Jaundice is the yellowish pigmentation of the skin, mucous membranes and of the white eyes caused by superior levels of the chemical bilirubin in the blood. Bilirubin is the yellow colored substance which is responsible for the yellowish staining of the skin and sclerae in jaundice. It is a waste product which remains in the bloodstream after the iron is removed from hemoglobin in red blood cells. When there is an overload of bilirubin, it will leak out into the surrounding tissues, saturating them with the yellow substance. One of the main functions of the liver is to filter out waste products like bilirubin, from the blood. When the bilirubin gets into the liver then the other chemicals get latched on to it which creates a substance called conjugated bilirubin. The conjugated bilirubin is secreted in bile and then excreted.The term jaundice is derived from the French word “jaune”, which means yellow. Jaundice is not a disease but is a visible sign of a primary disease process. It is also known as Icterus and is commonly associated with itchiness. Jaundice will be visible when the level of bilirubin in the blood exceeds 2.5-3 mg/DL. In adults, jaundice can be caused by the variety of medical conditions. Some causes are quite serious and potentially life-threatening. The product of bilirubin gives feces(stool) its brown color.
Causes of jaundice
Jaundice in adults can be caused by various medical conditions which can affect the normal metabolism or excretion of bilirubin. Bilirubin is mostly formed by the daily breakdown and destruction of RBC (red blood cells) in the bloodstream, which releases haemoglobin as they come apart. The heme segment of this hemoglobin molecule is then transformed into bilirubin, which is transported in the bloodstream to the liver for more metabolism and excretion. In the liver, the bilirubin is conjugated and is excreted into the gallbladder, then into the intestines. In the intestines, a part of the bilirubin is excreted in the feces and some are metabolized by the intestinal bacteria and excreted in the urine. Some of the conditions are as follows:
- Inflammation of the bile duct
- Acute inflammation of the liver
- Obstruction of the bile duct
- Gilbert’s syndrome
- Hemolytic anaemia
- Dubin-Johnson syndrome
- Crigler-Najjar syndrome
Types of Jaundice
There are three types of jaundice and they are:
- Hepatocellular jaundice
- Hemolytic jaundice
- Obstructive jaundice
Diagnosis of Jaundice
Basically, diagnosis of jaundice is based on the patient’s history and physical examination, paying close attention to the abdomen. Doctors will check for tumors in the abdomen and check the firmness of the liver. A firm liver indicates cirrhosis and a rock hard liver indicates towards cancer.
The harshness of jaundice is determined by some tests, the first test is liver function test which is conducted to find out whether or not the liver is functioning properly.
If the reason for the symptoms cannot be identified, a doctor may need blood tests to check levels of bilirubin and estimate the composition of the blood. Some of these tests include:
- Bilirubin tests
- Full blood count (FBC), or complete blood count (CBC)
- Hepatitis A, B, and C tests
If an impediment of the liver is suspected, the liver’s structure will be checked with the help of imaging tests. Some of these tests include:
- MRI scans
- Abdominal ultrasonography (ultrasound)
- CT or CAT scan
- Endoscopic retrograde cholangiopancreatography
A liver biopsy is quite a lot useful in checking the inflammation, cancer, fatty liver and cirrhosis. This test involves injecting a needle all the way through the skin and into the liver to get a sample of the tissue, which is later examined under a microscope.
The treatment for jaundice depends completely on the underlying cause. Once a diagnosis has been recognized, the suitable course of treatment can then be initiated. Certain patients will have need of hospitalization, whereas others can be treated at home.
- In some individuals with jaundice, the treatment will consist of supportive care and can be managed at home. For example, most cases of mild viral hepatitis can be treated at home with watchful waiting and close monitoring by the doctor.
- End of alcohol consumption is necessary for patients who have cirrhosis and alcoholic hepatitis,
- Jaundice caused by drugs/medications/toxins will have the need of discontinuation of the offending agent.
- A variety of medications may be used to treat the conditions which may lead to jaundice, such as steroids in the treatment of some autoimmune disorders.
- Antibiotics may be necessary for infectious causes of jaundice, or for the complications connected with certain conditions leading to jaundice.
- Blood transfusions may be essential in individuals with anemia from hemolysis or as a consequence of bleeding.
- Individuals who are suffering from cancer, leading to jaundice will have need of consultation with an oncologist, and the treatment will differ depending on the type and stage of cancer.
- Surgery and various insidious procedures may be needed for certain patients with jaundice. For example, certain patients who have gallstones may require surgery. Other individuals with liver failure/cirrhosis may have need of a liver transplant.
Certain patients who suffered from jaundice will not suffer any kind of long-term effects and get fully recovered, while for some others jaundice can be the first sign of a life-threatening condition. Some of the potential complications are as follows:
- Electrolyte abnormalities
- Liver failure
- Chronic hepatitis
- Kidney failure
- Brain dysfunction
There are certain measures which can be followed to prevent the risk of jaundice and some of them are listed below:
- Taking medicines as instructed and prescribed by the doctors in order to prevent the potential risk of liver damage.
- Avoid unprotected sexual intercourse or intravenous drug use. Implement precautions while working with needles and blood products. This will help in decreasing the risk of hepatitis B or C.
- Take vaccines against hepatitis A and B.
- Avoid contaminated food products or unsafe drinking water.
- While traveling to the areas where malaria is viral then it is better to take the recommended precautions and medications in order to prevent malaria.
- Consumption of alcohol should be done responsibly. Consuming alcohol in huge amount will damage the liver and will not function properly, which will increase the risk of alcoholic hepatitis, alcoholic cirrhosis and pancreatitis.
- Avoiding cigarette smoking is another preventive measure.