What is Jaundice

 

 

What is Jaundice

A person with jaundice may notice a yellowish tinge to their skin, mucous membranes, and the whites of the eyes. It can happen with various health conditions and usually indicates a problem with the liver or bile ducts.

When the liver is not working properly, it can cause a waste material called bilirubin to build up in the blood.

What are the different types of jaundice?

 

Types of  Jaundice are categorized by where they happen within the liver’s process of taking in and filtering out bilirubin. Include  

• Pre-hepatic jaundice: Health conditions that affect the blood’s rate of breaking down blood cells cause bilirubin to overflow into bodily tissues. It occurs before the blood reaches the liver.
• Hepatic jaundice: Hepatic jaundice happens when your liver tissue becomes less effective at filtering out bilirubin from your blood.
• Post-hepatic jaundice: This type of jaundice happens when bilirubin filtered from the blood can’t drain properly into the bile ducts or digestive tract to be passed out of the body. It occurs after bilirubin is filtered out in the liver and occurs because of a blockage.

What causes jaundice?

Jaundice can be caused by a problem in any of the three phases in bilirubin production.

Before the production of bilirubin, you may have what's called unconjugated jaundice due to increased levels of bilirubin caused by:

• Reabsorption of a large hematoma  (a collection of clotted or partially clotted blood under the skin).
•  Hemolytic anemias (blood cells are destroyed and removed from the bloodstream before their normal lifespan is over).

During production of bilirubin, jaundice can be caused by:

• Viruses, including hepatitis A, chronic Hepatitis B and C, and Epstein-Barr virus infection (infectious mononucleosis).
• Alcohol.
• Autoimmune disorders.
• Rare genetic metabolic defects.
• Medicines, including acetaminophen toxicity, penicillins, oral contraceptives,  chlorpromazine (Thorazine®) and estrogenic or anabolic steroids.

After bilirubin is produced, jaundice may be caused by obstruction (blockage) of the bile ducts from:

• Gallstones.
• Inflammation (swelling) of the gallbladder.
• Gallbladder cancer.
• Pancreatic tumor.

Signs and Symptoms of Jaundice

Infants

Typically, the telltale yellow or orange coloring of jaundice first appears on a baby’s face, then it migrates down the body to the chest, abdomen, arms, and legs.

 The whites of the eyes can also take on a yellowish hue. Signs in babies that warrant a same-day visit to the doctor include:

• Very yellow or orange skin color
• Extreme fussiness
• Difficulty waking up
• Not sleeping
• Poor feeding
• Limited wet or dirty diapers

If your baby exhibits any of the following symptoms, seek emergency medical assistance:

• Inconsolable or high-pitched crying
• Arching their body like a bow
• Stiff, limp, or floppy body
• Unusual eye movements

Adults

Certain adults are also susceptible to jaundice.

 

 While some don’t exhibit any symptoms, for others, signs may include:

• Change in skin color
• Flu-like symptoms, like fever and chills
• Dark urine
• Clay-colored stool
• Itchy skin
• Weight loss

Other signs of jaundice in adults include:

 

• Blood in Vomit or stool
• Tarry black stool 
• Extreme abdominal pain and tenderness
• Sudden drowsiness, agitation, or confusion
• Easy bruising or bleeding, sometimes causing a rash of tiny reddish-purple dots or larger splotches

Diagnosing jaundice

If you have jaundice, you'll have a number of tests to find out how severe it is and work out the underlying cause.

You'll probably have a urine test and liver function and blood tests.

Doctors diagnose jaundice by checking for signs of liver disease such as:

• Bruising of the skin.
• Spider angiomas (abnormal collection of blood vessels near the surface of the skin).
• Palmar erythema (red coloration of the palms and fingertips).

Urinalysis (urine testing) that's positive for bilirubin shows that the patient has conjugated jaundice. The findings of urinalysis should be confirmed by serum testing. The serum testing will include a complete blood count (CBC)  and bilirubin levels.

Your doctor will also do an exam to determine the size and tenderness of your liver. He or she may use imaging (ultrasonography and computer tomographic (CT) Scanning) and liver biopsy (taking a sample of the liver) to further confirm diagnosis.

Treating jaundice

Treatment for jaundice in adults and older children depends on what's causing it. This may involve treating the underlying condition, a blood transfusion or surgery.

Mild infant jaundice often disappears on its own within two or three weeks. For moderate or severe jaundice, your baby may need to stay longer in the newborn nursery or be readmitted to the hospital.

Treatments to lower the level of bilirubin in your baby's blood may include:

• Enhanced nutrition. To prevent weight loss, your doctor may recommend more-frequent feeding or supplementation to ensure that your baby receives adequate nutrition.
• Light therapy (phototherapy).Your baby may be placed under a special lamp that emits light in the blue-green spectrum. The light changes the shape and structure of bilirubin molecules in such a way that they can be excreted in both the urine and stool. During treatment, your baby will wear only a diaper and protective eye patches. Light therapy may be supplemented with the use of a light-emitting pad or mattress.
• Intravenous immunoglobulin (IV Ig). Jaundice may be related to blood type differences between mother and baby. This condition results in the baby carrying antibodies from the mother that contribute to the rapid breakdown of the baby's red blood cells. Intravenous transfusion of an immunoglobulin — a blood protein that can reduce levels of antibodies — may decrease jaundice and lessen the need for an exchange transfusion, although results are not conclusive.
• Exchange transfusion. Rarely, when severe jaundice doesn't respond to other treatments, a baby may need an exchange transfusion of blood. This involves repeatedly withdrawing small amounts of blood and replacing it with donor blood, thereby diluting the bilirubin and maternal antibodies — a procedure that's performed in a newborn intensive care unit.

Preventing jaundice

It's not possible to prevent all cases of jaundice because it can be caused by a wide range of conditions or circumstances.

You can take precautions to minimize your risk of developing jaundice. These include:

• making sure you don't exceed the recommended daily amount (RDA) of alcohol units  
• maintaining a healthy weight for your height and build
• if appropriate, making sure you're vaccinated against hepatitis A  or hepatitis B  if you're travelling to high-risk areas of the world
• minimizing your risk of exposure to hepatitis c   because there's currently no vaccine for the condition; the most effective way of preventing hepatitis C is by not injecting illegal drugs, such as heroin, or making sure that you don't share drug injecting equipment if you do