JAUNDICE
JAUNDICE
Bilirubin is aby-product formed from the breakdown of hemoglobin present in red blood cells in the blood.It is thentransported to liver and metabolized and excreted from there. Any disease disrupting the normal bilirubin metabolism causes jaundice.
Jaundice is a sign of an underlying disease. It is identified as:
• Yellow discoloration of the skin, mucous membranes (the lining of the body’s passages and cavities, such as the mouth and nose) and the white of the eyes
• Light-colored stools
• Dark-colored urine
Symptoms:
- Anorexia
- Nausea and vomiting
- Fever
- Abdominal pain
- Swelling of the legs and abdomen
- Generalized weakness
- Itching of the skin.
- Weight loss
Causes:
The causes of jaundice are classified into three. They are,
- Pre-hepatic (here the disruption occurs before the bilirubin has been transported from the blood to the liver.) It occurs due to excessive destruction of red blood cells from:
- Sickle cell disease
- Thalassemia
- Hereditary spherocytosis
- G6PD deficiency
- Malaria
- Drugs or toxins and
- Autoimmune disorders.
- Hepatic (here the disruption occurs within the liver)
- Acute or chronic hepatitis (hepatitis A, B, C, E, Alcohol, obesity)
- Cirrhosis of liver
- Crigler-Najjar syndrome
- Gilbert’s syndrome
- Liver cancer
- Drugs or other toxins
- Auto immune disorders
- Post Hepatic (here the disruption occurs after excretion from the liver).The disruption prevents the bile (and the bilirubin inside it) from draining into the digestive system. It can be due to:
- Gallstones
- Cancer (of gall bladder, pancreas, common bile duct)
- Bile duct strictures
- Cholangitis
- Parasitic infections
DIAGNOSIS:
Once jaundice is identified by patient’s history and examination, the cause and severity of jaundice can be evaluated by few diagnostic tests as follows:
- BLOOD TESTS:
- Liver function test – which evaluates normal functioning of liver.It includesthe enzymes/proteins it synthesizes like alanine transaminase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and albumin; bilirubin (direct and indirect) which it excretes and the coagulation factors it produces indicated by coagulation studies like prothrombin time.
- Complete Blood Count (CBC)- measures the levels of red blood cells, white blood cells and platelets
- Serologic testing for specific liver disease: Hepatitis A, B and C markers, serum iron studies (for hemochromatosis), serum ceruloplasmin (for Wilson disease), antimitochondrial and other antibodies (for autoimmune hepatitis, celiac disease)
- Other blood tests: electroytes, tumor markers etc..
- IMAGING STUDIES:
- Abdominal Ultrasonography
- MRI scan
- CT Scan
- MRCP(Magnetic Resonance Cholangiopancreatography)
- EUS (Endoscopic Ultrasound)
- Liver biopsy
Complications:
- Anemia
- Bleeding
- Infection / Sepsis
- Liver failure
- Kidney failure
- Brain dysfunction
- Death
Treatment:
Treatment for jaundice depends on the underlying cause and may range from supportive care to liver transplantation. If the jaundice is due to obstruction to bile flow, the obstruction is relieved by removal of stones and stent placement by ERCP, dilatation of strictures, placement of drains, gall bladder and bile duct surgery, surgeries for cancers, radiologic approach for drains for strictures inside liver etc..
If the cause of jaundice is prehepatic or hepatic, alcohol cessation, discontinuation of the causative drugs or toxins, antiviral therapy, immunosuppressants etc..may be advised.
Diagnostic Indications & Treatment
- Symptoms
- Causes
- Complications
- Treatment
- Anorexia
- Nausea and vomiting
- Fever
- Abdominal pain
- Swelling of the legs and abdomen
- Generalized weakness
- Itching of the skin.
- Weight loss
The causes of jaundice are classified into three. They are,
- Pre-hepatic (here the disruption occurs before the bilirubin has been transported from the blood to the liver.) It occurs due to excessive destruction of red blood cells from:
- Sickle cell disease
- Thalassemia
- Hereditary spherocytosis
- G6PD deficiency
- Malaria
- Drugs or toxins and
- Autoimmune disorders.
- Hepatic (here the disruption occurs within the liver)
- Acute or chronic hepatitis (hepatitis A, B, C, E, Alcohol, obesity)
- Cirrhosis of liver
- Crigler-Najjar syndrome
- Gilbert’s syndrome
- Liver cancer
- Drugs or other toxins
- Auto immune disorders
- Post Hepatic (here the disruption occurs after excretion from the liver).The disruption prevents the bile (and the bilirubin inside it) from draining into the digestive system. It can be due to:
- Gallstones
- Cancer (of gall bladder, pancreas, common bile duct)
- Bile duct strictures
- Cholangitis
- Parasitic infections
- Anemia
- Bleeding
- Infection / Sepsis
- Liver failure
- Kidney failure
- Brain dysfunction
- Death
Treatment for jaundice depends on the underlying cause and may range from supportive care to liver transplantation. If the jaundice is due to obstruction to bile flow, the obstruction is relieved by removal of stones and stent placement by ERCP, dilatation of strictures, placement of drains, gall bladder and bile duct surgery, surgeries for cancers, radiologic approach for drains for strictures inside liver etc..
If the cause of jaundice is prehepatic or hepatic, alcohol cessation, discontinuation of the causative drugs or toxins, antiviral therapy, immunosuppressants etc..may be advised.
A TIPPS Procedure was done at Kolhapur which gave patient immediate relief. This kind of procedure is done for the first time ever in this region.
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