Jaundice is a yellow discolouration of the skin, mucous membranes, and the whites of the eyes caused by increased amounts of bilirubin in the blood. Bilirubin is a by-product of the daily natural breakdown and destruction of red blood cells in the body. Jaundice is a sign of an underlying disease process.
Classification
A. Haemolytic
- Congenital
- Sickle cell anaemia
- Congenital Spherocytosis
2. Acquired
- G6PD deficiency
- Infections (viral, bacterial, protozoal)
- Serum antibodies (Rh incompatibility, Autoimmune haemolytic disease)
- Trauma to red cells (cardiac haemolysis, microangiopathic haemolysis)
- Hodgkin’s disease
B. Hepatocellular
- Acute
- Viral hepatitis
- Hepatic immaturity
- Drug hepatitis
- Alcoholic hepatitis
- Leptospirosis
- Yellow fever
- Infectious mononucleosis
2. Chronic
- Cirrhosis
- Congenital hyper- bilirubinemia
C. Obstructive Jaundice
- Without mechanical obstruction
- Acute (Drugs, Viral hepatitis, Pregnancy)
2. With mechanical obstruction
- Intrahepatic (neoplasm, reticulosis, congenital obliteration of bile duct)
- Extrahepatic (inside duct- gallstones, foreign body, parasites in duct wall, congenital atresia, stricture tumour of the bile duct, sclerosing cholangitis; Outside duct- CA head of pancreas/ampulla Of Vater, Metastasis in porta hepatis, Chronic pancreatitis)
Causes
- Acute hepatitis
- Bile duct obstruction
- Gallstones
- Cirrhosis
- Haemolytic Anaemia
- Malaria
- Autoimmune diseases
- Hereditary
- Gilbert’s syndrome
- Crigler-Najjar syndrome
- Dubin-Johnson syndrome
- Rotor’s syndrome
- Neonatal jaundice
- Eating large quantities of carrots, pumpkin, or melon (pseudojaundice)
- Carcinoma of the gall bladder, pancreas
Symptoms and signs
- Confusion
- Backache
- Dark-coloured urine
- Diarrhoea
- Dry mouth/eyes
- Fever
- Headache
- Itching
- Light-coloured stools
- Loss of appetite
- Nausea
- Pain abdomen
- Poor feeding(newborn)
- Swelling of the legs and abdomen
- Vomiting
- Weakness
- Weight loss
- Yellow discolouration of the skin, mucous membranes, and the whites of the eyes
Investigations
- Blood test
- complete blood count
- liver function tests
- lipase/amylase level
- electrolytes panel
- viral markers
- Urine test
- Stool test
- Barium swallow/meal
- Abdominal ultrasound
- CT scan
- ERCP
- Liver biopsy
- Endoscopy
- Laparotomy
Treatment of jaundice
The treatment of jaundice depends on the underlying cause.
Anaemia
- Iron supplements
- Iron-rich foods in the diet
- Ayurvedic Medicines like Tinifat, Arogyavardhini
Hepatitis
Ayurvedic Medicines
Cirrhosis
- Rest
- Low salt diet
- Ayurvedic Medicines
- Shunt surgery
Obstruction
Surgery; for gall stones, tumours
Gilbert’s syndrome
There is no treatment for Gilbert’s syndrome
Neonatal jaundice
- Phototherapy (exposed to ultraviolet (UV) light)
- Blood transfusion (if phototherapy fails)
Complications
- Deafness
- Cerebral Palsy
- Acute Bilirubin Encephalopathy
- Kernicterus
Prevention
- Take anti-malarial treatment before travelling to high-risk regions.
- Avoid heavy alcohol use (alcoholic hepatitis, cirrhosis, and pancreatitis).
- Avoid medications and toxins which can cause hemolysis or directly damage the liver.
- Avoid medications that can cause hemolysis (G6PD deficiency).
- Avoid potentially contaminated food/water and maintain good hygiene (Hepatitis A).
- Intravenous drug use or unprotected intercourse (Hepatitis B).
- Vaccines for hepatitis (Hepatitis A, Hepatitis B)