Information for the Public
What is Jaundice
Jaundice
refers
to
yellowish
discolouration
of
the
skin
and
eyes.
It
occurs
when
the
bilirubin
levels
in
the
blood
increase.
One
of
the
main
functions
of
the
liver
is
to
get
rid
of
toxins
whether
ingested
with
or
without
our
knowledge.
They
also
get
rid
of
waste
products
produced
by
the
body.
Bilirubin is one such product.
What is Bilirubin
Red
blood
cells
(RBC)
have
a
life
span
of
around
120
days.
Throughout
life
they
are
continuously
replaced.
During
the
recycling
process
the
old
and
damaged
RBCs
are
broken
down
and
bilirubin
is
an
end
product.
The
bilirubin
thus
formed
is
carried
in
the
bloodstream
to
the
liver
where
it
mixes
with
bile
in
a
process
called
conjugation.
This
conjugated
bilirubin
is
transported
with
the
bile
to
the
gut
where
it
is
degraded
further
and
eliminated
in
the
stools.
A
small
amount
is
also
excreted
in
the
urine.
Normally
the
level
of
bilirubin
in
the
blood
is
about
1.2
milligrams
per
deciliter
(mg/dL)
for
adults
and
about
1
mg/dL
for
children.
When the level in the blood rises to about 3 mg/dL the skin and eyes (conjunctiva) become yellow and jaundice results.
Significance of Jaundice:
If
your
bilirubin
levels
are
higher
than
normal,
it’s
a
sign
that
either
significantly
larger
number
of
red
blood
cells
are
breaking
down
or
that
your
liver
isn’t
functioning
properly
to
clear
the
bilirubin
from
your blood.
Another
reason
could
be
that
the
excretory
pathway
from
the
liver
is
being
blocked
so
no
bilirubin
is
conjugated
or
is
transported
by
bile to the gut.
Types of Jaundice:
•
Hemolytic jaundice
•
Hepatocellular jaundice
•
Obstructive or post-hepatic jaundice
Hemolytic jaundice
When
there
is
excessive
destruction
of
RBCs
haemolytic
jaundice
results.
This
can
happen
in
Sickle
cell
anaemia,
Thalassemia
and
certain drugs that can cause destruction of red blood cells.
Hepatocellular jaundice
In hepatocellular jaundice, the liver cells are affected hence conjugation of bilirubin is impaired.
The liver cells may be affected in:
•
Viral infections (Hepatitis A B and C)
•
Alcohol abuse
•
Cirrhosis of liver
•
Autoimmune liver disease
•
Gilbert syndrome
•
Drugs eg acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs)
•
Mushroom poisoning
Obstructive (Cholestatic) jaundice
In
obstructive
jaundice,
the
transport
of
bilirubin
to
the
intestines
is
affected
due
to
a
blockage
of
the
bile
ducts.
If
blockage
is
within
the
liver
it
is
termed
intrahepatic
cholestasis.
If
outside
(bile
duct)
it
is
termed
extrahepatic
cholestasis.
The
accumulated
bilirubin
spills
over
into
the
blood.
The causes include:
Tumor or inflammation in the bile ducts or gallbladder
Stones in the gallbladder or bile ducts
Pancreatic cancer
Congenital disorders of bile ducts
Infection
It
should
be
emphasised
that
jaundice
is
in
itself
a
symptom
of
an
underlying
disease.
Except
Haemolytic
Jaundice
all
other
types
indicate
pathology
in
and
around
the
liver.
The
clinical features will therefore depend on the disease.
Symptoms:
Fever
Tiredness and lethargy
Abdominal pain
Loss of appetite
Nausea
Severe itching
How is Jaundice Evaluated?
A
complete
and
thorough
history
and
physical
examination
is
essential
to
give
a
clue
to
the
possible
cause.
The
doctor
will
ask
you
about
the
onset
and
duration
of
symptoms,
history
of
weight
loss,
family
history,
history
of
blood
transfusion,
and
history
of
drug
ingestion
or
IV
drug
use.
During
physical
examination,
he
will
look
for
signs
of
anaemia,
fever,
presence
of
liver
enlargement,
enlarged
lymph
nodes
etc
to
rule
in
or
rule
out
certain
causes.
Blood tests
:
•
Bilirubin level in blood (total, conjugated & unconjugated bilirubin)
•
Blood test to rule out haemolytic anaemia
•
Blood test to check function of liver: Serum transaminases (ALT and
AST) Serum alkaline phosphatase, gamma-GT level.
•
Viral serology for hepatitis B and C
•
Blood culture to check for infectious causes.
Urine Test:
Urine is checked for presence of bile salts and bile pigments
Diagnostic imaging:
This is done to visualize the gall bladder, the pancreas and the liver:
Ultrasound
CT-scan
MRI scan
ERCP - Occasionally specialised tests such as endoscopic retrograde cholangiopancreatography
Liver
Biopsy
–
Only
done
when
other
tests
are
not
helpful
or
further
information
is
needed.
A
liver
biopsy
carries
some
risk
of
bleeding and infection.
How is Jaundice Treated?
The treatment of jaundice involves management of the underlying cause and providing symptomatic relief.
Analgesics and antipyretics to relieve symptoms of pain and fever
Cholestyramine for relief of itching
Liver supplements in hepatocellular jaundice to improve liver function (viral hepatitis A which is usually self-limiting).
Anti-viral medication for Hepatitis B and C
Management of haemolytic anaemia
Surgery to remove gallstone or stone in bile duct.
Appropriate management of tumor in the liver, gallbladder, biliary tree or pancreas
How can Jaundice be Prevented?
Not all causes of jaundice can be prevented. However infectious and drug induced causes can be prevented.
Proper hygienic practices such as regular handwashing before eating and after emptying bowels
Avoid sharing personal items such as razors and toothbrushes
Blood and blood components should be checked thoroughly for Hepatitis B and C before transfusion.
Hepatitis B vaccination in high risk individuals such as doctors and lab personnel who handle blood and blood products
Practising safe sex
Avoid sharing IV needles
Ensure clean and sterile needles are used while getting tattooed
Avoid alcohol abuse
Avoid abuse of painkillers such as NSAIDs and acetaminophen
How long will it take to recover from jaundice?
The
duration
depends
on
the
cause
of
jaundice.
Usually
hepatitis
A
infection
is
self-limiting
and
the
patient
recovers
in
4-6
weeks.
In
cases
of
obstruction,
the
jaundice
disappears
once
the
obstruction
is
relieved
eg
removing
bile
duct
stones.
In
malignancy
the
course
of
disease
may
be
prolonged
and
difficult
to
predict.
In
liver
failure
eg
alcoholism
and
cirrhosis
jaundice
may
be
progressively
worse.
Diet recommended in jaundice.
A
diet
filled
with
fresh
fruits
and
green
vegetables
is
essential.
Avoid
oily
and
spicy
foods.
Alcohol
intake
should
be
avoided.
Liver
supplements will help.
Can jaundice be fatal?
Most cases of jaundice recover completely. In instances of liver failure or incurable cancer, it could be life-threatening.
Jaundice
may
indicate
a
serious
underlying
pathology.
Consult
a
doctor
without
delay
for
a
full
check
up
if
you
or
someone
close to you is affected.
NB: This topic is discussed in greater detail in the “
Medical Forum” under Gastroenterology
.
Lakshmi Venkataraman. MD
Jaundice
Previous Topics Discussed on Health
Signs you may see with Jaundice:
Anaemia (haemolytic jaundice)
Liver enlargement
Weight loss
Serious Signs: Swelling abdomen (ascites), visible blood
vessels on skin (spider naevi), enlarged breast tissue in men
(gynaecomastia) and tremor