Jaundice is a yellowing of the skin and the whites of the eyes and body fluids caused by an accumulation of a cellular waste production called bilirubin. In many cases, yellowness in the white part of the eyes is more evident than in the skin. It is caused by an increase in the amount of bilirubin in the blood. Jaundice is not a disease in and of itself, but a warning that the liver is having a trouble controlling bilirubin as it should. The liver builds bilirubin from dying red blood cells and other sources. It then transfers bilirubin into bile, which has some purposes, among them the digestion of fatty acids and neutralization of stomach acid. If there is surplus bilirubin for the liver to handle, or if the liver\’s performance is compromised, jaundice can result. Bilirubin is a yellowish pigment that is generated from the breakdown of heme, mainly from hemoglobin and red blood cells (RBCs). Bilirubin is transmitted by the blood to the liver, where the liver processes it, allowing it to be excreted in bile. Bile is a thick, yellow-green-brown fluid that is secreted into the upper small intestine (duodenum) to throw away waste products (like bilirubin and excess cholesterol) and to support in the digestion of fats.
Increased breakdown of red blood cells, inherited alterations in bilirubin metabolism, liver disease or injury, and intervention with bile excretion, all of these may trigger jaundice.
Causes
Jaundice may be caused by several diverse ailing conditions. It is easy to understand the different causes of jaundice by recognizing the problems that disrupt the normal bilirubin metabolism and/or excretion.
Pre-hepatic
Jaundice in these cases is the result of speedy increase in the collapse and damage of the red blood cells (hemolysis), crushing the liver\’s capability to sufficiently eliminate the increased levels of bilirubin from the blood.
Instances of conditions with increased breakdown of red blood cells include:
- Malaria,
- Sickle cell crisis,
- Spherocytosis,
- Thalassemia,
- Glucose-6-phosphate dehydrogenase deficiency (G6PD),
- Drugs or other toxins, and
- Autoimmune disorders
- Hepatic (the problem arises within the liver)
Jaundice in these cases is caused by the liver\’s inability to properly metabolize and excrete bilirubin. Examples include:
Hepatitis (commonly viral or alcohol related),
Cirrhosis,
Drugs or other toxins,
Crigler-Najjar syndrome,
Gilbert\’s syndrome and
Cancer
Post-hepatic
Post-hepatic jaundice, also termed as obstructive jaundice, is caused by a disruption to the drainage of bile in the biliary system. The most regular causes are gallstones in the common bile duct, and pancreatic cancer in the head of the pancreas. Moreover, a group of parasites known as \”liver flukes\” can exist in the common bile duct, resulting in obstructive jaundice. Causes of obstructive jaundice include:
Gallstones in the bile ducts,
Cancer (pancreatic and gallbladder/bile duct carcinoma),
Strictures of the bile ducts,
Cholangitis,
Congenital malformations,
Pancreatitis,
Parasites,
Pregnancy etc
Examples of more rare conditions that may cause jaundice:
Crigler-Najjar syndrome: This type is an inborn condition that can initiate serious unconjugated hyperbilirubinemia (high bilirubin concentrations); a gene mutation leads to an insufficiency in an enzyme indispensable for bilirubin conjugation.
Dubin-Johnson syndrome: It is an inherited disorder. This brings about the retention of conjugated bilirubin (and some other compounds that make the liver black) in liver cells; patients can suffer from intermittent jaundice.
Rotor’s syndrome: This inherited conjugated hyperbilirubinemia causes intermittent jaundice. This is akin to Dubin-Johnson without the retention of other compounds or a black liver.
Pseudojaundice: In this case the skin of a person can turn into yellowish when they eat large quantities of carrots, squash, or cantaloupe due to the presence of beta-carotene; this is a transitory and benign condition that is not associated to bilirubin or bile.
Newborn jaundice
Physiological jaundice
This type of jaundice is generally obvious on the second or third day of life. It is the most common cause of newborn jaundice and is by and large a passing and not detrimental condition. Jaundice is caused by the inability of the newborn\’s undeveloped liver to process bilirubin from the accelerated collapse of red blood cells that arises at this age. As the newborn\’s liver matures, the jaundice ultimately disappears.
Maternal-fetal blood group incompatibility (Rh, ABO)
This type of jaundice occurs when there is inaptness between the blood types of the mother and the fetus. This leads to improved bilirubin levels from the breakdown of the fetus\’ red blood cells (hemolysis).
Breast milk jaundice
This form of jaundice happens in breastfed newborns and usually emerges at the end of the first week of life. Certain chemicals in breast milk are thought to be responsible. It is generally a risk-free condition that resolves spontaneously. Mothers are advised to do not have to discontinue breastfeeding.
Breastfeeding jaundice
This type of jaundice arises when the breastfed newborn does not obtain sufficient breast milk intake. This may crop up because of deferred or inadequate milk production by the mother or because of poor feeding by the newborn. This inadequate intake results in dehydration and smaller amount bowel movements for the newborn, with successive decreased bilirubin emission from the body.
Celhalohematoma (a collection of blood under the scalp)
At the time of delivery, the newborn may sustain a bruise or injury to the head, resulting in a blood collection/blood clot under the scalp. As this blood is naturally broken down, abrupt high levels of bilirubin may devastate the processing capability of the newborn\’s undeveloped liver, causes jaundice.
Symptoms
General signs and symptoms seen in individuals with jaundice comprise:
Yellow discoloration of the skin,
Mucous membranes,
The Whites of the eyes
Light-colored stool
Dark-colored urine
Itching of the skin
The underlying disease may lead to additional signs and symptoms. These may include:
Nausea and vomiting,
Abdominal pain,
Fever,
Weakness,
Loss of appetite,
Headache,
Confusion,
Swelling of the legs and abdomen
Symptoms of newborn Jaundice
In newborns, as the bilirubin level climbs, jaundice will naturally progress from the head to the trunk, and then to the hands and feet. Additional signs and symptoms that may be seen in the newborn include:
Poor feeding,
Lethargy,
Changes in muscle tone,
High-pitched crying and
Seizures
Exams and Tests
Blood tests
These may originally comprise a complete blood count (CBC), liver function tests (including a bilirubin level), lipase/amylase level to detect inflammation of the pancreas (pancreatitis), and an electrolytes panel. In women, a pregnancy test may be obtained. Supplementary blood tests may be required depending upon the primary results and the history provided to the practitioner.
Urinalysis: Urinalysis is an examination of the urine and is a very useful test in the diagnosis of screening many diseases.
Maging
Ultrasound: This is a secure, painless imaging study that uses sound waves to observe the liver, gallbladder, and pancreas. It is very effective for diagnosing gallstones and dilated bile ducts. The abnormalities of the liver and the pancreas can be detected through this method.
Computerized tomography (CT) scan: A CT scan is imaging study parallel to an X-ray that gives more details of all the abdominal organs. Though not as good as ultrasound at identifying gallstones, it can also detect different other abnormalities of the liver, pancreas, and other abdominal organs.
Cholescintigraphy (HIDA scan): A HIDA scan is an imaging study that employs a radioactive substance to assess the gallbladder and the bile ducts.
Magnetic resonance imaging (MRI): MRI is an imaging study that utilizes a magnetic field to test the organs of the abdomen. It may be effective for thorough imaging of the bile ducts.
Endoscopic retrograde cholangiopancreatography (ERCP): ERCP is a process that occupies the introduction of an endoscope (a tube with a camera at the end) through the mouth and into the small intestine. A dye is then inserted into the bile ducts as X-rays are taken. It can be helpful for detecting stones, tumors, or narrowing of the bile ducts.
Liver Biopsy
In this procedure, a needle is inserted into the liver after a local anesthetic has been administered. Often ultrasound will be used to guide placement of the needle. The small sample of liver tissue which is obtained is sent to a laboratory for examination by a pathologist (a physician who specializes in diagnosis of tissue samples). Among other things, a liver biopsy can be useful for diagnosing inflammation of the liver, cirrhosis, and cancer.
Jaundice Treatment
Treatment of Jaundice try to heal the cause of the underlying condition which deteriorates the diseases and any probable problems associated with it. Once a diagnosis is completed, treatment can then be aimed at to deal with that particular condition, and it may or may not require hospitalization. Jaundice in newborns must be treated if it becomes serious as deposits can lead to enduring brain damage. In all other cases, it is not the jaundice that needs to be treated but the primary condition. If the condition resolves, then the diseases will resolve too.
Treatment may be composed of expectant management (watchful waiting) at home with rest.
Medical treatment with intravenous fluids, medications, antibiotics, or blood transfusions may be obligatory.
If a drug/toxin is the cause, these must be withdrawn.
In certain cases of newborn jaundice, exposing the baby to special colored lights (phototherapy) or exchange blood transfusions may be required to lessen elevated bilirubin levels.
Surgical treatment may be recommended.
Self-Care at Home
The purposes of home therapy include symptom relief and controlling the medical condition causing the underlying jaundice. The various measures that should be followed include:
Maintain sufficient hydration by drinking fluids, and take rest as needed.
Avoid drinking alcohol until the patient has consulted it with their health care practitioner.
Some dietary restrictions may be advised by the health care practitioner.
In certain cases of newborn jaundice, the parents or caregivers can put the baby next to a well lit window a few times a day to reduce increased bilirubin levels. In more severe cases, a health care practitioner may necessitate to release the baby home from the hospital with home phototherapy.
Ensure adequate milk intake for the baby in cases of breastfeeding jaundice.
Foods and Fluids to prevent jaundice
The green leaves of radish should be crushed and their juice extracted through cloth. An adult patient should intake half a liter of this juice daily. It stimulates a healthy appetite and proper evacuation of bowels and this gradually decrease the trouble. In a good number of cases, absolute cure can be ensured within 8 or 10 days.
Take a glass of fresh tomato juice, blended with a bit of salt and pepper early in the morning. It is an effective tonic for jaundice.
The juice extracted from the green leaves of pigeon pea should be taken in doses of 60 ml daily. It is an effective home remedy for jaundice.
Soak 8 kernels of almonds, 2 dried dates, and 5 small cardamoms overnight in water. The outer coating of the almond kernels and the inner seeds of dried dates should be pealed off the next morning and the whole material should be grinded into a fine paste. Then, 50 grams of sugar and an equal amount of butter should be mixed in it and the patient should lick this mixture.
You should take 1 glass of sugarcane juice, mixed with the juice of half a lime, and drink it twice daily. It is extremely effective treatment for jaundice though it must be clean and preferably prepared at home.
You can also take 20 ml of lemon juice mixed with water several times a day. This will guard the damaged liver cells.
Boil 1 cup of barley in 3 liters of water and simmered for 3 hours. Gulp it a number of times in a day. It is also an effective home remedy for jaundice.
Prevention
The crucial medical conditions causing jaundice can in a few cases be averted. Some preventive steps include the following:
Stay away from alcohol (alcoholic hepatitis, cirrhosis, and pancreatitis).
Vaccines for hepatitis (hepatitis A, hepatitis B)
Take medications which check malaria before traveling to high-risk regions.
Avoid high-risk activities like intravenous drug use or unprotected intercourse (hepatitis B).
Evade potentially contaminated food/water and retain good hygiene (hepatitis A).
Avoid medicines that can bring about hemolysis in vulnerable individuals (such as those with G6PD deficit, a condition that leads to red blood cell breakdown after consumption of certain substances).
Ignore medications and toxins which can result in hemolysis or affect the liver directly.