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Jaundice is a yellowish discoloration of the skin and mucous membranes caused by hyperbilirubinemia. It is the result of the accumulation of bilirubin in the bloodstream and subsequent deposition in the skin, sclera, and mucous membranes. The normal range for total bilirubin is 0.2 to 1.2 mg/dL. Jaundice may not be clinically evident until serum levels exceed 3 mg/dL. Jaundice becomes visible when the bilirubin level is about 2 to 3 mg/dL (34 to 51 μmol/L).
There are three main types of jaundice:
- Hepatocellular jaundice occurs as a result of liver disease or injury.
- Hemolytic jaundice occurs as a result of hemolysis, or an accelerated breakdown of red blood cells, leading to an increase in production of bilirubin.
- Obstructive jaundice occurs as a result of an obstruction in the bile duct. This prevents bilirubin from leaving the liver.
The underlying etiology of jaundice may be quite difficult to discern. A pointed history and physical examination are of utmost importance. By using this approach, an accurate diagnosis is possible in approximately 85% of patients.
Self diagnosis – If you get symptoms like yellow tinge to the skin and whites of the eyes, dark urine, and itchiness, you probably have jaundice.
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How Does Jaundice Affect Your Body?
Jaundice results from high levels of bilirubin in the blood. Bilirubin is the normal breakdown product from the catabolism of haem and thus is formed from the destruction of red blood cells. Under normal circumstances, bilirubin undergoes conjugation within the liver, making it water-soluble. It is then excreted via the bile into the GI tract, the majority of which egested in the faeces as urobilinogen. Around 10% is reabsorbed into the bloodstream and excreted through the kidneys. Jaundice occurs when this pathway is disrupted.
What Are The Causes of Jaundice?
Common causes of jaundice include:
- Acute hepatitis – Liver inflammation due to a variety of causes, including hepatitis A, B, C, D, and E viral infections, alcohol abuse, and some medications (e.g., acetaminophen) and toxins
- Obstruction of the bile ducts; causes may include:
- Damage and scarring
- Biliary atresia, a congenital condition associated with abnormal development of the bile ducts that leads to the backup and pooling of the bile and to the increase of bilirubin in the blood
- Pancreatic cancer, can sometimes lead to a blockage in the bile ducts
- Conditions that lead to a significant increase in the destruction of red blood cells, thereby causing an increase in the production of bilirubin, such as hemolytic anemia, due to an abnormal hemoglobin variant, malaria, autoimmune disorder, or hemolytic disease of the newborn (HDN)
- Gilbert syndrome – A mild inherited condition associated with decreased bilirubin metabolism due to a decrease in enzyme activity; those affected may have temporary jaundice during times of illness or stress and increases in their unconjugated bilirubin levels.
- Cirrhosis – In its late stages, can cause jaundice
- Physiologic jaundice of the newborn – The liver of a newborn infant has not yet developed its ability to metabolize bilirubin, so newborns frequently go through a brief period of jaundice right after they are born. Newborns with jaundice are carefully monitored and generally improve within 48 to 72 hours. If the jaundice persists or is severe, however, the infant may be treated and evaluated for other and more severe conditions, such as hemolytic disease of the newborn
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What Are The Risk Factors of Jaundice?
Conditions that increase the risk of developing jaundice include:
- Acute inflammation of the liver – This may impair the ability of the liver to conjugate and secrete bilirubin, resulting in a buildup.
- Inflammation of the bile duct – This can prevent the secretion of bile and removal of bilirubin, causing jaundice.
- Obstruction of the bile duct – This prevents the liver from disposing of bilirubin.
- Hemolytic anemia – The production of bilirubin increases when large quantities of red blood cells are broken down.
- Gilbert’s syndrome – This is an inherited condition that impairs the ability of enzymes to process the excretion of bile.
- Cholestasis – This interrupts the flow of bile from the liver. The bile containing conjugated bilirubin remains in the liver instead of being excreted
What Are The Symptoms of Jaundice?
Common symptoms of jaundice include:
- A yellow tinge to the skin and the whites of the eyes, normally starting at the head and spreading down the body
- Pale stools
- Dark urine
- Abdominal pain
- weight loss
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How is Jaundice Diagnosed?
Tests used to detect liver damage and evaluate liver function may include:
- ALT (Alanine aminotransferase)
- ALP (Alkaline phosphatase)
- AST (Aspartate aminotransferase)
- Bilirubin, Total (conjugated and unconjugated), Direct (conjugated) and Indirect (unconjugated)
- GGT (Gamma-glutamyl transferase)
- Prothrombin time (PT) – The liver produces proteins involved in the clotting (coagulation) of blood; the PT measures clotting function and, if abnormal, may indicate liver damage.
- Urine bilirubin (often as part of a urinalysis)
Tests used to detect infections that affect the liver, such as:
- Hepatitis A
- Hepatitis B
- Hepatitis C
- Hepatitis E
- Cytomegalovirus (CMV)
- Epstein-Barr virus (EBV)
Tests used to detect decreased red blood cell survival may include:
- Complete blood count (CBC)
- Reticulocyte count (if CBC is abnormal)
- Blood smear: to visualize RBCs under a microscope
Imaging tests and liver biopsies may be used to help evaluate the status and structure of the liver, gallbladder, and bile ducts. Testing may include:
- Abdominal ultrasound
- CT (computed tomography) scan
- MRI (magnetic resonance imaging) scan, often including MRCP (magnetic resonance cholangiopancreatogram, to visualize the pancreas and bile ducts)
- Endoscopic retrograde cholangiopancreatography (ERCP, a direct imaging of the pancreas and bile ducts)
- Liver biopsy
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How To Prevent & Control Jaundice?
Common preventive measures include the following:
- Avoid heavy alcohol use (alcoholic hepatitis, cirrhosis, and pancreatitis).
- Vaccines for hepatitis (hepatitis A, hepatitis B)
- Take medications which prevent malaria before traveling to high-risk regions.
- Avoid high-risk behaviors such as intravenous drug use or unprotected intercourse (hepatitis B).
- Avoid potentially contaminated food/water and maintain good hygiene (hepatitis A).
- Avoid medications that can cause hemolysis in susceptible individuals (such as those with G6PD deficiency, a condition that leads to red blood cell breakdown after consumption of certain substances).
- Avoid medications and toxins which can cause hemolysis or directly damage the liver.
Treatment of Jaundice – Allopathic Treatment
Medical treatment of jaundice targets the specific cause, rather than the jaundice itself. Such as:
- Hepatocellular jaundice is treated with anti-viral medications and steroids
- Hemolytic jaundice is treated with iron supplements
- Obstructive jaundice is treated with surgery to remove the obstruction followed by medication
There is also medication induced jaundice, in other words, jaundice which occurs as a side effect to consuming certain medicines. In such cases, the medicines are discontinued and alternative medicines are prescribed.
Treatment of Jaundice – Homeopathic Treatment
- Lupulus – for jaundice in newborns or neonatal jaundice
- Chelone and Chelidonium – for jaundice with pain in liver
- Leptandra and Nux Vomica – for jaundice with diarrhoea
- Phosphorus and China – for jaundice with great weakness
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Jaundice – Lifestyle Tips
Follow these tips to alleviate symptoms of jaundice:
- Maintain adequate hydration by drinking fluids, and rest as needed.
- Take medications only as instructed and prescribed by a health care practitioner.
- Avoid medications, herbs, or supplements which may cause detrimental side effects. Consult a health care practitioner for advice.
- Avoid drinking alcohol until the patient has discussed it with their healthcare professional.
- Certain dietary restrictions may be recommended by a health care practitioner.
- In certain cases of newborn jaundice, the parents or caregivers can place the baby next to a well-lit window a few times a day to decrease elevated bilirubin levels. In more severe cases, a health care practitioner may need to discharge the baby home from the hospital with home phototherapy.
- Provide adequate milk intake for the baby in cases of breastfeeding jaundice.
- If symptoms worsen or if any new symptoms arise, consult a health care practitioner.
What Are The Recommended Exercises for a Person With Jaundice?
As far as the exercise in jaundice is concerned as the sufferer is also experiencing exhaustion and fatigue, so no strenuous exercise is recommended. However, the milder types of exercises like walking, yoga, and pilates are commonly those that are recommended by the Doctors and these help in maintaining a healthy body weight.
Jaundice & Pregnancy – Things to Know
Jaundice in pregnancy, whilst relatively rare, has potentially serious consequences for maternal and fetal health. It can be caused by pregnancy or occur intercurrently. Causes of jaundice specific to pregnancy include:
- Pre-eclampsia associated with HELLP syndrome (hemolysis, elevated liver enzymes and low platelet count).
- Acute fatty liver of pregnancy.
- Hyperemesis gravidarum.
- Intrahepatic cholestasis of pregnancy.
Common Complications Related to Jaundice
Complications that may arise from jaundice include:
- Abdominal bloating
- Swelling of legs
- Liver failure
- Kidney failure
- Stomach pain
Other FAQs About Jaundice
Q. Can we eat a banana in jaundice?
A. Banana should be avoided when suffering from jaundice. Bananas are rich in fibre content which exert much pressure on the digestive system. It also increases the level of bilirubin in the body which increases the effects of jaundice.
Q. Can jaundice cause death?
A. Death from obstructive jaundice in the first few weeks of its course is quite rare and is only occasionally observed. After a period varying from four to six months, however, patients suffering from occlusion of the common bile duct usually deteriorate rapidly and die.
Q. What level of jaundice is dangerous?
Severe jaundice (when levels of bilirubin are high, usually above 25 mg) that is not treated can cause deafness, cerebral palsy, or other forms of brain damage. In rare cases, jaundice may be a sign of of another condition, such as an infection or a thyroid problem.