body's immune system attacks healthy tissue)
 Metabolic syndrome (a group of risk factors for heart disease that includes high
blood pressure, blood sugar, and cholesterol levels, and belly fat)
 Genetic disorders that cause fat, protein, or other substances to build up

Abnormal growths may cause an enlarged liver. These may be due to:

 Cysts
 Tumors that start in or spread to the liver
 An enlarged liver is one that's bigger than normal. The medical term is
hepatomegaly (hep-uh-toe-MEG-uh-le). Rather than a disease, an enlarged liver is
a sign of an underlying problem, such as liver disease (Cirrhosis ,Hepatitis) ,
congestive heart failure or cancer(Cancer that begins in another part of the
body and spreads to the liver, Leukemia, Liver cancer, Lymphoma),
Bile duct or gall bladder obstruction.
When enlarged liver results from liver disease, it might be
accompanied by:

 Abdominal pain

 Fatigue

 Nausea and vomiting

 Yellowing of the skin and the whites of the eyes (jaundice)

Abdominal Examination

1. Exposure
2. Lighting and position
3. General Inspection
Observe for clues around the bed (Drains, vomit, NG tube),
body habitus ( healthy, obese, cachectic), jaundice
(hepatic/biliary disease), abdominal distension
Inspect the abdomen
Scars, distension, masses,
4. Light Palpation
Note any masses/tenderness//guarding. Observe the
patients face for signs and discomfort.
Deep Palpation
Assess size/shape/consistency of any masses found.
Liver Palpation
Feel the liver edge and note the degree of extension below
the costal.
margin(cm).
Splenic Palpation
Feel for the splenic edge moving
towards your index finger during inspiration.
5. Percussion
Percuss the borders of the liver (to estimate size), percuss
the spleen, percuss the bladder (to assess for bladder
distension)
6. Auscultation
Listen for bowel sounds(absent if none noted within 2
minutes), listen for aortic bruits,listen for renal bruits
The average liver size varies by age and can be:

 8.5 cm for 1–5 years

Shortness of breath is a common complaint in those with chronic
liver disease which is very common due to liver disease, one
of them is hepatitis, it can also be due to other diseases . A
common cause of liver enlargement in children is the
hepatitis virus. Usually occurs around 6 months or more.
This leads more to Hepatomegaly, which is enlargement of
liver size. This condition generally occurs due to liver
disease, one of which is hepatitis. In which one of the
symptoms of Hepatomegaly is Skin and yellowish eyes.

Hepatocytes (parenchymal cells) are the basic structural

component of the liver, representing 60% of the total cell number
and 80% of the total liver volume.
1. The bile duct is a channel that connects the liver and gallbladder (where
bile is stored).
2. The gallbladder is located just below the liver and serves to store bile
that is produced by the liver.
3. Blood vessel, blood from organs such as the spleen, pancreas,
gallbladder and intestine converge in the hepatic portal vein.