Jaundice

Jaundice is a condition that causes yellowish color of the skin and the eyes due to increased levels of bilirubin in blood. This is known as hyper-bilirubinemia. As such jaundice is not a disease but it indicates the underlying medical condition. It can develop due to several medical issues and sometimes it can be life threatening causing death. Exact cause of jaundice is to be determined to start suitable treatment.

In healthy condition, the level of bilirubin in blood would be 3-20 per liter but when jaundice develops the level would go beyond 35 -40 mo/L. Jaundice is caused by pre-hepatic, hepatitis and post hepatic conditions. Jaundice needs to be treated after knowing the underlying medical causes. Neonatal jaundice is common in newborns but it is harmless and does not cause serious effects.

Causes :

Whenever the metabolism of bilirubin in the blood is disturbed it can cause jaundice. Bilirubin is a component produced during the breaking up of red blood cells and they release hemoglobin in this process. It is the heme that gets metabolized into bilirubin which is then released into the blood. When they reach liver, the bilirubin is further broken down and sent into the intestines. A portion of birlirubin is expelled in the form of feces and other part is further metabolized to get expelled through urine.

If there is any dysfunction in the above metabolism it can cause accumulation of bilirubin leading to jaundice. Basically problem can occur in 3 different stages namely

  • Metabolism of bilirubin can get disturbed before they are sent to the liver (pre hepatic)
  • Metabolism can get dysfunctional in the liver (hepatic)
  • Metabolism of bilirubin can get affected after it is sent from the liver (post hepatic)

Pre Hepatic :

Various medical conditions can cause hemolysis (loss of red blood cells) which can lead to increase in the level of bilirubin. The liver would become incapable to metabolize such extreme high levels of bilirubin causing jaundice. Malaria, thalassemia, sickle cell disease, exposure to toxins and G6PD deficiency and certain other autoimmune disorders can affect the normal level of bilirubin in the blood.

Hepatic :

Jaundice can develop due to increase in the conjugated or un-conjugated levels of bilirubin. Hepatitis infection caused by virus, liver cirrhosis (due to over consumption of alcohol), Crigler Najjar syndrome, certain drugs and liver cancer can cause abnormality in the functions of liver leading to jaundice.

Post Hepatic Factors :

If there is disruption of normal functions of excretion of bilirubin (which is now changed into bile) from the liver, it can cause jaundice. Any medical conditions that affect the functions of bile ducts or pancreas like gallstone formation, pancreatitis, bile duct cancer, cholangitis and parasitic infection of pancreas can lead to jaundice.

Symptoms :

The major symptom of jaundice is the yellowish coloration of the skin. It can be mild to moderate and severe based on the medical issues inside. The mucus membranes turn yellow in color and for many people the white portion of the eyes will turn yellow. The symptoms are not the same for all people it varies with individual’s health condition and intensity of the problem.

Some other common signs of jaundice are diarrhea, nausea, vomiting, itching or skin, change in normal color of the skin (dark), bleeding of rectum, fever, chills, loss of weight, loss of appetite, mild confusion of thoughts, swelling of abdomen and legs.

Who are at risk?

A person with hereditary disorder like thalassemia is more prone to get jaundice than others. Hereditary spherocytosis can also cause jaundice. A person who drinks alcohol heavily is at high risk of developing jaundice and cirrhosis. People who get infected with virus hepatitis of A, B, or C is prone to develop liver problems and jaundice.

Diagnosis :

It is difficult to determine the underlying medical condition that causes jaundice. Your doctor will complete the physical exam and order for series of tests like blood count, urine analysis, and liver function test and electrolytes level. In addition he may request for more tests like ultrasound scanning of the liver, pancreas and gallbladder to rule out any abnormalities. Further you may be asked to undergo CT or MRI scan based on the results. If required, he may do a liver biopsy by collecting a small tissue sample from your liver.

Treatment :

Treatment options may vary with individual and based on the underlying medical issues. Your doctor is the right person to devise suitable plan for treating jaundice. Some people are hospitalized if they have severe symptoms and most of them can be treated as outpatients. Antiviral medications are given if jaundice has developed due to hepatitis infection. The person will be asked to repeat certain tests mentioned above and the results are compared and monitored closely.

If the underlying cause is alcohol consumption, you will have to quit drinking with the help of your doctor. Alcoholic hepatitis and pancreatitis can develop due to alcohol abuse. Overdose of certain medications and toxins can cause jaundice. In such cases proper antidote is given. Corticosteroids are often prescribed for treating jaundice developed from autoimmune disorders. For patients with severe anemia, blood transfusion is to be done based on their symptoms and test results. If liver cancer or pancreatic cancer has caused jaundice, your doctor will initiate suitable treatment like surgery or chemotherapy. In serious cases, gallstone surgery and liver transplantation is done for saving the life of the patient.

Complications :

For many people, jaundice can be mild to moderate and for some it can cause potential life threatening complications like severe anemia, sepsis, internal bleeding, and abnormal levels of electrolytes, chronic hepatitis, liver/kidney failure and even death.

Prevention :

You cannot totally prevent development of jaundice but you can always reduce the risk factors. Do not take overdose of medications and consult your pharmacist or GP in case of doubt. People with G6PD problem should be very careful in using certain medications. Avoid having unprotected sex with strangers and do not share needles since you are at risk of developing autoimmune disorders.

Vaccination is available for hepatitis and you can prevent developing it. Practice good hygiene while using public toilets and eating food/water. Avoid traveling to areas prone to malarial epidemic. If you are habitual drinker, reduce the intake of alcohol immediately with the help of your doctor/counselor. Quit smoking and drinking since both can harm your lungs and liver.

Prognosis :

Jaundice can become fatal if there is delay in treatment and if the diagnosis is not made correctly. Prognosis of jaundice varies squarely with the individual’s case history. There are many patients who have recovered fully from jaundice but there are some serious cases that are fatal.

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