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JAUNDICE

Overview

Jaundice is a condition that is characterized by yellowish discoloration of skin and sclera (the outer white layer of the eye). It frequently occurs in newborn babies but does not happen that often in adulthood. Jaundice is caused by abnormal levels of bilirubin in the blood. The blood cells in your system undergo a natural breakdown process after a certain time interval. Bilirubin is released as a product of this breakdown process and gets excreted through urine and feces after further metabolism. When this natural process is disturbed, an abnormally high amount of bilirubin is released, which causes jaundice. 

Causes

The causes of jaundice are divided into three types depending on the metabolism of bilirubin. Since blood cells normally go through the liver for a breakdown process, the three types are categorized as pre-hepatic, hepatic, and post-hepatic causes. 

Pre-hepatic causes of jaundice are linked to increased breakdown of blood cells within your body. This can occur due to sickle cell anemia, thalassemia, malaria, hemolytic anemia, spherocytosis, etc. The excessive breakdown of blood cells results in increased levels of bilirubin. 

Hepatic causes of jaundice are primarily related to the diseases or conditions that affect your liver. One of the common diseases that damage the liver is hepatitis. Other factors include alcohol poisoning, drug toxicity, cirrhosis, Gilbert’s syndrome, etc. Damage of the liver cells disturbs the normal breakdown of blood cells; hence the level of bilirubin raises in your bloodstream.

Post-hepatic causes are associated with a blockage of the bile duct that carries the metabolized bilirubin out of the liver for excretion. This can occur due to multiple factors, including bile duct stones, stricture of the biliary duct, cancer of the head of the pancreas, pancreatitis, etc. This obstructs bilirubin’s normal excretion, resulting in high levels of this compound in the blood. 

Risk Factors And Epidemiology

Risk factors of jaundice are linked with its causes. Newborn babies are at the highest risk of getting jaundice because their systems have not developed. The occurrence of jaundice in adults depends on various factors. Alcohol is an important risk factor as an excess of alcohol can limit the normal functions of the liver. Usage of illegal drugs, toxins, or steroids may affect your liver and cause liver toxicity. Other systemic diseases that affect the liver, such as hepatitis, cirrhosis, fatty liver, etc., are also risk factors for jaundice. 

Jaundice is not a common disease among adults. It only occurs as a consequence of other systemic abnormalities. It has been noticed that jaundice is more prevalent in men than women. Some researches also indicate that jaundice occurs more often in smokers. 

Signs And Symptoms

The characteristic symptom of jaundice is the yellowish discoloration of skin and sclera, which occurs due to high bilirubin levels in the blood. This also leads to the dark color of urine and the pale color of feces. Increased bilirubin levels in the blood may also cause itchiness or skin irritation. You may experience nausea, vomiting, and loss of appetite as well. If jaundice occurs due to acute infection such as viral hepatitis, it may be accompanied by fever, chills, and abdominal pain. Jaundice occurring due to other systemic diseases will present with their associated symptoms. 

Diagnosis

The first step towards a diagnosis of jaundice is the intake of history and clinical examination. A detailed history is required, including habits of alcohol, toxins, or other drugs. Presenting symptoms are noticed, and clinical examination is done to identify the possible cause. Blood tests are performed to identify the level of total serum bilirubin, conjugated bilirubin, unconjugated bilirubin, and protein levels (especially albumin). Liver function tests determine the levels of liver enzymes such as alkaline phosphatase (ALP), alanine transaminase (ALT), and aspartate transaminase (AST). Abnormality in the levels of these enzymes indicates liver damage. Urinalysis is also performed to confirm the increased levels of bilirubin in urine. Other tests may be indicated if your doctor suspects a different underlying disease. 

Differential Diagnosis

Jaundice occurs as a symptom linked with multiple systemic diseases. It is important to differentiate whether the increase in bilirubin levels is a result of pre-hepatic, hepatic, or post-hepatic causes. The underlying cause is determined based on history, symptoms, clinical examination, and other diagnostics tests, including blood tests, urinalysis, radiographic imaging, etc.  

Treatment

Phototherapy is the safest treatment method used to treat jaundice in newborn babies. Adult jaundice does not require any particular treatment if it is of mild severity. If jaundice occurs due to excessive breakdown of blood cells, appropriate treatment measures are needed after diagnosing the underlying cause. Jaundice that occurs due to hepatitis or other liver-related diseases is treated with suitable medications. The only cases of jaundice that may require surgical intervention are those associated with liver failure or where a stone or any other cause blocks the bile duct. Surgery needs to be done to restore the normal passage of bile from the bile duct. 

Medication

Medications are given only after an accurate diagnosis of the cause and origin of jaundice. Medications may vary depending on whether jaundice is because of pre-hepatic, hepatic, or post-hepatic causes. Symptomatic medicines such as antipyretics, analgesics, corticosteroids, etc., may be prescribed in calculated dosages to relieve symptoms.

Prognosis

The prognosis of jaundice depends on the cause and severity of the underlying disease. The majority of the cases of neonatal and adult jaundice are treated effectively by medications and surgery if it may be required. Few cases may lead to severe complications such as fulminant hepatic failure, which may increase the risk of mortality. 

Prevention

Jaundice cannot be prevented if it develops in newborn babies as it is mostly a natural occurrence at such a young age. Adult jaundice can be prevented by maintaining the intake of alcohol, drugs, or other lethal toxins. Causes of other liver diseases such as viral hepatitis or fatty liver should be avoided as much as possible. Cholesterol levels should be maintained by improving diet and lessening the intake of oily products. Exercise and dietary modifications improve liver functions and maintain normal bilirubin levels in the blood.