Jaundice
Overview of Jaundice
Jaundice is a condition marked by the yellowing of the skin, sclera (the white part of the eyes), and mucous membranes due to an accumulation of bilirubin. Bilirubin, a byproduct of hemoglobin breakdown, is normally processed in the liver and expelled from the body. Jaundice occurs when there is an excess of bilirubin, either due to increased production or impaired elimination.
Normal bilirubin levels in the blood are below 1 mg/dl. Yellowing of the sclera (called icterus) becomes visible when bilirubin levels reach around 3 mg/dl, as the sclera has a high affinity for bilirubin due to its high elastin content. As bilirubin levels rise, the skin may take on a yellow to green hue. The green color is caused by biliverdin, a type of bile pigment.
In most cases, jaundice in adults does not require direct treatment, as the focus is typically on addressing its underlying causes or managing complications. While diet and lifestyle changes can help in many cases, more severe causes may require immediate surgical intervention or long-term management.
Important Facts of Jaundice
Usually seen in
- Adults over 45 years old
Gender affected
- Both men and women, though more common in men
Body part(s) involved
- Liver,
- Gallbladder,
- Pancreas
Prevalence
Mimicking Conditions
- Carotenoderma,
- Quinacrine use
Necessary health tests/imaging
- Laboratory Tests: Complete blood count (CBC), Alanine transaminase (ALT), Aspartate transaminase (AST), γ-Glutamyltransferase (GGT)
- Imaging: Ultrasonography, Dual-phase CT, Magnetic resonance cholangiopancreatography (MRCP), Liver biopsy
Treatment
- Medications: Iron supplements, Antihistamines, Cholestyramine, Rifampin, Naltrexone
- Surgery: Liver transplant
Specialists to consult
- General physician,
- Gastroenterologist,
- Internal medicine specialist
Symptoms Of Jaundice
The symptoms of jaundice can vary, with some individuals showing signs and others not. Common symptoms include:
- Yellowish discoloration of the skin, mucous membranes, and sclera
- Pale or clay-colored stools
- Dark urine
- Itchy skin
- Weight loss
- Vomiting
- Nausea
- Loss of appetite
Additional symptoms that may accompany jaundice include:
- Fatigue, tiredness, or drowsiness
- Abdominal pain or tenderness
- Blood in vomit or stools
- Dark or tarry stools
- Flu-like symptoms such as fever and chills
- Agitation or confusion
- Easy bruising or bleeding, sometimes leading to a reddish-purple rash
Triggering Factors Of Jaundice
Jaundice can be classified into three main types based on its causes:
Pre-hepatic Jaundice
Pre-hepatic jaundice, also known as hemolytic jaundice, occurs due to the destruction of red blood cells (hemolysis). The causes are categorized into:
- Congenital causes (present from birth):
- Spherocytosis: A condition where red blood cells are abnormal and may lead to anemia, jaundice, and an enlarged spleen.
- Elliptocytosis: A hereditary condition where red blood cells are oval-shaped instead of the usual round shape.
- Congenital LCAT deficiency: A genetic disorder that impairs cholesterol processing, leading to hemolytic anemia, corneal opacities, and kidney failure.
- Thalassemia: An inherited blood disorder where the body cannot produce enough hemoglobin.
- Sickle cell anemia: A group of inherited disorders that cause red blood cells to have an abnormal shape.
- Stomatocytosis: A rare red blood cell disorder, where cells are mouth-shaped instead of round.
- Acanthocytosis: A condition where red blood cells have an abnormal shape, associated with various diseases.
- Echinocytes: Red blood cells that appear spiky, resembling sea urchins, due to various disorders.
- GSH synthetase deficiency: A disorder that prevents the production of glutathione, which protects cells from damage.
- Pyruvate kinase deficiency: An inherited enzyme deficiency that causes red blood cells to break down too easily.
- G6PD deficiency: A genetic disorder that reduces the levels of glucose-6-phosphate dehydrogenase, protecting red blood cells from damage.
- Erythroblastosis fetalis: Hemolytic anemia in a fetus or newborn.
Acquired causes:
- Microangiopathy: A condition affecting small blood vessels, leading to hemolysis.
- Hemolytic uremic syndrome: Damage to the small blood vessels in the kidneys causing hemolysis.
- Disseminated intravascular coagulation: A disorder where the body’s clotting mechanisms go awry.
- Paroxysmal nocturnal hemoglobinuria: A rare disorder causing premature breakdown of red blood cells.
- Thrombotic thrombocytopenic purpura: A condition where small blood clots form in the blood vessels.
- Hypophosphatemia: Low phosphorus levels in the blood that may cause muscle weakness or organ failure.
Other causes:
- Resorption of large hematomas (blood clots)
- Autoimmune hemolysis
- Long-distance running
- Infections such as malaria
- Exposure to chemicals like nitrites and aniline dyes
- Toxins like snake venom
- Blood transfusion reactions
- Trauma
- Vitamin B12 or folic acid deficiencies
Hepatic Jaundice
Hepatic jaundice is caused by a defect within the liver, specifically in the hepatocytes. The causes include:
- Congenital causes:
- Wilson’s disease: A rare inherited condition that causes copper buildup in the liver and other organs.
- Rotor’s syndrome: A mild disorder marked by elevated bilirubin levels.
- Hemochromatosis: An inherited disorder where excess iron accumulates in the body.
- Crigler-Najjar syndrome: A severe condition that leads to high bilirubin levels.
- Gilbert’s syndrome: A common and harmless liver condition causing mild bilirubin elevation.
- Dubin-Johnson syndrome: A condition characterized by jaundice appearing during adolescence or early adulthood.
Acquired causes:
- Drug-induced hepatitis: Such as hepatitis caused by NSAIDs.
- Sepsis: A systemic infection leading to liver dysfunction.
- Pregnancy: Certain conditions during pregnancy can affect liver function.
- Malnutrition: Can contribute to liver dysfunction.
- Physical trauma: Injuries to the liver can lead to jaundice.
- Hepatic adenoma: Non-cancerous tumors in the liver.
- Viral hepatitis: Inflammation of the liver due to viral infections like hepatitis A, B, or C.
- Alcoholic hepatitis: Liver inflammation caused by excessive alcohol consumption.
- Autoimmune hepatitis: A condition where the immune system attacks the liver.
Post-hepatic Jaundice
Post-hepatic jaundice is caused by obstruction in the biliary system (the liver, gallbladder, or bile ducts), leading to the buildup of bile. It is also referred to as obstructive jaundice. The causes include:
- Congenital causes:
- Biliary atresia: A condition where bile ducts are blocked or absent, preventing bile flow.
- Cystic fibrosis: An inherited disorder affecting mucus production and leading to bile duct obstruction.
- Idiopathic dilatation of the common bile duct: A condition that may indicate obstructive jaundice.
- Pancreatic biliary malfunction: When the sphincter controlling bile flow does not work properly.
- Choledochal cyst: A congenital condition where bile ducts are abnormal.
Acquired causes:
- Portal biliopathy: Abnormalities in bile ducts seen in patients with portal cavernoma.
- Strictures: Narrowing of the bile ducts, which can obstruct bile flow.
- Choledocholithiasis: The presence of gallstones in the bile duct.
- Intra-abdominal tuberculosis: Tuberculosis affecting the abdomen and potentially the liver or bile ducts.
Other causes:
- Trauma
- AIDS
- Tumors
- Cholecystitis (inflammation of the gallbladder)
- Pancreatitis (inflammation of the pancreas)
Potential Risks for Jaundice
Certain factors may increase the likelihood of developing jaundice, particularly those associated with liver and gallbladder disorders. These include:
- Autoimmune diseases
- Long-term use of medications that can harm the liver
- Infections such as hepatitis A, B, or C
- Exposure to industrial chemicals
- Congenital abnormalities
- Trauma to the liver
- Bile duct obstruction
- Deficiencies in vitamins or enzymes
- Heavy alcohol consumption
Diagnosis Of Jaundice
The diagnostic approach for jaundice depends on whether the underlying cause is pre-hepatic (primarily unconjugated hyperbilirubinemia), hepatic (mixed hyperbilirubinemia), or post-hepatic (conjugated hyperbilirubinemia). Identifying jaundice involves examining signs of liver dysfunction, which includes:
Physical Examination and Medical History
A thorough history, especially regarding alcohol and drug use, can help pinpoint intrahepatic issues such as alcoholic liver disease, viral hepatitis, chronic liver disease, drug-induced liver injury, or possible underlying malignancies.
The physical examination should focus on:
- Assessing encephalopathy, including testing for asterixis (a motor control disorder) and any mental status changes.
- Observing for signs of chronic liver disease, such as bruising.
- Checking for abnormal blood vessel formations under the skin (spider angiomas), redness of palms (palmar erythema), and enlarged breast tissue in men (gynecomastia).
- Thoroughly examining the abdomen for liver and spleen enlargement, tenderness in the upper-right abdomen, and the presence of ascites (fluid accumulation).
Laboratory Evaluation
The lab tests to determine the cause of jaundice should include:
- Fractionated Bilirubin: Used to assess liver diseases, hemolytic disorders, hematologic conditions, and metabolic disorders, including hepatitis and gallbladder blockages.
- Complete Blood Count (CBC): To detect hemolysis and evaluate for anemia or thrombocytopenia, common in liver dysfunction.
- Alanine Transaminase (ALT) and Aspartate Transaminase (AST): To assess liver cell damage.
- γ-Glutamyltransferase (GGT): Elevated GGT levels can indicate bile duct obstruction and hepatocellular injury.
- Alkaline Phosphatase (ALP): High ALP levels are linked to bile duct obstruction and liver disease but can also point to conditions affecting bones, kidneys, intestines, or placenta.
Other Tests:
Low prothrombin time (INR), albumin, and protein levels may indicate liver decompensation or decreased liver function.
If the cause of jaundice remains unclear after these tests, further investigations, including hepatitis panels and autoimmune panels (such as testing for antinuclear, smooth muscle, and liver-kidney microsomal antibodies), may be necessary.
Imaging
Non-invasive imaging techniques are used in jaundice cases, such as:
- Ultrasound and Dual-phase CT: To check for obstruction, cirrhosis, and liver vessel health.
- Magnetic Resonance Cholangiopancreatography (MRCP): For visualizing the biliary tree, both intra and extrahepatic.
Liver Biopsy
In cases where the cause of jaundice is not clear after physical exams, lab tests, and imaging, a liver biopsy may be required to make a definitive diagnosis.
Preventive Measures Of Jaundice
Since jaundice reflects liver function and can result from a range of causes, there are no universal preventive measures. However, maintaining a healthy liver can prevent many forms of jaundice. Key preventive strategies include:
- Avoiding Hepatitis Infections: Protecting against hepatitis A, B, and C infections.
- Maintaining a Healthy Weight: Preventing obesity and managing cholesterol levels.
- Eating a Balanced Diet: Promoting liver health through proper nutrition.
- Exercising Regularly: Supporting overall health and liver function.
- Limiting Alcohol Intake: Avoiding excessive alcohol consumption.
- Avoiding Exposure to Harmful Chemicals: Reducing contact with industrial toxins and chemicals.
- Careful Medication Management: Ensuring medications are taken only in prescribed doses and consulting a doctor before using any herbal treatments.
- Quitting Smoking and Avoiding Recreational Drugs: Protecting liver health by avoiding substances that cause harm.
- Vaccinations: Getting vaccinated before traveling to regions with higher risks of liver infections.
- Practicing Safe Sex: Using condoms to reduce the risk of infections.
- Routine Checkups: Having regular health checkups, especially for individuals with a family history of autoimmune conditions.
Specialists to Visit
Jaundice, characterized by yellowing of the skin or the whites of the eyes, can indicate serious liver issues. The following specialists can help diagnose and treat jaundice:
- General Physician
- Gastroenterologist
- Internal Medicine Specialist
Seek medical advice if you notice:
- Yellowing of the skin or whites of the eyes.
- Itching, darker urine, and lighter-colored stool.
Treatment Of Jaundice
In adults, jaundice generally doesn’t require specific treatment, and its management focuses on addressing the underlying cause. Key treatment approaches include:
- Acute Viral Hepatitis: Typically resolves on its own as the liver heals.
- Surgical Intervention: May be necessary if jaundice is caused by a blocked bile duct.
- Managing Pruritus (Itchy Skin): Associated with cholestasis, pruritus can be treated according to severity. For mild cases, warm or oatmeal baths may provide relief. Antihistamines can help, and medications such as cholestyramine or colestipol are beneficial for moderate to severe cases.
- Other Therapies: Less commonly used options include Rifampin, Naltrexone, Sertraline, and Phenobarbital.
- Hemolytic Jaundice: Treated with iron supplements and iron-rich foods.
- Steroid Therapy: Can help alleviate jaundice.
- Liver Transplantation: Considered for severe cases of jaundice or pruritus when all other treatments fail, or if liver function is severely compromised.
Health Complications Of Jaundice
The complications associated with jaundice vary depending on the underlying condition, the type, and the severity of the jaundice. Common complications include:
- Bleeding
- Constipation
- Abdominal pain
- Gastritis
- Diarrhea
- Anemia
- Infections
- Abdominal bloating
- Swelling in the legs
- Liver cirrhosis
- Kidney failure
In severe cases, rarer complications may arise, such as:
- Primary sclerosing cholangitis (a bile duct disorder)
- Cholangiocarcinoma (bile duct cancer)
- Hepatic amyloidosis (amyloid buildup in the liver)
- Chronic hepatitis (persistent liver inflammation)
- Cholangitis (inflammation of the bile ducts)
Alternative Therapies For Jaundice
Jaundice may signal an underlying condition, and addressing its root cause is crucial for recovery. Below are some alternative treatments:
Unani Medicine
Unani is a traditional healing system practiced in South and Central Asia. It emphasizes a bland, oil-free diet along with adequate rest to promote healing. Dietary guidelines include:
- Consuming easily digestible food, typically liquid-based diets
- High-carbohydrate, low-fat meals without spices
- Drinking sufficient fluids, particularly boiled water
- Eating raw or steamed vegetables and fruit juices
- Adding fruits, yogurt, and porridge to the diet
- Beneficial foods like bitter gourd (Karela) and drumsticks (Saijan ki phalli)
- Including calcium-rich foods and minerals like iron and magnesium
- Smaller, frequent meals
- A week-long fasting with fruit juices is recommended for detoxification.
Home Remedies
Several food items can aid in managing jaundice symptoms:
- Sugarcane Juice: Helps strengthen the liver and supports its functions.
- Yogurt (Dahi): Contains probiotics that lower bilirubin levels and boost immunity.
- Tomatoes (Tamatar): Rich in lycopene, a potent antioxidant aiding liver detoxification.
- Indian Gooseberry (Amla): Packed with Vitamin C, it supports liver function and regulates bilirubin levels.
- Goat’s Milk: Easily digestible, it provides antibodies beneficial for jaundice.
- Grape (Angoor) Juice: Especially green grapes, aid liver health and balance bilirubin levels.
- Ginger (Adrak): Known for its antioxidant properties, it supports liver recovery and reduces cholesterol.
- Garlic (Lahsun): A strong antioxidant that helps detoxify the liver.
- Lemon (Nimbu): Promotes immunity and supports liver function by clearing bile ducts.
- Holy Basil (Tulsi): Protects the liver, strengthens immunity, and combats infections.
- Papaya Leaves (Papita): Rich in enzymes that promote digestion and support liver health.
Homemade Remedies for Jaundice
While jaundice typically resolves on its own, home management is important for alleviating symptoms and supporting overall recovery. Measures to take at home include:
- Eating Bland, Pleasant-Tasting Food
- Consuming a Balanced, Low-Fat Diet
- Avoiding Supplements, Herbs, or Medications That Could Cause Side Effects
- Staying Hydrated with Fluids and Juices
- Taking Rest as Needed
- Following Doctor’s Instructions
- Avoiding Herbal Treatments
- Using Moisturizers for Itchy Skin
- Taking Warm Baths for Comfort
Lifestyle Modifications Jaundice
Managing jaundice often requires medical treatment, but lifestyle modifications can help ease the condition:
- Practice proper hygiene to avoid infections.
- Limit alcohol consumption.
- Follow a well-balanced, healthy diet.
- Consult a doctor before using herbal remedies.
- Avoid medications harmful to the liver.
- Stay hydrated with plenty of fluids.
- Engage in regular physical activity.
- Get vaccinated for hepatitis B and C.
Frequently Asked Questions
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