By: Dr. Anurudh Verma (Sr. Associate Editor-ICN Group)
LUCKNOW: Jaundice, also known as icterus, is a term used to describe a yellowish tinge to the skin and sclerae (the white part of the eye) that is caused by an excess of bilirubin in the blood (hyperbilirubinemia).
The color of the skin and sclerae varies depending on levels of bilirubin; mildly elevated levels display yellow skin and sclerae, while highly elevated levels display brown.
Causes of jaundice
Jaundice most often occurs as a result of an underlying disorder that either causes over production of bilirubin or prevents the liver from disposing of it, both of which result in bilirubin being deposited in tissues.
Some underlying conditions that may cause jaundice are:
- Acute inflammation of the liver – may impair the ability of the liver to conjugate and secrete bilirubin, resulting in a buildup.
- Inflammation of the bile duct – may prevent the secretion of bile and removal of bilirubin, causing jaundice.
- Obstruction of the bile duct – prevents the liver from disposing of bilirubin.
- Hemolytic anemia – production of bilirubin increases when large quantities of red blood cells are broken down.
- Gilbert’s syndrome – an inherited condition that impairs the ability of enzymes to process the excretion of bile.
- Cholestasis – a condition where the flow of bile from the liver is interrupted. The bile containing conjugated bilirubin remains in the liver instead of being excreted.
More rare conditions that may cause jaundice include:
- Crigler-Najjar syndrome – an inherited condition that impairs the specific enzyme responsible for processing bilirubin
- Dubin-Johnson syndrome – an inherited form of chronic jaundice that prevents conjugated bilirubin from being secreted out of the liver’s cells
- Pseudojaundice – a harmless form of jaundice in which the yellowing of the skin results from an excess of beta-carotene, not from an excess of bilirubin; usually from eating lots of carrots, pumpkin, or melo
Symptoms of jaundice
- Yellow tinge to the skin and the whites of the eyes, normally starting at the head and spreading down the body
- Pruritis (itchiness)
- Fatigue
- Abdominal pain – typically indicates a blockage of the bile duct
- Weight loss
- Vomiting
- Fever
- Paler than usual stools
- Dark urine
Types of jaundice
There are three main types of jaundice:
- Hepatocellular jaundice – occurs as a result of liver disease or injury
- Hemolytic jaundice – occurs as a result of hemolysis (an accelerated breakdown of red blood cells) leading to an increase in production of bilirubin
- Obstructive jaundice – occurs as a result of an obstruction in the bile duct (a system of tubes that carries bile from the liver to the gallbladder and small intestine), which prevents bilirubin from leaving the liver
Diagnosis of jaundice
Jaundice is initially diagnosed through the following methods:
- Medical history – the doctor will ask a series of questions about the severity and duration of symptoms, your diet, when they started and how often they occur.
- Physical examination – a doctor will examine the person with suspected jaundice to see if an obvious cause can be determined through the physical examination of different parts of the body
- Blood test – a blood test will be requested to measure levels of bilirubin and other liver and bile duct substances in the blood to determine if there are any problems.
Further tests can be recommended if these do not provide an exact cause:
- CAT scan – a computerised tomography scan produces clear images of the liver and bile duct
- Liver biopsy – a small portion of liver tissue is removed to examine if a serious problem with the liver is suspected (including malignancy
- MRI – an MRI test produces clear images of the liver and bile duct
- Ultrasound – an ultrasound test produces clear images of the liver and bile duct
Complications in Jaundice
If the preventive measures or jaundice treatment is not taken in time then it can lead to following complication
- Acute bilirubin encephalopathy:
Bilirubin becomes toxic to cells of the brain. If a baby is suffering from serve jaundice, there is a risk of bilirubin that pass in to the brain, a situation is known as acute bilirubin encephalopathy.
Indications of acute bilirubin encephalopathy in a baby with jaundice:
- Poor sucking or feeding.
- Fever
- Vomiting
- High-pitched of crying.
- Backward arching of the neck and body.
- Listlessness or difficult in waking.
- Kernicterus:
It is the syndrome that develops when acute bilirubin encephalopathy that leads to permanent damage to the brain. It results in:
- Hearing loss.
- Permanent upward gaze.
- Improper development of the tooth enamel.
- Involuntary and there is uncontrolled movements.
Risk factors
- Premature birth.
- Blood type.
- Breast-feeding.
- Significant brushing during brushing.
Management :-Constipation should be avoided. If needed, enema should be given.Patient should be kept on simple diet. ensure your home has adequate supply of foods which are low fat (unprocessed) and that there are plenty of vegetables and fruits to eat every day.
The antioxidants and other nutrients in the vegetables and fruit are needed by your partner to aid their recoveryFish, meat, egg, ghee should be avoided. Fruit juice including canejuice should be preferred.
(To Be Continued…)
