Symptoms of a Biliary Colic: Bilirubin in Urine, Steatorrhea, and Jaundice (Nursing)

00:01 Now, some other symptoms where we talked about the things that look weird.

00:04 Yeah, we're gonna look at your pee, your poop, and your skin.

00:08 So, the urine is gonna look kinda this weird amber color.

00:12 It might even be kinda foul-smelling.

00:14 Your stool is gonna be gray-colored.

00:17 This is because you've got a lot of undigested fats in it.

00:20 Now, you see the color up there.

00:22 That's a pretty good tone for what you're looking for with gray stool.

00:26 We used to teach clay-colored stool, but then I was teaching in Oklahoma.

00:33 You know what we have here? Red dirt.

00:36 So, as we were teaching clay-colored stool, students were picturing red stool.

00:41 So, once we put that together, I had to be very specific and say, "In other parts of the country, they probably call it clay-colored stool, but in Oklahoma, we call it gray stool," so you know exactly what shade you're looking for.

00:55 Remember, it's got that funny color because it has undigested fats.

01:00 Why does it have undigested fats? Remember that stone is blocking the bile from getting down to the small intestine so it can be digested. Now, this one is the most obvious.

01:13 People don't usually like to talk about the color of what they're dropping into the toilet, but the skin is gonna be really obvious. They might have jaundiced skin or sclera.

01:23 So, the whites of their eyes become kinda yellowish or pumpkin-colored.

01:28 Same thing with their skin.

01:30 So, I know this is a list, but I wanted you to understand the why behind each of these changes.

01:36 I don't want you memorizing lists because that never works long term.

01:40 I want you to have these results in your mind long term for exams, but most importantly, when you take care of patients.

01:48 So, let's talk about the urine first, urine and bilirubinuria.

01:52 Okay, so bilirubinuria is an end product of the breakdown of bilirubin.

01:59 Okay, do me a favor. Circle the word bilirubin. Good.

02:03 Okay, so what bilirubinuria is, it's an end product when we breakdown bilirubin.

02:09 Now, let's talk about bilirubin for just a minute.

02:12 Remember, when old red blood cells are being broken down, like they've served their purpose, they've delivered oxygen to all the tissues, they're done.

02:21 Now, they're gonna be broken down. Bilirubin is a part of that process.

02:26 Right, that same bilirubin that's right in your definition.

02:29 So, bilirubin is an orange yellowish pigment formed in the liver by the breakdown of hemoglobin and it's excreted in the bile.

02:39 Okay, so let's back that up and make sure you got that this is what's gonna start to make sense why you have the color changes.

02:47 So, bilirubinuria is an end product of breaking down of bilirubin.

02:52 What's bilirubin? Remember, bilirubin is when old red blood cells are broken down and bilirubin is a part of that process. So, what color is bilirubin? Well, it's orange and yellow pigment.

03:07 That's formed in the liver when you're breaking down the hemoglobin and it's dropped into the bile.

03:13 So, if anything interrupts the process of that bile making it down to the small intestine to be continued to be processed, that's why we have color changes.

03:23 So, you're back to bilirubinuria, it's the end product of the breakdown of bilirubin, it's a yellow pigment, and normal levels are right there for you on the screen, right? 0.1-1.0 mg/dL in urine. So, if I took a urine sample and I tested it, that would be the normal level of bilirubinuria.

03:42 If I've got somebody who's got that bile blocked, when I test their urine, that level would be much lower.

03:52 Okay, so you got bilirubin.

03:54 It's a waste product when the liver breaks down those red blood cells.

03:58 Now, and the liver conjugates bilirubin. That's right.

04:02 It takes it from a non-water soluble form and makes it water soluble so you can pee it out.

04:09 So, that's what conjugate means.

04:10 The liver conjugates the bilirubin, makes it water soluble, and now it becomes part of the bile. Okay, so you're with us.

04:18 I know this is a lot of review of bilirubin, but it's gonna make lab work so much simpler for you.

04:25 So, you see, you've got up there, just to remind you, we've got the liver, the gallbladder, we've got the small intestine, and the pancreas.

04:32 But now I want you to take it -- look at the urine and the color changes that you should look for.

04:38 Okay, we've got our line up of five bladders, right? On the left, you've got the classic light yellow all the way over to what it looks like with red or blood in it.

04:49 Okay, we put these up here just as another reminder for you of what urine should look like and then what unusual cases or examples of urine are.

04:59 Now, if the patient has total bile obstruction, like it is completely blocked, that stone is it's like a plug in the duct.

05:09 Bilirubin doesn't make it to the small intestine so it's not converted to bilirubinuria.

05:15 That's one reason. So, remember, instead or bilirubinuria, the kidneys will excrete bilirubin and that's what makes that weird amber brown urine. Okay? So, I'm looking at the patient's urine, if it has an odd or a strange color, that's because there could be a total bile obstruction, it's not making it through the processing, and that's what changes the color of the urine.

05:39 And onto the next waste product, stool. Now, the stool is gray-colored.

05:46 Remember, I don't say clay-colored anymore, it's gray-colored because of the presence of undigested fats.

05:52 If that bile is obstructed, then bilirubin doesn't make it down to the small intestine, and when you've got lot less pigment or no pigment, that's why you have that light or clay-colored stool.

06:04 Now, this is an unattractive word. Steatorrhea or fatty stools.

06:10 That's how they get their name.

06:12 So, if you're documenting, if you are charting what this look like, this is what you would chart.

06:17 Gray color, appears to be steatorrhea, which we all know is fatty stools.

06:21 That's those undigested fat components. You can actually -- they're noticeable.

06:26 You can see them in the stool because not enough bile made it to the small intestine to help digest those fats.

06:32 See, when this happens and it's obstructed the bile, we've told you why the urine has a funny color, we've told you why the stool has a funny color, but what do you think happens to all that bilirubin while it backs up? And that's why we've got the picture visual for you there with a big sign that says backup because when bilirubin can't make it down, can't travel down to the small intestine, so it can be broken down and excreted, it will back-up into other areas.

07:04 So, circulating blood levels of bilirubin will begin to rise.

07:09 This is a big problem and the reason for another change in your lab work.

07:14 Look at what you've got going with skin.

07:16 This is the reason that skin has changed.

07:19 This is the reason that your sclera is changed.

07:21 When that bile flow is blocked, remember, it's gonna back up into the blood stream and it starts to be evident in the color of the patient's skin and in their eyes.

07:30 Now, this is a pretty significant case.

07:33 Some people can have a gallbladder attack and they're not jaundiced and their eyes aren't yellow, but if someone has severe blockage, this is a sign that we have a big problem that needs to be dealt with pretty quickly.