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Jaundice – What You Need to Know

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Jaundice – What You Need to Know


When it comes to Jaundice many of us think that it is a disease – but, in reality, it is not a disease – Yes! In other words, it indicates an underlying condition or disease process.

The term Jaundice is derived from a French word “JAUNE” meaning “YELLOW.”

When we talk about jaundice – we mean it as a visible sign of underlying disease. This is a very apparent sign in the form of Yellowish discolouration of the skin and the whites of the eyes.

This happens when there is an elevated level of bilirubin in the blood – which is known as HYPERBILIRUBINEMIA. This condition can be due to many reasons including some very serious and potentially life-threatening conditions. Therefore, any person who develops jaundice must undergo a thorough and comprehensive medical examination and evaluation to determine the cause of jaundice.

Let us Understand how yellowish discolouration of the skin happens

Red blood cells carry oxygen as they contain haemoglobin that binds with oxygen. This haemoglobin is broken down as a normal process of recycling in the body and forms bilirubin – which in turn is moved to the liver in the bloodstream and binds with bile.

Bilirubin combines with glucuronic acid and then carried into the gallbladder (for storage). From gallbladder, bilirubin is carried into the digestive tract through bile ducts – from there it is eliminated out through stool (higher percentage is eliminated) and a small amount is eliminated in urine.

Jaundice results when bilirubin cannot be moved out of the liver as it normally does. When this happens, bilirubin levels build up and increase in the bloodstream and then deposited in the skin and whites of eyes. It is known as jaundice.

When the bulk of bilirubin is not eliminated in stool, it is eliminated in urine making the colour of urine dark yellowish and thus stool appears light-coloured.

What are the causes of jaundice?

Before understanding the causes of jaundice, it is important to understand this classification of jaundice: pre-hepatic (outside the liver); Hepatic (Within the liver), and Post Hepatic (after excretion of bilirubin from the liver).

Pre-hepatic Cause of Jaundice

There are many diseases which cause huge destruction of RBCs and increase the levels of bilirubin in the blood. The rapid increase in the levels of bilirubin disturbs the normal metabolic activity of the liver and thus bilirubin levels shoot up in the bloodstream. Malaria, some hereditary diseases, certain drugs, toxins, autoimmune disorders, thalassemia, hereditary spherocytosis, sickle cell disease, glucose-6-phosphate dehydrogenase deficiency (G6PD) and several other disorders can cause jaundice which is pre-hepatic.

Hepatic causes of jaundice: Bilirubin levels in the bloodstream can increase due to abnormal functioning of the liver – metabolic abnormalities or due to abnormalities in the normal excretion of bilirubin. Conditions that affect the liver – such as hepatitis – A, B, C, D, and E; Alcoholic liver disease, liver toxicity; drug-induced liver toxicity; Liver Cirrhosis; autoimmune disorders and liver cancer.

Post-hepatic causes of Jaundice: When bilirubin excretion is obstructed or disrupted while bilirubin in the form of bile flows from the liver to the intestine it may result in jaundice due to post-hepatic cause. The conditions which are responsible for the elevated levels of bilirubin in the bloodstream include pancreatitis, obstruction of bile ducts due to gallstones, cholangitis, bile duct cancer, gallbladder cancer, pancreatic cancer, strictures of the bile ducts and some parasitic infections like liver flukes.

In a nutshell, Jaundice indicates or suggests a problem of the blood, gallbladder, or liver.

Symptoms of Jaundice

When it comes to signs and symptoms of jaundice, they may vary from person to person – as some persons may have very few symptoms and others may not have any symptoms at all. Symptoms, in general, may depend on the underlying cause of jaundice.

Those who have jaundice may experience any of the following signs and symptoms.

Yellowish skin (prominent sign)·

 Itching·

Nausea and vomiting·

Pale-coloured stools·

Dark-coloured urine·

Loss of appetite·

Weakness·

Weight loss·

Fever and chills·

Diarrhea·

Headache·

 Abdominal pain·

Confusion

Individuals who develop severe liver disease have these symptoms: abdominal pain, nausea, vomiting, itching all over the body and appearance of spider-like blood vessels – that are visible in the skin (spider angiomas). These symptoms are suggestive of serious liver problems.

The other symptoms suggestive of liver complications may include accumulation of fluid within the abdomen (Ascites); a tendency to bruise or bleed easily; accumulation of toxic substances due to malfunctioning of the liver that causes abnormalities in brain function (drowsiness and confusion) and bleeding in the stomach and oesophagus due to portal hypertension.

Diagnosis of Jaundice

When a person is presented with the signs and symptoms of jaundice, the gastroenterologist does a complete physical examination and then medically evaluates the patient based on the medical history, signs and symptoms and associated conditions.

During the examination, the gastroenterologist checks, heart rate, blood pressure, fever and other signs associated with liver impairment. The doctor gently presses the abdomen to know whether the liver or spleen is enlarged and also to check other abnormalities – such as lump, tenderness, and swelling on the liver.

The doctor orders some blood tests, electrolyte panel, liver-specific blood tests, and lipase levels. In addition, urine analysis and hepatitis tests may also be ordered.

Based on the results of the initial blood tests, further tests and studies may also be required to diagnose the underlying cause of jaundice. To detect any abnormalities of the liver, gallbladder and pancreas, abdominal ultrasound is recommended.

Sometimes, gastroenterologists also perform ERCP or liver biopsy when they feel that further investigations are needed.

Jaundice Treatment

The treatment of jaundice usually depends on the diagnosis of the underlying cause. A Gastroenterologist begins the treatment, once a diagnosis is made. In some cases, jaundice is managed as outpatient care at home, but certain cases of jaundice may need hospitalization.

In mild cases of viral hepatitis, jaundice can be managed at home under the supervision of a medical practitioner – the care is basically supportive type. For treating hepatitis C related jaundice, novel medications are available.

Individuals who drink alcohol excessively may develop alcoholic hepatitis – which may lead to liver cirrhosis and acute pancreatitis. Physicians advise alcohol cessation therapy in such cases. Drugs, medications and toxins induced hepatitis can be managed by the discontinuation of the agents that are causing jaundice.

For the treatment of autoimmune disorders that are causing jaundice steroids and other medicines may be prescribed by the doctor. If the cause of jaundice is related to infections such as cholangitis, antibiotics may be prescribed to treat infectious conditions.

If the cause of jaundice and liver cirrhosis is cancer, then oncologist treats the condition. In some severe cases of jaundice that have led to haemolysis, anaemia and bleeding, a blood transfusion may be required.

If the cause of jaundice is gallstones, then gallbladder surgery may be required to treat it. End-stage liver disease (liver cirrhosis) and liver failure may require a liver transplant.

The Risk Factors of Hepatitis (Jaundice)

Hepatitis is the major cause of jaundice, the factors that may increase the risk of hepatitis are as follows:
Exposure to hepatitis B or hepatitis C virus·

Getting a tattoo or body piercing done·

Injecting illegal & recreational drugs·

Sharing toothbrushes and razor blades·

Travelling to a place where jaundice is prevalent·

Working closely with high-risk individuals·

Working at a day-care centre·

High-risk sexual activities·

Having multiple sex partners·

Having blood transfusion done·

Having haemodialysis done


Complications of Jaundice

When it comes to complications and the severity of such complications, the underlying condition leading to jaundice is important. Some individuals suffer less severe complications and long-term adverse effects and thus recover fully.

However, some cases of jaundice indicate a life-threatening underlying condition, which must be addressed promptly to save a life. There are some potential complications associated with jaundice including anaemia, electrolyte imbalances, internal bleeding, chronic hepatitis, sepsis, infections kidney failure, liver failure, and brain dysfunction.

Prevention of Jaundice

There are many causes that lead to jaundice – among those, it is not always possible to prevent all, but some of the conditions leading to jaundice can be prevented. In this regard, there are certain measures that can be taken including the following:

Be vigilant as far as taking medicines, as an overdose of certain medicines can cause potential damage to the liver. Take the medicines as instructed by the doctor, which may reduce the potential risk of liver damage.
·        Even if you are taking over-the-counter medicines discuss those with your doctor.
·        Avoid intravenous drug use
·        Adopt universal standard practices while donating and transfusing blood.
·        Use sterile needles for injections and drug infusions
·        Restrain from high-risk, unprotected sexual acts
·        Get vaccinated for hepatitis B or C.
·        Avoid unsanitary water and contaminated food products (it will reduce the risk of developing hepatitis A)
·        Avoid alcohol and smoking
·        Take precautions while travelling to potentially high-risk areas and places or countries.
·  Never Ignore Jaundice as it could be due to several causes – which are often life-threatening.

DO YOU KNOW WHAT TO EAT IF YOU HAVE JAUNDICE?

Dr. Nagarjuna Yarlagadda

MBBS, MD (General Medicine), DM (Gastroenterology – PGI)

Chief Gastroenterologist, Hepatologist & Therapeutic Endoscopist

Medical Director, Sunshine Hospitals

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