Jaundice is a condition in which the whites of the eye, skin, and mucous membranes turn yellow in color. The coloration occurs due to the buildup of bilirubin. Bilirubin is a byproduct of old red blood cells. When hemoglobin of RBCs is broken down it produces bilirubin. Bilirubin is transported to the liver, where they bind with the bile and are further eliminated through stools. However if the bilirubin is not able to travel through the liver or other blockages it accumulates in blood causing deposition in eyes, skin, and mucous membranes. This condition is apparent when the serum bilirubin exceeds 35micromole/L.
Sometimes it also manifests as a light-colored stool or dark-colored urine. When the blockage prevents bilirubin from being excreted as a stool, it causes bilirubin to be eliminated in urine.
Other symptoms that accompany jaundice include:
- Abdominal pain
- Spider-like blood vessels are visible under the skin causing easy bruising and bleeding
- In men, it is observed as enlarged breasts, shrunken testes etc.
- Blood in stool
- Tenderness in abdomen
- Agitation, confusion
- Muscular pain
- Bloody nose
By itself, Jaundice cannot be categorized as a disease, it is a symptom of possible underlying conditions. Thus, to treat jaundice it is important to identify the underlying cause and treat it. Without proper diagnosis of the condition that is causing jaundice treatment may not be effective, only symptomatic relief is possible.
Conditions that cause jaundice
The basic cause of jaundice is an excess of bilirubin caused due to various factors. Jaundice can occur in infants and adults.
Jaundice in infants
Infants born between 35 weeks of gestation and 38 weeks most commonly have jaundice. This is because the baby’s liver is not mature enough to eliminate excess bilirubin. Being born before 37 weeks or bruising during birth are common causes for jaundice in infants.
Routine checks every 12 hours after birth are done to ensure no worsening of symptoms. In case there is a further increase in coloration or other symptoms are noticed, it becomes a cause of concern. In most cases jaundice in infants if diagnosed appropriately is treatable.
In infants, it is diagnosed using a light meter to measure transcutaneous bilirubin level or blood tests that measure total serum bilirubin.
Jaundice in adults
The underlying cause for any form of jaundice is liver inflammation or malfunction, or diseases that cause the inflammation. In adults some of the common causes of jaundice include
- Liver cirrhosis – long term exposure to toxins, alcohol or repeated infections in liver causing scarring in liver tissues.
- Liver infections – Hepatitis A, Hepatitis B, Hepatitis C, Hepatitis D, parasite infections or leptospirosis
- Pancreatic cancers and liver cancers
- Alcoholic hepatitis – scarring of liver due to long term exposure to alcohol
- Some drugs such as acetaminophen, birth control pills, penicillin
- Gall bladder stones that cause blockage of bile duct
- Blood disorders such as red blood cell abnormality, blood sepsis,
- Autoimmune disorders causing inflammation of the liver
- Birth defects that cause metabolic malfunctioning such as: Gilbert syndrome, Dubin-Johnson syndrome, Rotor syndrome and Criggler-Najjar syndrome to name a few.
- Hemolytic anemia
Diagnosis in adults :
Since jaundice is a symptom of another disease that manifests as coloration in eyes, skin etc – the diagnosis remains incomplete unless the basic cause has been identified. The yellow coloration is usually easy to spot however the challenge is identifying the fundamental reason behind this. Some of the methods to diagnose include
- Blood test: Complete CBC count, liver function test, antibody tests, measurement of serum bilirubin, blood cultures, enzyme quantifications etc
- Urine analysis: Measurement of bilirubin or other compounds related to liver function
- Testing for liver infections: Hepatitis, bacterial, parasitic infection tests
- Imaging: Sonography, CT, MRI to detect damage, scarring or blockage of bile ducts
- Endoscopy: To image and diagnose malfunction in bile ducts
- Laparoscopy: In cases when the diagnosis is unclear, laparoscopy gives clarity on the cause by imaging liver and gallbladder.
- Biopsy: Biopsy of liver tissue is done to diagnose liver cirrhosis, cancer and other implications.
Treat the disease or symptoms?
The big question we need to address is if we need to address the symptoms of the disease. While symptomatic relief can be temporary, unless the fundamental cause has been appropriately diagnosed and treated, jaundice can recur. Hence it is most crucial to identify the disease that has caused jaundice to treat it. Else, liver inflammation and bilirubin accumulation can prove fatal. It is for this reason that the treatment protocol varies based on the disease.
As already mentioned, in infants jaundice is treatable and in most cases, symptoms recede in less than a month. It is commonly treated with phototherapy and in severe cases, doctors may advise blood transfusion, but it is unlikely.
In adults jaundice, symptoms and severity may vary. In some cases, they can be managed very well while others could be chronic and require lifelong medical supervision. In other severe cases despite the correct diagnosis, treatment, and surgery jaundice may prove fatal. Once the condition has been established, it is important to discuss the prognosis with the health care provider.
Some of the treatment options include:
- Beta-blockers, intravenous antibiotics and a low protein diet.
- Vaccinations in the case of viral diseases.
- Antibiotics to treat bacterial liver damage.
- Severe liver damage may require a liver transplant treatment
- Chemotherapy, radiation, medication and surgery in cases of cancer.
- Blood transfusion to provide RBC’s in cases of hemolytic anemia
- Removal of the gallbladder for gallbladder stone removal
- Bile duct blockages are treated by surgeries to open up bile duct.
It is clear that jaundice is a symptom of an underlying disease, infection, or condition. It is important to note that Jaundice itself isn’t treated, it is the cause of jaundice that needs to be looked at. To prevent is better than to cure. By maintaining a healthy lifestyle common metabolic dysfunction and alcoholic cirrhosis can be avoided. Likewise, if any medication causes jaundice-like symptoms, bring it to the notice of your doctor. Good hygienic practices and vaccinations can help prevent infections that cause jaundice. Most importantly, jaundice should never be ignored and needs to be appropriately diagnosed and treated from the time yellow coloration and discomfort have been noticed. Whenever you experience any of these symptoms, be sure to visit the best jaundice hospital in Chennai