Patient's Complete Guide to Jaundice

Overview of Jaundice

Jaundice (یرقان/Yarkan) is a condition associated with yellow discolouration of the skin and the whites of eyes. It is not a disease itself but a symptom of other underlying diseases. It occurs due to the accumulation of bilirubin in the liver. It is also known as yellow fever. Bilirubin is a waste product produced by the breakdown of red blood cells (RBCs). In low amounts, it causes yellowing while in high amounts it causes brown discolouration. Normally, bilirubin enters the liver and leaves the body along with other chemical substances in bile juice. Due to bilirubin, the faeces appear brown in colour.

However, if bilirubin doesn’t excrete from the body, it starts to leak in the surrounding tissues. This causes the yellowing of the skin and eye whites.

 

Signs and Symptoms of Jaundice

Sometimes, jaundice is asymptomatic but if it is the symptom of an underlying disease or infection following symptoms may appear in adults:

  • Yellowish discolouration of the skin and eye whites
  • Dark urine
  • Fatty stool
  • Skin itching
  • Fever 
  • Abdominal pain
  • Chills

However, in children symptoms of jaundice may include yellowish or greenish discolouration of teeth.

If jaundice is due to biliary tract cancers, abdominal pain is the most common symptom. If it is not the symptom of infection, people experience weight loss and skin itching. When jaundice is caused by liver damage, the following symptoms may appear:

  • Polyarthralgias (inflammation of the joints)
  • Chronic hepatitis or inflammation of the liver
  • Acute hepatitis A, B or C
  • Pyoderma gangrenosum (a type of skin disease)

Types of Jaundice

Jaundice can be classified into three main types based on its location within the liver:

  • Hepatocellular Jaundice: It occurs due to liver damage or injury. 
  • Hemolytic Jaundice: Hemolytic jaundice occurs due to the breakdown of large amounts of red blood cells that results in hemolytic anaemia. 
  • Obstructive Jaundice: Obstructive jaundice occurs due to the blockage of bile ducts. Obstruction of the bile duct prevents the release of bilirubin from the liver. 
  • Neonatal Jaundice: Jaundice in newborn babies is called neonatal jaundice. Jaundice is most common in newborn babies, particularly in premature babies. It occurs due to excess bilirubin because the baby's liver is not fully developed. This condition is termed breast milk jaundice. In babies, jaundice is recovered on its own after some time when their liver is fully developed.

Causes of Jaundice

Old RBCs are destined to be destroyed in the liver, as a result of which bilirubin is formed. These RBCs travel to the liver and break down into bilirubin that is yellow in colour. After that, bilirubin enters the intestine and leaves the body along with the stool. If the liver is damaged bilirubin accumulates in the body and causes jaundice.

In adults, jaundice can be the indication of:

  • Alcohol misuse
  • Liver cancer
  • Cirrhosis (scarring of the liver, usually due to alcohol)
  • Thalassemia
  • Gallstones (cholesterol stones made of hardened fat material or pigment stones made of bilirubin)
  • Hepatitis A
  • Hepatitis B
  • Hepatitis C
  • Hepatitis D
  • Hepatitis E
  • Biliary (bile duct) obstruction
  • Pancreatic cancer
  • G6PD deficiency
  • Sickle cell anemia
  • ABO incompatibility reaction
  • Acute pancreatitis
  • Yellow fever
  • Drug-induced immune hemolytic anemia
  • Hemolytic anemia (a condition in which the number of RBCs is decreased)

Risk Factors of Jaundice

Jaundice is often caused by many underlying illnesses. It can occur either due to excessive production of bilirubin or the inability of the liver to get rid of it. This results in bilirubin accumulation in tissues. Underlying illnesses may include:

  • Acute Inflammation of the Liver: This affects the liver’s ability to conjugate and release bilirubin, resulting in accumulation in the body.
  • Inflammation of the Bile Duct: If bile ducts are inflamed, bile cannot be released that preventing bilirubin release. It results in jaundice. 
  • Obstruction of the Bile Duct: It also prevents the release of bilirubin.
  • Gilbert’s Syndrome: It is a genetic problem that impairs the enzyme's ability to process the secretion of bile. 
  • Hemolytic Anemia: Hemolytic anaemia is the breakdown of a large number of red blood cells that results in hemolytic anaemia. It causes an increase in bilirubin concentration, hence jaundice. 
  • Cholestasis: Cholestasis is a liver disease in which the release of bile from the liver is blocked. Bilirubin remains in the liver and is not excreted resulting in jaundice.

Some less common conditions that can cause jaundice may include:

  • Dubin-Johnson Syndrome-Chronic jaundice that inhibits the release of conjugated bilirubin 
  • Crigler-Najjar Syndrome-Inherited disease that impairs the processing of bilirubin.
  • Pseudojaundice: This is a condition in which yellowing of skin occurs due to excessive amounts of beta-carotene, not bilirubin. It mostly occurs due to consuming large quantities of carrots or melons.

Health-Related Complications of Jaundice

Sometimes itching due to jaundice can be so intense that it leads to:

  • Scratching of raw skin 
  • Insomnia
  • In extreme cases thoughts of suicide

Prevention

Jaundice is a disease that has numerous causes. Some general preventive tips for jaundice are as follows:

  • Avoid heavy alcohol drinking 
  • Update your vaccination for other types of Hepatitis such as A and B
  • Remember to make healthy lifestyle choices
  • Refrain from unprotected sexual intercourse 
  • Avoid intravenous drugs 
  • Check your cholesterol level 
  • Make sure to maintain personal hygiene

Diagnosis

For the diagnosis of jaundice, doctors mostly inquire about the history of patients, symptoms and then perform a physical examination. In physical examination, the firmness of the liver is checked. A firm liver can be the indication of cirrhosis-scarring or inflammation of the liver.

Jaundice can be confirmed by various diagnostic tests. The first test is a liver function test that is performed to check the functionality of the liver. If the exact cause of jaundice can’t be found, the following blood tests are performed to check the level of bilirubin.

  • Bilirubin Tests: This test is performed to compare the level of unconjugated and conjugated bilirubin. If the level of unconjugated bilirubin is high as compared to conjugated, it indicates hemolytic jaundice. 
  • Complete Blood Count (CBC): This test is performed to measure the levels of red blood cells, white blood cells, and platelets.
  • Hepatitis A, B, and C Tests: An antibody test is performed to check the antibodies for hepatitis virus in the blood of patients. 
  • Imaging Tests: If the doctor suspects an obstruction in the liver, imaging tests such as MRI, CT or ultrasound scans are performed. Other options include:
    • Endoscopic retrograde cholangiopancreatography (ERCP)
    •  Endoscopy
    • X-ray imaging
  • Liver Biopsy: Liver biopsy is performed to check for
    • Inflammation 
    • Cirrhosis
    • Cancer 
    • Fatty liver

In this test, a small portion of liver tissues is removed and observed under a microscope to check for any changes in the liver structure.

 

Treatment of Jaundice | When to Consult a Doctor

Treatment of jaundice depends on the underlying illness.

The following treatments can be used:

  • Hemolytic Jaundice can be treated by increasing the level of iron in the blood. It can be done by adding iron rich foods to regular meals or taking iron supplements.
  • Hepatitis-induced jaundice can be treated by antiviral or steroid drugs.
  • Obstruction-Induced Jaundice surgery is required. 
  • If jaundice is caused by medication, alternative medicines are opted for treatment. 

If you experience severe symptoms of jaundice seek immediate medical care.

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