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Jaundice

Jaundice is described as yellowish discoloration of the skin, mucous membranes, and the whites of the eyes. It is basically a sign of the underlying disease process and is caused by an increase in amounts of bilirubin in the blood.

??Jaundice can occur in adults as well as in new born babies (neonatal jaundice). In adults Jaundice can be caused due to a variety of medical conditions, some of which are serious and potentially life-threatening. While neonatal jaundice is a benign condition that improves without serious effects.

Jaundice Causes

Jaundice is specifically the dysfunctioning of the normal metabolism or excretion of bilirubin at any stage. That is why the causes of jaundice are generally classified as pre-hepatic (the problem arises before secretion to the liver), hepatic (the problem arises within the liver), and post-hepatic (the problem arises after bilirubin is excreted from the liver).

Pre-hepatic causes

Pre-hepatic causes are the ones in which there israpid increase in the breakdown and destruction of the red blood cells above the liver’s ability to adequately remove them from blood. The conditions that causes increased breakdown of red blood cells include:

  • Malaria
  • Sickle cell crisis
  • Hereditary Spherocytosis
  • Thalassemia
  • Glucose-6-phosphate dehydrogenase deficiency (G6PD)
  • Drugs or other toxins
  • Autoimmune disorders
Hepatic causes

Hepatic causes are the ones in which liver becomesunable to properly metabolize and excrete bilirubin like:

  • Acute or chronic Hepatitis (A, B, C, D, E or alcohol related)
  • Cirrhosis
  • Drugs or other toxins
  • Crigler-Najjar syndrome
  • Gilbert’s syndrome
  • Liver Cancer
Post-hepatic

The causes of Jaundice thatobstruct the normal drainage of conjugated bilirubin in the form of bile from the liver into the intestines include:

  • Bile duct gallstones
  • Cancer (pancreatic and gallbladder/bile duct)
  • Strictures of the bile ducts
  • Cholangitis
  • Congenital malformations
  • Pancreatitis
  • Parasites
  • Pregnancy
Neonatal Jaundice

Although Jaundice is a normal physiological process in newborn babies due to immature liverbut it can be caused by several different conditions like:

  • Physiological jaundice
  • Maternal-fetal blood group incompatibility (Rh, ABO)
  • Breast milk jaundice
  • Breastfeeding jaundice
  • Cephalohematoma
Jaundice Symptoms

Although Jaundice itself is a sign of an underlying disease process but show the following indications

  • Yellow discoloration of the skin, mucous membranes, and the whites of the eyes
  • Pale-colored stools
  • Dark-colored urine
  • Itching of the skin
  • Nausea and vomiting
  • Rectal bleeding
  • Abdominal pain
  • Diarrhea
  • Fever& chills
  • Generalized body weakness
  • Loss of appetite
  • Weight loss
  • Headache
  • Confusion
  • Swelling of the legs and abdomen
Symptoms of Neonatal Jaundice
  • Jaundice progresses from the head to the trunk, and then to the hands and feet
  • Poor feeding
  • Lethargy
  • Changes in muscle tone
  • High-pitched crying
  • Seizures
Exams and Tests

As jaundice is a symptom of the underlying disease, a thorough medical evaluation is most important to determine the cause. The doctor takes detailed medical history of the patient and perform a physical examination which may or may not reveal the cause of jaundice. This is followed by certain diagnostic tests that include:

  • Blood test
  • Urinalysis
  • Ultrasound
  • Computerized tomography (CT) scan
  • Magnetic resonance imaging (MRI)
  • Cholescintigraphy (HIDA scan)
  • Endoscopic retrograde cholangiopancreatography (ERCP)
  • Liver biopsy
Jaundice Treatment

Treatment of jaundice typically depends upon the underlying cause and any potential complications related to it:

  • In cases where jaundice is not causing any severe condition in patient, expectant management (watchful waiting) at home with rest is advised
  • Some cases may require medical treatment with IV fluids, medications, antibiotics, or blood transfusions
  • In case of neonatal jaundice, baby is exposed to special colored lights (phototherapy) or blood transfusions to decrease elevated bilirubin levels
  • Surgical treatment may be required