Icterus

Definition

Icterus (jaundice) is the yellow discoloration of the skin, sclera, and mucous membranes caused by elevated serum bilirubin. Best assessed in the sclera and under the tongue, especially in darker-skinned patients.

Types

• Pre-hepatic: Hemolysis. Elevated unconjugated bilirubin.
• Hepatic: Hepatitis, cirrhosis.
• Post-hepatic (obstructive): Gallstones, tumor.

Assessment

Examine sclera in natural light; palpate for hepatomegaly, splenomegaly; inspect urine (dark) and stool (clay-colored if obstructive). Obtain LFTs, bilirubin (total/direct), CBC, coagulation, imaging as indicated.

Nursing Considerations

Address pruritus (cool environment, cholestyramine, soft fabrics, lotions). Assess for bleeding (synthetic dysfunction → decreased clotting factors). Treat underlying cause. Phototherapy for neonatal hyperbilirubinemia.

NCLEX Relevance

Assess sclera for jaundice, especially in darker-skinned patients.