Jaundice

Jaundice means yellow skin or eyes. It is caused by the excessiveness of a chemical called bilirubin. Bilirubin is a yellowish pigment produced mostly from red blood cells breaking down. A red blood cell lives about 120 days in your body. As old red blood cells break down, new cells are generated to replace them. This cycle goes on the entire time and bilirubin is generated constantly. Under normal physiology, it is transported to the liver for processing, and eventually secreted into bile, which is then drained into your upper small bowel. Anything that goes wrong in the breakdown of red blood cells, liver problems, or blocking of the bile draining system, will lead to jaundice. Jaundice can happen at any age. Here, we mainly talk about adult form of jaundice.

Most common medical conditions that associate with jaundice:

Overproduction of bilirubin

  • Malaria
  • Sickle cell anemia
  • Thalassemia
  • Paroxysmal nocturnal hemoglobinuria (PNH)
  • Spherocytosis
  • Glucose 6-phosphate dehydrogenase deficiency
  • Hemolytic uremic syndrome (HUS)
  • Disseminated intravascular coagulation (DIC)
  • Autoimmune hemolytic anemia
  • Bacterial, viral or fungal infection
  • Heavy metal poisoning
  • Trauma

Liver problems (most liver diseases cause jaundice)

  • Gilbert's syndrome
  • Crigler-Najjar syndrome
  • Dubin-Johnson syndrome
  • Rotor’s syndrome
  • Acute viral hepatitis
  • Chronic viral hepatitis
  • Other liver infections
  • Liver cirrhosis
  • Hepatic tumors
  • Primary biliary cirrhosis (PBC)
  • Primary sclerosing cholangitis (PSC)
  • Autoimmune hepatitis
  • Alcohol liver disease
  • Non-alcoholic fatty liver disease (NAFLD)
  • Pregnancy associated liver problems
  • Hemochromatosis
  • Wilson’s disease
  • Vascular disorders of liver
  • Medications

Problems of the bile draining system

Other

  • Total parental nutrition(TPN)
  • Malnutrition
  • Pseudojaundice. A benign condition with yellow skin but is not associated with bilirubin. It is due to large consumption of beta-carotene contained foods, such as squash, carrots, and cantaloupe, etc.

Symptoms and Signs of jaundice:

Jaundice may occur suddenly or slowly depending on the cause. Common symptoms and signs are:

  • Yellow skin
  • Light colored stools
  • Dark or brown-colored urine

Depending on the etiology, other symptoms maybe accompanied with jaundice, such as abdominal pain, nausea, vomiting, fatigue, weight loss, fever, chills, itchiness, etc.

Diagnosis and Treatment

Diagnosis is to check the bilirubin level first, then find the cause. This usually involves one or more of the following tests:

  • Blood works
  • Stool studies
  • Paracentesis
  • X-ray
  • Abdominal ultrasound
  • Echocardiogram
  • CT scan
  • MRI/MRCP
  • Liver biopsy
  • Endoscopy
  • Colonoscopy
  • ERCP
  • EUS

After the cause is found and confirmed, treatment will focus on treatment of the underlying disease.

References:

  1. PubMed Health.
  2. Wikipedia.
  3. Mayo clinic online health information.
  4. Sleisenger and Fordtran's Gastrointestinal and Liver Disease- by Mark Feldman MD, et al.
  5. The Little Black Book of Gastroenterology-by David W. Hay.
  6. Principles of Clinical Gastroenterology by Tadataka Yamada, et al.


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