Jaundice

Jaundice



Definition of Jaundice

 

Also known as Icterus, Jaundice is yellowish pigmentation of skin, membrane over Sclera (Whites of eyes) and mucous membranes caused by increased level of Bilirubin in blood (Hyperbilirubinemia). Concentration level of Bilirubin is normally 1.2 mg/dL in blood plasma. Concentration higher than that of 2.5 mg/dL leads to Jaundice. Jaundice is normally found in liver diseases like Hepatitis or Liver cancer. Jaundice also refers to Leptospirosis or Biliary tract obstruction. Common example of which are as follows.

  • Gallstones or pancreatic cancer

  • Biliary Atresia

Yellow discoloration of hands or soles instead of Sclera and mucous membranes is due to Carotenemia. It is a harmless condition and is helpful to differentiate from Jaundice. Jaundice can occur due to variety of reasons among some of which can prove serious even life threatening. Neonatal Jaundice is a condition common in newborn babies. It is benign in nature and tends to disappear without serious after effects.  

 

Cause of Jaundice

 

Jaundice is caused by variety of medical conditions affecting normal metabolism and Bilirubin excretion. Bilirubin is produced by breakdown of red blood cells in blood. This breakage releases Hemoglobin upon rupture. Hemo portion of it is converted into Bilirubin that is transported from blood stream to liver. If there is dysfunctioning of Bilirubin, this causes Jaundice. Causes for Jaundice have been classified into the following three.

 

Pre-Hepatic:

The cause of Jaundice in Pre-Hepatic phase is due to Hemolysis (excessive destruction) of red blood cells from various conditions. The rapid increase in levels of Bilirubins leads to incapability of liver to properly metabolize the bilirubin. This leads to unconjugated bilirubin increase. The conditions that lead to this hemolysis of red blood cells are as follows.

  • Malaria

  • Sickle Cell Disease

  • Thalassemia

  • Drugs

  • Autoimmune disorders

  • Glucose 6 phosphate dehydrogenase deficiency (G6PD)

 

Hepatic:

During Hepatic Phase Jaundice is caused by abnormalities in metabolism and excretion of Bilirubin. This phase leads to increase in levels of both conjugated and unconjugated bilirubin. Conditions which cause Hepatic jaundice are as follows.

  • Hepatitis commonly viral (Hepatitis A, B, C, D, E) or alcohol related.

  • Cirrhosis

  • Crigler-Najjar syndrome

  • Gilbert’s Syndrome

  • Liver cancer

  • Autoimmune disorders

 

Post-Hepatic:

Jaundice of Post-Hepatic cause arises due to drainage disruption and excretion of conjugated bilirubin in form of bile from liver into intestines. This results in increase levels of conjugated bilirubin in blood stream. Condition causing post-hepatic jaundice is as follows.

  • Gallstones

  • Cancer e.g. Pancreatic Cancer, Gallbladder Cancer and Bile duct Cancer.

  • Cholangitis

  • Parasites like Liver Fluke

  • Pancreatitis

Signs and Symptoms of Jaundice

 

Jaundice itself is not a disease instead it is a visible sign of an underlying disease process. Depending upon causes of jaundice, patients exhibit different symptoms. Some patients may have very few while others may suffer from severe symptoms. Patients of jaundice can experience following symptoms.

  • Pale colored stools

  • Urine of dark color

  • Itching of skin

  • Nausea and vomiting

  • Anal bleeding

  • Constipation

  • Fever

  • Chills

  • Weakness

  • Loss of appetite

  • Pain in abdominal region

  • Headache

  • Swelling of legs and abdomen

 

Risk Factors for Jaundice

 

Risk factors for developing jaundice are based upon the under laying cause. Some of these risk factors are as follows.

 

Hereditary conditions:

People who have certain hereditary conditions are at increased risk for developing jaundice through Hemolysis. The conditions are as follows.

  • Thalassemia

  • Hereditary spherocytosis

 

Alcohol consumption:

Person who heavily consumes alcohol is at high risk for developing following conditions.

  • Alcoholic Hepatitis

  • Pancreatitis

  • Cirrhosis

All these conditions puts the person at risk of jaundice.

 

Exposure to viral diseases:

People who are at risk for developing viral diseases like Hepatitis B or C are also at risk for developing jaundice.

 

Premature birth:

Baby born as a result of premature birth is at risk of jaundice. He/she is unable to process bilirubin and have fewer bowel movements those results in less bilirubin excretion through stool.

 

Blood type:

If the blood type of baby is different than that of mother than baby may receive antibodies through Placentia which can cause baby’s blood cells to break down more quickly. This puts the infant at higher risk for Jaundice.

Diagnosis of Jaundice

 

A comprehensive medical diagnosis is required to determine the cause of jaundice. The initial steps for diagnosis of jaundice include the following.

  • History of illness

  • Physical exam to determine cause of jaundice

  • Blood testing that includes Liver function tests, CBC (complete blood count) electrolyte panel and lipase levels.

  • Urinalysis

Depending upon the results of this initial diagnosis further evaluation is needed for diagnosing underlying disease. Imaging studies are needed to diagnose abnormalities of liver, gallbladder, and pancreas. These imaging studies include the following.

  • Ultrasound

  • CT (Computerized tomography) scan

  • MRI (Magnetic resonance imaging)

Invasive diagnosis to determine cause of jaundice includes following procedures.

  • Endoscopic retrograde cholangiopancreatography (ERCP)

  • Liver biopsy

 

Prevention from Jaundice

 

Some of the measures that can be taken to prevent risk of developing jaundice are as follows.

  • Intake of medication as instructed by doctor to prevent potential liver damage.

  • Avoid high risk behaviors like unprotected intercourse and intravenous drug use.

  • Implementation of precautions while working with blood products and needles.

  • Take vaccination for Hepatitis A and B.

  • Avoid contaminated food products and unsanitary water.

  • When traveling to areas more prone to malaria, always take precautions and medications to prevent development of malaria.

  • Avoid smoking as it causes risk for pancreatic cancer and many other conditions.

 

Treatment Of Jaundice

The treatment of jaundice depends upon the underlying cause. After the diagnosis appropriate course of treatment is started. Following are some of the treatments for jaundice.

 

Care at Home:

In certain individual with jaundice, treatment can be managed at home. For example mild viral hepatitis can be monitored at home.  

 

Alcohol Cessation:

Quitting alcohol is necessary in patients suffering from Cirrhosis, alcoholic hepatitis or acute Pancreatitis.

 

Antibiotics:

Antibiotics are used for infectious causes of jaundice. Complication like Cholangitis that lead to jaundice also needs use of antibiotics.

Blood transfusion:

Patients suffering with Anemia from hemolysis or bleeding require blood transfusion.

 

Surgery:

Surgery and various other invasive procedures are required for treatment of certain patients of jaundice. Patients with gallstones require surgery. Patients with liver failure require liver transplant.