The patient in the icteric phase of hepatitis asks the nurse, "Why are my stools no longer brown?" How should the nurse respond?
1. "Your liver isn't making any of the substance that makes stools brown."
2. "The pigment is backing up into your blood and turning your skin yellow."
3. "It is being released into your bloodstream and turning your blood darker red."
4. "The answer is not known. More research is needed regarding this question."
Correct Answer: 2
The icteric (jaundiced) phase usually begins 5 to 10 days after the onset of symptoms. It is heralded by jaundice of the sclera, skin, and mucous membranes. Inflammation of the liver and bile ducts prevents bilirubin from being excreted into the small intestine. As a result, the serum bilirubin levels are elevated, causing yellowing of the skin and mucous membranes. The stools are light brown or clay colored because bile pigment is not excreted through the normal fecal pathway. Instead, the pigment is excreted by the kidneys, causing the urine to turn brown. The liver continues to make bilirubin, even during hepatitis. The blood does not become darker when bilirubin levels are elevated. The cause of this phenomenon is known.
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