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| Jaundice |
Jaundice is yellowish discoloration of the skin, sclera and mucous membranes due to hyper bilirubinemia and deposition of bile pigments. Equilibrium between bilirubin production and clearance is disturbed. Serum bilirubin level greater than 2mg/dL. Jaundice is NOT a disease, but rather a sign that can occur in many different diseases.
What is Bilirubin
Bilirubin is a yellowish pigment found in bile, a fluid made by the liver. The breakdown product of Hgb from injured RBCs and other heme containing proteins. Bilirubin produced by reticulo-endothelial system. Bilirubin released to plasma bound to albumin. Hepatocytes conjugate it and excrete through bile channels into small intestine.
What causes increase Bilirubin
Bilirubin overproduce by reticulo-endothelial system. Bilirubin failure uptake from hepatocyte. Bilirubin failure to conjugate or excrete. Obstruction of biliary excretion into intestine.
What is normal range of Bilirubin
Direct (also called conjugated) bilirubin: 0 to 0.3 mg/dL
Total bilirubin: 0.3 to 1.9 mg/dL
How many types of Jaundice
Jaundice is mainly three types -
- Pre hepatic / Hemolytic jaundice
- Hepatic jaundice
- Post hepatic / Obstructive/ Surgical jaundice
Some other type of jaundice -
- Pathologic Jaundice
- Gilbert Syndrome jaundice
- Obstructive Jaundice
- Neonatal Jaundice
What is symptoms of Jaundice
Common signs and symptoms seen in individuals with jaundice include : -
- Yellow discoloration of the skin
- Mucous membranes
- The white part of the eyes becomes yellow
- Light-colored stools
- Dark-colored urine
- Itching of the skin
- Nausea and vomiting
- Abdominal pain
- Fever
- Weakness
- Loss of appetite
- Headache
- Confusion
- Swelling of the legs and abdomen
What is the causes of Jaundice
Some following reason and causes of develop jaundice -
- Too much bilirubin being produced for the liver to remove from the blood (for example, patients with hemolytic anemia have an abnormally rapid rate of destruction of their red blood cells that releases large amounts of bilirubin into the blood)
- A defect in the liver that prevents bilirubin from being removed from the blood, converted to bilirubin/glucuronic acid (conjugated) or secreted in bile.
- Blockage of the bile ducts that decreases the flow of bile and bilirubin from the liver into the intestines. For example, the bile ducts can be blocked by cancer, gallstones, or inflammation of the bile ducts. The decreased conjugation, secretion, or flow of bile that can result in jaundice is referred to as cholestasis: however, cholestasis does not always result in jaundice.
Which diagnostic test for Jaundice
The registered medical practitioner or doctor will perform a physical exam. This may reveal liver swelling.
- A bilirubin blood test will be done. - Other tests vary, but may include:
- Hepatitis virus panel to look for infection of the liver
- Liver function tests to determine how well the liver is working
- Complete blood count to check for low blood count or anemia
- Abdominal ultrasound
- Abdominal CT scan
- Endoscopic retrograde cholangiopancreatography (ERCP)
- Percutaneous transhepatic cholangiogram (PTCA)
- Liver biopsy
- Cholesterol level
- Prothrombin time
Can we prevent Jaundice
Due to the wide range of potential causes, it's not possible to prevent all cases of jaundice. However, there are four main precautions that you can take to minimize your risk of developing jaundice. They are Following -
- Ensuring that you stick to the recommended daily amount (RDA) for alcohol consumption.
- Maintaining a healthy weight for your height and build.
- If appropriate, ensuring that you're vaccinated against a hepatitis A or B infection, vaccination would usually only be recommended depending on where in the world you're travelling.
- Minimizing your risk of exposure to hepatitis C because there's currently no vaccine for the condition.
What is treatment for Jaundice
Treatment of Jaundice depends on the cause of the underlying condition leading to jaundice and any potential complications related to it. Once a diagnosis is made, treatment can then be directed to address that particular condition, and it may or may not require hospitalization.
- Treatment may consist of expectant management (watchful waiting) at home with rest.
- Medical treatment with intravenous fluids, medications, antibiotics, or blood transfusions may be required.
- If a drug/toxin is the cause, these must be discontinued.
- In certain cases of newborn jaundice, exposing the baby to special colored lights (phototherapy) or exchange blood transfusions may be required to decrease elevated bilirubin levels.
- Surgical treatment may be required in case of obstruction jaundice.
What is pre hepatic Jaundice
Excessive amount of bilirubin is presented to the liver due to excessive haemolysis, in pre-hepatic jaundice. Elevated un-conjugated bilirubin in serum. During pre-hepatic jaundice, haemolytic anemia develops.
- Urine color - Normal
- Stool color - Normal
- Pruritus - No
What is hepatic jaundice
Impaired cellular uptake, defective conjugation or abnormal secretion of bilirubin by the liver cell. Both conjugated and un-conjugated bilirubin may be elevated in serum.
Symptoms
- Hepatitis
- Cirrhosis
- Crigler-Najjar Syndrome
- Dubin-Johnson Syndrome
- Rotor’s Syndrome
Diagnostic Test result -
- Urine color - Dark
- Stool color - Normal
- Pruritus - No
What is post-hepatic jaundice
Impaired excretion due to mechanical obstruction to bile flow. Elevated conjugated bilirubin in serum.
Symptoms
- Gallstone
- Malignancy
- Inflammation
Diagnostic Test result -
- Urine color - Dark
- Stool color - Acholic
- Pruritus - Yes
When jaundice develop during pregnancy
Most of the diseases discussed previously can affect women during pregnancy, but there are some additional causes of jaundice that are unique to pregnancy.
Cholestasis of Pregnancy
Cholestasis of pregnancy is an uncommon condition that occurs in pregnant women during the third trimester. The cholestasis often is accompanied by itching but infrequently causes jaundice. The itching can be severe, but can be treated with drugs (ursodeoxycholic acid or ursodiol [Actigall, Urso]).
There also is an association between cholestasis of pregnancy and cholestasis caused by oral estrogens, and it has been hypothesized that it is the increased estrogens during pregnancy that are responsible for the cholestasis of pregnancy.
Pre Eclampsia
Pre-eclampsia, previously called toxemia of pregnancy, is a disease that occurs during the second half of pregnancy and involves several systems within the body, including the liver. It may result in high blood pressure, fluid retention, and damage to the kidneys as well as anemia and reduced numbers of platelets (thrombocytopenia) due to destruction of red blood cells and platelets. It often causes problems in the fetus. Although the bilirubin level in the blood is elevated in pre-eclampsia, it usually is mildly elevated, and jaundice is uncommon.
Acute fatty liver of pregnancy
Acute fatty liver of pregnancy (AFLP) is a very serious complication of pregnancy. The cause of AFLP is unclear, but is often associated with pre-eclampsia. It occurs late in pregnancy and results in failure of the liver. It can almost always be reversed by immediate delivery of the fetus. There is an increased risk of infant death. Jaundice is common, but is not always present in AFLP.
What is Pathologic Jaundice
Pathologic jaundice can occur in children and adults and is diagnosed when jaundice presents a health risk. Several forms of hepatitis, cirrhosis of the liver and other liver diseases, bile duct blockage, along with infections and medications, can also cause pathological jaundice.
What is Obstructive Jaundice
Obstructive jaundice caused by following factors :-
- Failure of hepatocyte to initiates bile flow.
- Obstruction of bile flow in the bile duct or portal tracts.
- Obstruction of bile flow in the extrahepatic bile duct.
- Bilirubin formation rate is normal.
- Conjugation is normal equal to direct bilirubin.
What is Gilbert syndrome Jaundice
Gilbert's syndrome is a harmless hereditary condition that results in mild jaundice. During times of illness or stress, people with Gilbert's syndrome will experience low levels of some bilirubin-processing enzymes in their livers. Once diagnosed, Gilbert's syndrome does not require further medical treatment.
What is Neonatal Jaundice
Jaundice is clinically detectable in the newborn when the serum bilirubin levels are greater than 85 μmol/L. This occurs in approximately 60% of term infants and 80% of preterm infants.
Neonatal jaundice first becomes visible in the face and forehead. Blanching reveals the underlying color. Jaundice then gradually becomes visible on the trunk and extremities.
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