Jaundice: Treatment, symptoms, advice and help
Jaundice is defined as the accumulation of bilirubin in the blood. Bilirubin is produced by metabolism of haemoglobin in the liver. The presence of jaundice usually signifies an underlying liver dysfunction; however jaundice can be present with normal liver function in certain conditions. Determination of the aetiology of jaundice is important in deciding the line of management.
Jaundice: Incidence, age and sex
Jaundice is a common symptom and can affect an individual of any age. The incidence of jaundice varies according to underlying aetiology.
Signs and symptoms of jaundice: Diagnosis
Jaundice manifests as yellow discolouration of sclera (whites of the eyes). As the serum bilirubin levels increase, the skin can also become pale. If the jaundice is due to liver dysfunction or obstruction of bile outflow, the urine also becomes high coloured or yellow. In hepatitis there may be associated symptoms like fatigue, nausea, vomiting and loss of appetite. In haemolytic jaundice (see below), there may be symptoms of anaemia and bleeding (cola coloured urine). There is usually enlargement of liver. A lump may also be palpable in abdomen in cases of malignancies of liver and biliary tract.
Jaundice is confirmed by finding of raised levels of bilirubin in the blood. In liver dysfunction and biliary outflow obstruction, there is rise of the conjugated fragment of the bilirubin while in haemolytic jaundice, unconjugated bilirubin is elevated. Associated abnormalities in other liver function tests depend upon the underlying aetiology.
Causes and prevention of jaundice
There are a large number of causes of jaundice. Jaundice due to liver dysfunction occurs in viral hepatitis (caused by hepatitis viruses A, B, C, D, and E), alcoholic liver disease and drug toxicity. Obstruction to the outflow of bile occurs in stone in the biliary tract, cancer of the gall bladder, the bile duct, the pancreas and the upper small intestine. Haemolytic jaundice occurs due to destruction of red blood cells.
Some of the causes of jaundice are preventable. Hepatitis can be prevented by provision of good sanitation, hygiene, using sterile needles and safe blood and having safe sex. Limitation of alcohol intake can prevent alcoholic liver disease. Early surgical treatment of stones of gall bladder and biliary tract can prevent obstruction and jaundice.
The complications of jaundice depend upon its aetiology. Advanced jaundice generally leads to dehydration, malnutrition and vitamin deficiencies. Viral hepatitis may lead to chronic liver disease, cirrhosis and liver cancer.
The treatment of jaundice involves adequate hydration, avoidance of drugs which may harm the liver and abstinence from alcohol. The underlying cause needs to be treated accordingly. Biliary obstruction usually necessitates surgical intervention. Viral hepatitis is usually self-limiting. Haemolytic jaundice may need evaluation by a haematologist, in order to plan subsequent treatment plan.