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Jaundice is a condition in which a person's skin and sclerae develops a yellowish tinge duce to presence of excess bilirubin in the blood (hyperbilirubinema). This condition is also known as icterus in which the body fluids may also turn yellow. Mildly elevated levels of bilirubin leads to yellow skin; where as highly elevated levels can lead to a brown tinge. The normal level of bilirubin in blood serum is between 0.2 mg/dL and 1.2 mg/dL (milligrams per deciliter). A person is said to have jaundice when the bilirubin level in the blood exceeds 2.5 to 3 mg/dL. Jaundice in adults can be caused by a variety of conditions and some can be quite serious and even life-threatening. A person suffering from jaundice needs to go through comprehensive medical diagnosis in order to determine the type of jaundice so that the doctor can decide upon the right path of treatment.
Role of Bilirubin in Jaundice
In order to understand jaundice, its causes, types and treatment, we must first understand the function of bilirubin. Bilirubin is a yellow colored substance or waste product that remains after the iron is removed from hemoglobin. When there is an excess of bilirubin in the blood, it can leak into the surrounding tissues. The liver helps to filter out waste products such as bilirubin from the blood. Once the bilirubin enters the liver, other chemicals attach to it and create conjugated bilirubin, which forms bileand is then excreted.
Types of Jaundice
There are three types of jaundice which are classified depending on what is disrupting the normal removal of bilirubin from the body.
This type of jaundice is caused by conditions such as sickle cell anemia and haemolytic anemia. In these conditions, the disruption occurs before the bilirubin has been transported from the blood to the liver.
This type of jaundice is also known as hepatocellular jaundice. In this case, the disruption happens inside the liver. It is caused by conditions such as cirrhosis, Gilbert's syndrome, etc.
Also known as obstructive jaundice, in this condition, the disruption prevents the bile from draining out of the gallbladder. It is caused by gallstones, tumors or obstruction of the bile duct.
Causes of Jaundice
Jaundice is more of a sign of an underlying disease process than a disease. Some of the underlying causes of jaundice are as follows:
Acute Inflammation of the Liver:
This condition can impair the ability of the liver to conjugate and release bilirubin, causing a buildup of bilirubin
Inflammation of the Bile Duct:
It may hinder the secretion of bile and removal of bilirubin from the blood, causing jaundice
Obstruction of the Bile Duct:
It hinders the liver from disposing bilirubin and leads to hyperbilirubinema
In this condition, large quantities for erythrocytes are broken down leading to increased production of bilirubin
It is an inherited condition that destroys the ability of enzymes to process the excretion of bile
It is a condition in which the flow of the bile from the liver is interrupted. The bile containing conjugated bilirubin builds up in the liver instead of being excreted.
Symptoms of Jaundice
The common symptoms of jaundice in adults include:
- Yellowing of the skin and the whites of the eyes (sclerae)
- Yellowing of mucus membranes in the mouth and nose
- Dark colored urine
- Paler feces
- Abdominal pain
- Pruritis (itching)
- Weight loss
Diagnosis of Jaundice
Diagnosis of jaundice is made based on the patient's history and physical exam. Some of the tests for jaundice include:
Highlevels of unconjugated bilirubin levels in relation to conjugated bilirubin level indicate accelerated breakdown of erythrocytes.
Complete Blood Count (CBC):
This test measures the levels of red blood cells, white blood cells and platelets in a blood sample.
Complete LFT includes Bilirubin (Total, direct and indirect), SGPT SGOT, GGT, Serum Protein, Albumin etc. In hepatic type of jaundice which is mostly due to hepatitis, SGPT and SGOT are markedly raised.
If hepatitis is due to alcohol, GGT will be raised with reduced protein and albumin levels.
Other useful tests are HAV (hepatitis A virus), HBsAg, HVC (Hepatitis C virus) and HEV ( Hepatitis E Virus) detection.
Magnetic Resonance Imaging (MRI)
It is used to identify the location of bile duct obstruction as well as the cause of the obstruction.
It is especially useful in identifying gallstones, tumors and dilated bile ducts.
Computerized tomography (CT) Scan - It is used to identify tumors and dilated bile ducts.
Endoscopic Retrograde Cholangiopancreatography (ERCP):
This imaging test is used to identify the cause and location of a bile duct obstruction.
A biopsy is useful for checking fatty liver, liver inflammation, cancer and cirrhosis.
Treatment for Jaundice
Jaundice treatment depends on the specific cause of jaundice. The treatment targets the specific cause rather than the jaundice itself.
The main objective of pre-hepatic jaundice treatment is to prevent the rapid breakdown of the red blood cells that cause bilirubin levels to rise up in the blood. Pre-hepatic jaundice caused by malaria can be treated by medication that cures the infection. Jaundice caused by genetic blood disorders such as thalassaemia and sickle cell anemia is treated by replacing red blood cells.
In case of intra-hepatic jaundice, not much can be done to repair the liver damage that has been done already. The aim of the treatment is to prevent further liver damage. Further liver damage caused by infections such as viral hepatitis or glandular hepatitis can be prevented with anti-viral medications. Liver damage caused by alcohol exposure can be avoided by reducing and limiting the consumption of alcohol. In case of severe liver damage, liver transplant is a viable option.
Treatment for post-hepatic jaundice includes surgery that unblocks the bile duct. It may be necessary to remove the gallbladder, a section of the bile duct system or a section of the pancreas as well in order to prevent further blockage.
Jaundice is a serious and potentially life-threatening disease which calls for proper diagnosis and urgent treatment. Are you in search of an experienced jaundice specialist in Hyderabad? Then you can get in touch with Dr. Sachin Daga, He is a Liver Transplant & Hepatobiliary Surgeon with 14 years of experience.