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Jaundice is a cause for concern. Also known as icterus, it is a condition, which is characterised by a yellowish discolouration of the skin and the whites (sclera) of the eyes. It is a symptom or clinical sign, not a disease by itself. The yellow colouration is caused by an excess amount of the bile pigment known as bilirubin in the body. Normally, about one per cent of our red blood cells retire every day, to be replaced by fresh red blood cells. Bilirubin is formed by the breakdown of haemoglobin during the destruction of worn-out red blood cells. The old ones are processed in the liver and disposed of. The pigment is then excreted by the liver into the bile via the bile ducts. Much of the resulting bilirubin leaves the body in the stool. If there are too many red blood cells retiring for the liver to handle, yellow pigment builds up in the body. When there is enough to be visible, jaundice results.
Cause and Pathogenesis
Excess amounts of bilirubin in the body can be caused by the overproduction of bilirubin, the failure of the liver cells to metabolise or excrete the bilirubin produced, or a blockage of the bile ducts. Overproduction of bilirubin may be caused by the destruction of an unusually large number of red blood cells, which occurs in a condition known as haemolytic anaemia. In this condition the liver cannot excrete the bilirubin which is formed more rapidly. This may occur in diseases such as malaria, thalassemia, and haemolytic disease (due to destruction of the red blood cells) of the new-born. Often, mild jaundice occurs as a common and normal condition in newborn babies because at birth there is both a deficiency in the enzyme that helps to eliminate bilirubin and also an increased breakdown of red blood cells (RBC) in the body. In babies, the condition generally disappears within a few days after birth as the enzyme is formed in the body. Physiologic jaundice is the name for normal jaundice commonly seen in healthy babies. Sometimes, deficiency of this enzyme can also cause jaundice in adults.
Pathologic or the clinical types of jaundice present a health risk, either because of its degree or its cause. It arises for many reasons, including blood incompatibilities, blood diseases, genetic syndromes, hepatitis, cirrhosis, bile duct blockage, other liver diseases, infections, or medications.
There are various strains of hepatitis viruses. They are hepatitis A (HAV), hepatitis B (HBV), hepatitis C (HCV), hepatitis D (HDV), and hepatitis E (HEV). Viruses F and G also exist and may cause primary hepatitis. Hepatitis A is a common cause of infective jaundice. Transmitted through water, food and by the faecal-oral route. It often affects children and young adults, but the incidence is rising among those who are HIV positive.
The other viruses such as Hepatitis B and C are transmitted through blood. They spread through the body secretions of infected persons. Close contact, blood transfusion, contaminated needles and tattooing are factors responsible for the spread of this dreaded infection. Homosexuals contract these infections more easily. These viruses are more resistant to the various methods of sterilisation than the AIDS virus. They are a major cause for concern as they spread rapidly. There are more people infected by Hepatitis B virus in the world than the AIDS virus. Hepatitis B and C infections can lead to chronic liver diseases, cirrhosis and eventually liver cancer & liver failure.
The other viruses associated with jaundice are Hepatitis D and E. Hepatitis D is seen in individuals who are susceptible to Hepatitis B or its carriers, such as haemophiliacs and IV drug users. The disease manifestation is severe in children Hepatitis E infection can be acquired from contaminated water. Hepatitis E is seen primarily among young adults in developing countries. It is most severe in pregnant women. Congenital non-haemolytic hyperbilirubinemia such as Gilbert’s Syndrome also causes jaundice. Sometimes certain drugs such as chlorpromazine (an anti-psychotic drug) may inhibit bilirubin excretion by the liver, causing jaundice.
Symptoms
The main symptom of jaundice is the characteristic yellowish colour of the skin, sclera (whites) of the eyes, nail beds and tongue. Other symptoms usually depend on the actual cause of the jaundice. In some types of jaundice, bilirubin is excreted in the urine, which becomes yellowish brown in colour. If the excretion of bile is obstructed, stools are almost white and the digestion of fat is consequently impaired. If the jaundice has been present for a long time, pruritis (intense itching) may occur. Due to obstruction, lipid deposits on the skin such as xanthelesmas on the eyelids or xanthomas can develop. Some patients with jaundice may also have vomiting and abdominal pain, malaise and severe weakness. Complications include hepatic failure with its attendant complications such as bleeding, vomiting of blood, accumulation of fluid in the abdomen (ascites), and a condition called hepatic encephalopathy where the patient has altered consciousness and later coma. Fulminant hepatic failure and hepatic coma may often be fatal even with treatment. Another complication of hepatitis is the development of cirrhosis (due to destruction of the liver cells) and also conditions such as chronic active hepatitis wherein the jaundice may persist for several months. The prognosis in these conditions may be poor although the results are better with prompt and effective treatment.
Stones or growths, blocking the pathway of bile, cause obstructive jaundice. They usually originate in the gall bladder. This often requires removal of the gall bladder along with the stones in the biliary pathway.
Treatment and Immunisation
The treatment for jaundice depends upon the type of jaundice. For viral hepatitis causing jaundice, there is no definitive treatment. Only supportive measures are given. The virus is slowly eliminated from the body with the help of the immune system. In case of jaundice caused by blockage to the pathway of bile, surgery may be needed.
Hepatitis B is one of the common causes of jaundice that can have serious consequences. Immunising a person can prevent this viral infection and its consequences. The vaccine is easily available and is usually given in three doses either at monthly intervals or two doses are given at monthly intervals and the third six months after the first dose. Immunisation with the vaccine now begins from the infant period itself. A single booster dose is required once every five years to maintain the protection.
Food rich in glucose is recommended in jaundice. It helps the liver cells to regenerate besides providing the required nourishment for the body. It is advised to take fats in reduced quantity while deep fried food and alcohol should be avoided.
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