Jaundice

Jaundice is a yellow discoloration 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

1. 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  

1. Acute

• Viral hepatitis
• Hepatic immaturity
• Drug hepatitis
• Alcoholic hepatitis
• Leptospirosis
• Yellow fever
• Infectious mononucleosis

2. Chronic

• Cirrhosis
• Congenital hyper- bilirubinemia 

C. Obstructive Jaundice

1. 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 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

1. Gallstones
2. Cirrhosis

• Haemolytic Anaemia

1. 1. Malaria
   2. Autoimmune diseases

• Hereditary

1. 1. Gilbert’s syndrome
   2. Crigler-Najjar syndrome
   3. Dubin-Johnson syndrome
   4. Rotor’s syndrome

• Neonatal jaundice 
• Eating large quantities of carrots, pumpkin, or melon (pseudojaundice)
• Carcinoma of gall bladder, pancreas

Symptoms And Signs–

• Confusion
• Backache
• Dark-colored urine
• Diarrhoea
• Dry mouth/eyes
• Fever
• Headache
• Itching
• Light-colored stools
• Loss of appetite
• Nausea
• Pain abdomen
• Poor feeding(newborn)
• Swelling of the legs and abdomen
• Vomiting
• Weakness
• Weight loss
• Yellow discoloration of the skin, mucous membranes, and the whites of the eyes

Investigations—

• Blood test

1. complete blood count
2. liver function tests
3. lipase/amylase level
4. electrolytes panel
5. viral markers

• Urine test
• Stool test
• Barium swallow/meal
• Abdominal ultrasound
• CT scan
• ERCP
• Liver biopsy
• Endoscopy
• Laparotomy

Treatment—

The treatment of jaundice depend on the underlying cause.

• Anaemia 

1. Iron supplements
2. Iron-rich foods in  diet
3. Ayurvedic Medicines like Tinifat, Arogyavardhini

• Hepatitis       

1.  Ayurvedic Medicines

• Cirrhosis

1. Rest
2. Low salt diet
3. Ayurvedic Medicines
4. Shunt surgery

• Obstruction

Surgery; for gall stones, tumor

• Gilbert’s syndrome

There is no treatment for Gilbert’s syndrome

• Neonatal jaundice

1. Phototherapy (exposed to ultraviolet (UV) light)
2. Blood transfusion (if phototherapy fails)

Complications—         

1. Deafness
2. Cerebral Palsy
3. Acute Bilirubin Encephalopathy
4. Kernicterus

 PREVENTION–

1. Take anti-malarial treatment before travelling to high-risk regions.
2. Avoid heavy alcohol use (alcoholic hepatitis, cirrhosis, and pancreatitis).
3. Avoid medications and toxins which can cause hemolysis or directly damage the liver.
4. Avoid medications that can cause hemolysis (G6PD deficiency).
5. Avoid potentially contaminated food/water and maintain good hygiene (Hepatitis A).
6. Intravenous drug use or unprotected intercourse (Hepatitis B).
7. Vaccines for hepatitis (Hepatitis A, Hepatitis B)