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Jaundice

Jaundice is referred to as the medical condition where the quantity of bilirubin in the bloodstream increases. This increase of bilirubin turns the skin to pale, yellow color. In addition, eyes and mucus membranes also turn yellowish. High amount of bilirubin in the blood causes skin to appear brown.

Bilirubin is produced when the red blood cells break down naturally and the process of red blood cells breaking naturally is referred to as icterus. It is a yellow colored waste material which remains in the bloodstream, once the iron is removed from the blood. Usually, liver filters out waste from the blood. Till bilirubin reaches to the liver, other chemicals also join it which results in conjugated bilirubin.
When liver produces the digestive juice termed as “bile”, conjugated bilirubin enters into it and leaves its color. Excess of bilirubin can spread into surrounding tissues and the condition is known as hyperbilirubinemia causing yellowing of the skin and whites of eyes.

Types of Jaundice:

There are three major types of jaundice:

1. Hepatocellular jaundice – The reason behind the damage caused to the liver can be hepatotoxicity, chronic hepatitis, acute hepatitis, alcoholic liver disease, cirrhosis and drug-induced hepatitis.

Pre-matured death of cells affects the liver’s ability to metabolize and excrete bilirubin resulting in accumulation of unconjugated bilirubin in the blood.

2. Hemolytic jaundice – It is also caused due to liver injury or disease. It is a result of hemolysis which is described as an accelerated breakdown of red blood cells resulting in the elevation of bilirubin production.

3. Obstructive jaundice – It is caused due to the obstruction in the bile duct resulting in abnormal accumulation of bile. This obstruction doesn’t allow bilirubin to pass through the liver triggering jaundice.

Jaundice Symptoms:

Some of the most common symptoms and signs of jaundice are:

-   Yellowish, pale skin color

-   Yellowing of whites of eyes

-   Pale stools

-   Dark urine

-   Itchiness

Some of the many jaundice symptoms that may result from low bilirubin levels include:

-   Extreme fatigue

-   Weakness

-   Appetite loss

-   A headache

-   Confusion

-   Nausea

-   Pain in abdomen

-   Unexplained weight loss

-   Vomiting

-   Persistent fever

-   Swelling of the abdomen and legs

In case of newborns, jaundice progress from head to the trunk and spreads to feet and hands. The signs and symptoms in newborn include the following:

-   Lethargy

-   Changes in muscle tone

-   Seizures

-   High-pitched crying

-   Poor-feeding

What Causes Jaundice?

As discussed earlier, Jaundice is a medical condition where the skin, the mucous membrane, and the eyes turn yellow due to the increased amount of bilirubin in the blood. Some of the major causes of the excess production of bilirubin are:

Pre-hepatic (before bile is produced by the liver): Cause of this type of jaundice is a sudden increase in the destruction and breakdown of the red blood cells which is also termed as “hemolysis”. This affects the ability of the liver to filter the increased level of bilirubin from the blood. The conditions that may be caused due to the elevated breakdown of red blood cells include the following:

-   Thalassemia

-   Malaria

-   Sickle cell crisis

-   Spherocytosis

-   Autoimmune disorders

-   Deficiency of glucose-6 phosphate dehydrogenase (G6PD)

Hepatic (concern within the liver): In this case, the liver is unable to excrete and metabolize bilirubin properly. This results in Jaundice. The conditions arising due to this inability to excrete includes the following:

-   Cirrhosis

-   Crigler-Najjar syndrome

-   Hepatitis (alcohol or viral related)

-   Cancer

-   Gilbert’s syndrome

Post-hepatic Jaundice (liver) causes: Post-hepatic jaundice is caused due to blockage in the normal discharge of conjugated bilirubin in the form of bile; juice produced from the liver to the intestine. This results in an elevated level of conjugated bilirubin in the bloodstream. The conditions that cause post-hepatic jaundice include the following:

-   Cancer (bile duct cancer, gallbladder cancer, pancreatic cancer)

-   Gallstones in the bile ducts

-   Pancreatitis

-   Strictures of bile ducts

-   Parasites (e.g. Liver flukes)

-   Cholangitis

-   Congenital malformations

-   Pregnancy

Jaundice in newborns: Jaundice in newborns is caused due to different reasons including their immature liver. The condition is harmless initially; however, if proper treatment is not given it results in increased level of bilirubin. This condition will cause other medical conditions termed as “pathologic jaundice” and there is a high chance of brain damage, also known as “kernicterus”.

Newborn jaundice is common nowadays and requires proper medical evaluation. Some of the causes of newborn jaundice are mentioned below:

Cephalohematoma (blood clot under the scalp): During the birthing process of the baby, the newborn may get some injury or bruise in the head, resulting in blood clot (blood accumulation) under the scalp. There will elevated level of bilirubin as the blood clot breakdown naturally. This may overwhelm the processing capability of immature liver of the newborn, thus resulting in jaundice.

Breastfeeding Jaundice: The jaundice occurs when the newborns do not get the required amount of milk. The reasons behind insufficient milk intake include underproduction of milk in the lactating mother or due to improper feeding of the newborn.

Inadequate intake of milk by newborn causes dehydration and less bowel movement with reduced excretion of bilirubin from the body.

Physiological Jaundice: This type of jaundice is discovered in newborns between second and fifth days of the life. Physiological Jaundice is the most common jaundice and is a transient and harmless condition.

It is caused due to inability of the immature liver of the newborn to process bilirubin from increased breakdown of red blood cells. As the liver of the newborns mature, the jaundice also disappears eventually.

Breast milk jaundice: This type of jaundice is found in breastfed newborns and is evident at the end of first week of life. The factor responsible for this is certain chemicals present in breast milk.

The condition is usually harmless and subsides spontaneously. Typically, mother does not need to discontinue breastfeeding.

Incompatibility of blood group of mother and baby (Rh, ABO): Sometimes, the jaundice occurs because of unmatched blood groups of mother with fetus. This result in elevation in the level of bilirubin resulting in the breakdown of the fetus’ red blood cells also called as “hemolysis”.

The medical conditions or diseases that trigger Jaundice are mentioned below:

-   Hepatitis A, B, C, D and E

-   Drug overdose

-   Birth defects

-   Gilbert syndrome

-   Dubin-Johnson syndrome

-   Rotor syndrome

-   Crigler-Najjar syndrome

-   Chronic liver diseases

-   Gallstones

-   Gallbladder disorders

-   Blood disorders

-   Pancreatic cancer

-   Build-up of bile in the gallbladder

-   Breaking down of red blood cells.

-   Damage to the liver.

-   Bilirubin passing through liver into the digestive tract

Risk factors Related To Jaundice:

As already discussed earlier, Jaundice is caused because of the excess production of bilirubin in the blood. This may lead to bilirubin getting accumulated in the tissues. Here are just some of the many medical conditions that trigger the risk of jaundice:

Acute Liver Inflammations: The condition may affect the ability of the liver to secrete and conjugate bilirubin, resulting in a buildup.

Obstruction of the bile duct: This condition prevents liver from proper drainage of bilirubin.

Inflammation of the bile duct: This condition impairs liver’s ability to synthesis the bile and dispose of bilirubin. This results in jaundice.

Hemolytic anemia: When large number of red blood cells are broken down and destructed, production of bilirubin elevates.

Cholestasis: In the condition, flow of bile is interrupted from the liver. The bile containing conjugated bilirubin gets accumulate din the liver instead of getting discharged.

Gilbert’s Syndrome: This condition is inherited and causes impairment of enzymes which is responsible for drainage of bile.

Here’s a list of just some of the many rare medical conditions that trigger the risk of jaundice:

Dubin-Johnson syndrome: It is an inherited chronic jaundice that prevents synthesis of conjugated bilirubin from the cells of liver.

Pseudojaundice: This type of jaundice is harmless. In the condition, the yellowing of skin results due to excess of beta-carotene and not due to excess of bilirubin. The cause of jaundice is eating excess of pumpkin, melon, or carrot.

Crigler-Najjar syndrome: This condition is inherited and causes impairment of enzymes which is responsible for excretion of bilirubin.

Jaundice Complications:

The complications occur due to the underlying causes of the jaundice and not the jaundice itself. For instance, if Jaundice is caused because of the obstruction of the bile duct, it may lead to unexplained bleeding which is uncontrollable at times.

If not treated properly, Jaundice may lead to several complications including severe itching. In some cases, this may even lead to insomnia and even suicidal tendencies.

Jaundice Diagnosis:

In order to diagnose Jaundice, doctors often check the medical history of the patients and conduct a physical examination/test to determine the bilirubin level in the body.

When physically examining the patients, doctors look for swelling in the abdomen and inflammation in the liver. In case a patient is experiencing stiff liver, they must get it checked by a doctor as stiff liver indicates liver cirrhosis or liver cancer.

In addition, doctors may prescribe a range of other tests to diagnose jaundice. Liver function test is one such test that confirms jaundice. If the liver function test is positive, doctors may also prescribe:

-   Full blood count

-   Bilirubin tests

-   Hepatitis A, B, or C tests

-   Complete blood count

To diagnose liver obstruction, doctors may conduct the following tests:

-   CT Scans

-   MRI

-   Ultrasound Scans

-   X-ray imaging

-   ERCP (Endoscopic Retrograde Cholangiopancreatography)

In some cases, doctors may also prescribe liver biopsy to see if there is any liver inflammation, fatty liver, cirrhosis and cancer in the liver. Liver biopsy test is done by collecting a liver tissue.

Treatment of Jaundice:

Treatment of Jaundice depends upon the underlying cause of the disease. Doctors typically aims at treating the underlying cause of the disease.

Treatment of jaundice typically includes:

-   Iron supplements and iron booster food items are used to treat the jaundice triggered due to anemia by increasing the iron in the blood.

-   Antiviral medicines and/or steroids are used to treat jaundice caused due to hepatitis.

-   Surgery is performed to remove obstruction to treat jaundice caused due to liver obstruction.

-   Alternative medicines are used to treat jaundice caused due to overuse of certain medicine.

Prevention From Jaundice:

Typically, jaundice is triggered due to liver malfunction. Therefore, it is important to ensure healthy functioning of the liver by ensuring healthy and balanced diet, regular exercise and refraining from consumption of alcohol.

Myths Related to Jaundice:

Myth #1: Jaundice is a waterborne disease.

Fact: Though it is true that jaundice usually gets triggered due to contaminated water consumption, it is not the sole cause of the disease. It is also triggered because of leptospirosis, hepatitis B/C and malaria. And these are just some of the many diseases that aren’t waterborne. Some other such diseases include gall stones, cancer and Obstruction of bile duct.

Myth #2: Jaundice is caused only by liver problems.

Fact: While it is true that jaundice is mostly triggered by the malfunctioning of liver, not all liver related problems cause jaundice. There are many live issues and conditions that do not trigger jaundice at all.

Myth #3: Itching means that jaundice is getting better.

Fact: If triggered due to the obstruction of the bile duct, jaundice may be accompanied by severe itching. But, this does not indicate that the patient is recovering from the disease.

Myth #4: Jaundice results in insomnia or extreme sleepiness.

Fact: While it is true that jaundice patients experience extreme fatigue, insomnia or excessive sleepiness is not caused or triggered by the disease. However, insomnia or excessive sleepiness indicates malfunctioning of liver or liver failure. When experiencing such a condition, patients must immediately consult a certified medical professional.

Myth #5: Jaundice is not curable.

Fact: Many people believe that jaundice is not curable. But this is just a myth that plagues around jaundice. The reality, however, is akin to this myth. A liver function test and diagnosis of the disease can help people understand the underlying cause of the disease. Once the diagnosis of the disease us done and the cause of the disease is identified, it is prudent to seek expert medical advice and proper treatment to treat the underlying cause of the disease to ensure complete recovery.

Myth #6: Spices and non-vegetarian food isn’t advisable during jaundice.

Fact: Although doctors suggest those diagnosed with jaundice should ensure balanced diet, there is no hard and fast rule of not eating non-vegetarian and spices. But it is important to avoid consumption of too spicy food as it may lead to nausea. A healthy and balanced diet must be ensured to treat the malfunctioning of liver.

Myth #7: Consumption of turmeric complicates jaundice.

Fact: This is yet another myth around the disease. Researchers have no conclusive evidence that can prove that the consumption of turmeric complicates jaundice by the speeding up the production of bilirubin in the blood. So, it is safe to consume turmeric during jaundice. However, it makes sense to exercise caution to consume only small quantity of turmeric during jaundice.

Myth #8: Jaundice can be treated with the help of Sugarcane juice.

Fact: Many people believe that sugarcane juice can treat jaundice effectively. Only if it were true! Sugarcane juice helps increase the nutrients in the body, but it doesn’t help in treating the liver or slow the production of excessive bilirubin.

Myth #9: Water should be given to newborn babies to treat jaundice.

Fact: Typically, most newborn babies are born with jaundice. Some people think that making newborn babies drink water can help treat jaundice, especially if the baby is not adjusting to mother’s milk. But this is just a myth. Remember, there is nothing more safe than breast milk for the newborn babies and consumption of water can actually lead to complications of jaundice in babies.

Myth #10: Jaundice can spread by physical contact.

Fact: Many believe that jaundice is contagious and can be spread by physical contact. However, this is nothing but a myth.

Frequently Asked Questions (FAQs):

1)  What is infant jaundice?

Ans: Infant jaundice is a common medical condition that affects premature babies born, i.e., babies born before the pregnancy period completes. Usually, many babies who are born before the completion of the pregnancy period, i.e., before 38 weeks and start breastfeeding, often show jaundice symptoms. But in such cases there is nothing really to worry about. One must worry if the baby shows symptoms of malfunctioning or weak liver. In most cases, babies are born with not-so-strong liver. Hence, their livers aren’t able to remove bilirubin produced in blood. But gradually as the baby grows, their liver grows stronger and starts removing bilirubin from the blood.

No treatment is available for infant jaundice. Also, the symptoms of the disease subside on their own without any medication or treatment. However, some doctor may suggest medicines to treat infant jaundice in new born babies after a complete diagnosis of the disease and its complications. In such cases, one must not avoid giving medication to the new born babies as complications of infant jaundice may lead to brain damage.

2) What causes infant jaundice?

Ans: Here are just some of the many possible causes for infant jaundice:

-   Infant jaundice usually occurs because the livers of new born babies are underdeveloped. The signs and symptoms of the disease subside as the baby grows.

-   Infant jaundice may occur if there is some internal bleeding.

-   Infant jaundice may occur if the new born baby catches up blood infection.

-   Malfunctioning or deficiency of enzymes may also lead to infant jaundice.

-   Infant jaundice may occur if the red blood cells of the new born babies break down more than normal.

-   Infant jaundice may also occur if the new born baby’s blood is not compatible with his or her mother's blood.

-   Viral or bcterial infection may also lead to infant jaundice.

-   Lack of breastfeeding may also lead to infant jaundice.

3) Can jaundice occur without discoloration of the skin?

Ans: Discoloration of the skin is just one of the many symptoms of jaundice. In many cases, jaundice patients experience discoloration of skin at a very later stage. That’s why it makes sense for people with all the symptoms of jaundice.

Here’s a list of some other jaundice symptoms:

-   Abdominal pain

-   Dark urine

-   Vomiting

-   Persistent fever

-   Weight loss

-   Extreme fatigue

4)  Is it difficult to treat jaundice?

Ans: No, it is not at all difficult to treat jaundice. In fact, one can easily treat jaundice depending upon the underlying cause of the disease.

Here’s a list of just some of the many treatment options for jaundice:

-   Use of medicines to increase the iron in the blood may treat hemolytic jaundice.

-   Steroids can also treat jaundice.

-   Surgery to remove obstructions can help treat jaundice caused due to bile obstructions.

5) Can jaundice be fatal?

Ans: Typically, jaundice is not a fatal disease. However, people suffering from various liver issues may eventually catch chronic jaundice leading to life-threatening complications. Age also remains an important factor that plays a crucial role in the treatment of jaundice. The disease may prove to be life-threatening for elderly people. That’s why doctors recommend elderly citizens suffering from jaundice to get hospitalized. In addition, those consuming excessive amount of alcohol also damage the liver and develop chronic jaundice. Chronic jaundice may prove to be fatal in such cases.

6) What is Latent Jaundice?

Ans: Latent jaundice is the type of jaundice where the bilirubin in the blood increases. But there are no visible signs or symptoms of the disease. In this condition, the inner skin cells of the patients turn yellowish greenish.

7) What is the recovery period for jaundice?

Ans: Typically, it takes around 1 to 2 months for jaundice patients to recover completely. However, symptoms including pain, itching and weakness usually subside by the 3rd week. However, in order to ensure that the symptoms subside in due time and completely recover from the disease, one must ensure balanced and healthy diet.

Last updated on : 25-09-2018

Disclaimer : Docprime doesn’t endorse or take any guarantee of the accuracy or completeness of information provided under this article and these are the views strictly of the writer. Docprime shall not be held responsible for any aspect of healthcare services administered with the information provided on this article.

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