Jaundice

Symptoms Of Jaundice

Some individuals may present certain signs and symptoms while others don’t. Here are common symptoms of jaundice that include:

• A yellow tinge to the skin, mucous membranes, and the whites of the eyes

• Pale or clay-colored stools

• Dark urine

• Itchiness in the skin

• Weight loss

• Vomiting

• Nausea

• Loss of appetite

Other symptoms that accompany jaundice may include:

• Fatigue, tiredness, and drowsiness

• Abdominal pain and tenderness

• Blood in vomit or stool

• Dark or tarry stool

• Flu-like symptoms (fever and chills)

• Agitation or confusion

• Easy bruising or bleeding, causing the tiny reddish-purple rash

Causes Of Jaundice

On the basis of causes, jaundice can be classified into three types. They are:

1. Pre-hepatic jaundice

2. Hepatic jaundice

3. Post-hepatic jaundice

1. Pre-hepatic jaundice

This type of jaundice is caused due to hemolysis (destruction of red blood cells), therefore it is also known as hemolytic jaundice. The causes of prehepatic/hemolytic jaundice are classified into:

Congenital causes (present at birth)

• Spherocytosis: This condition affects the red blood cells (RBCs) and is characterized by anemia, jaundice, and enlarged spleen.

• Elliptocytosis: It is a hereditary disorder in which the RBCs are elliptical in shape rather than the normal round shape.

• Congenital LCAT deficiency: This is a genetic disorder that affects the body's ability to process cholesterol. It is characterized by corneal opacities (clear front surface of the eye), hemolytic anemia, and kidney failure.

• Thalassemia: It is an inherited blood disorder caused when the body doesn't make enough hemoglobin.

• Sickle cell anemia: It is a group of inherited disorders known as sickle cell disease that affects the shape of RBCs. 

• Stomatocytosis: A rare condition of RBCs characterized by a mouthlike or slitlike pattern rather than the normal shape.

• Acanthocytosis: It is a red cell phenotype (determines the antigen present in RBCs) indicative of various underlying conditions.

• Echinocytes: In this condition, the RBCs are crenated (notched) and resemble a hedgehog or sea urchin rather than the pale-centered biconcave disks.

• GSH synthetase deficiency: Glutathione synthetase (GHS) deficiency is a disorder that prevents the production of an important molecule called glutathione which is required to prevent cell damage.

• Pyruvate kinase deficiency: An inherited lack of the enzyme pyruvate kinase, without which, the RBCs break down too easily, resulting in hemolytic anemia (low level of RBCs).

• G6PD deficiency: It is a genetic disorder in which the enzyme called glucose-6-phosphate dehydrogenase (G6PD) is less. G6PD protects RBCs from substances in the blood that could harm them.

• Erythroblastosis fetalis: It is hemolytic anemia in the fetus or neonate.

Acquired causes 

• Microangiopathy: It is a disease of the microvessels and small blood vessels in the microcirculation system.

• Hemolytic uremic syndrome: It is a condition that can occur when the small blood vessels in the kidneys become damaged and inflamed.

• Disseminated intravascular clot: This is a serious disorder in which the proteins that control blood clotting become overactive.

• Paroxysmal nightly hemoglobinuria: It is a rare disorder in which RBCs break apart prematurely.

• Thrombotic thrombocytopenic purpura: This condition is characterized by the formation of blood clots (thrombi) in small blood vessels throughout the body.

• Hypophosphatemia: A condition in which your blood has a low level of phosphorus leading to muscle weakness, respiratory or heart failure, seizures, or comas.

• Other causes 

  • Resorption of extensive hematomas (blood clots)

  • Autoimmune hemolysis

  • Long-distance runners

  • Infections like malaria

  • Chemicals like nitrites and aniline dyes

  • Toxins such as snake venoms

  • Transfusion reactions

  • Trauma

  • Vitamin B12 deficiency

  • Folic acid deficiency

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2. Hepatic jaundice

It is a type of jaundice in which the basic defect lies within the liver mainly in the hepatocytes. The causes include:

Congenital causes

• Wilson’s disease: It is a rare inherited disorder that causes copper to accumulate in your liver, brain, and other vital organs.

• Rotor’s syndrome: A mild condition characterized by elevated levels of a substance called bilirubin in the blood (hyperbilirubinemia).

• Hemochromatosis: An inherited condition where iron levels in the body slowly build up over many years.

• Crigler Najjar syndrome: It is a severe condition characterized by hyperbilirubinemia.

• Gilbert’s syndrome: A common, harmless liver condition in which the liver doesn't properly process bilirubin.

• Dubin-Johnson’s syndrome: It is characterized by jaundice that appears during adolescence or early adulthood.

Acquired causes

• Drug-related hepatitis (e.g. NSAIDs)

• Sepsis

• Pregnancy 

• Malnutrition

• Physical trauma

• Hepatic adenoma (non-cancerous liver tumor)

• Viral hepatitis

• Alcoholic hepatitis

• Autoimmune hepatitis

3. Post-hepatic jaundice

It is the type of jaundice in which the cause lies in the biliary portion of the hepatobiliary system (liver, gallbladder, and bile ducts). The major cause of post-hepatic jaundice is biliary obstruction outside the liver, hence, it is also known as obstructive jaundice. The causes include:

Congenital causes

• Biliary atresia: This is a condition in which there is a blockage in the tubes (ducts) that carry bile from the liver to the gallbladder.

• Cystic fibrosis: An inherited disorder that affects the cells that produce mucus, sweat, and digestive juices.

• Idiopathic dilatation of the common bile duct: This can be an indicator for obstructive jaundice.

• Pancreatic biliary malfunction: A medical condition that results from the inability of the sphincter to contract and relax normally.

• Choledochal cyst: This is a congenital anomaly of the duct (tube) that transports bile from the liver to the gallbladder and small intestine. 

Acquired causes

• Portal biliopathy: It refers to the abnormalities seen in bile duct imaging that occur in patients with portal cavernoma (changes in the portal vein).

• Strictures: It causes abnormal narrowing of the bodily passages.

• Choledocholithiasis: It refers to the presence of at least one gallstone in the common bile duct. 

• Intra-abdominal tuberculosis (TB): A type of TB that affects the gut, the peritoneum (the lining of the abdominal cavity), abdominal lymph nodes, and, more rarely, the solid organs in the abdomen like the liver, pancreas, and spleen.

• Other causes: Trauma, AIDS, tumors, cholecystitis (inflammation of the gallbladder), and pancreatitis (inflammation of the pancreas).

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Risk Factors For Jaundice

The risk factors that may increase the chances of jaundice are similar to that for liver and gallbladder disorders. They may include:

• Autoimmune disorders

• Extensive use of medications that may damage the liver

• Infections like hepatitis A, hepatitis B, or hepatitis C

• Exposure to certain industrial chemicals

• Presence of congenital abnormalities

• Trauma to the liver

• Obstruction in the bile duct

• Deficiencies of certain vitamins and enzymes

• Excessive alcohol consumption

Diagnosis Of Jaundice

The differential diagnosis for jaundice is based on whether the disease responsible for jaundice is pre-hepatic (primarily unconjugated hyperbilirubinemia), hepatic (mixed hyperbilirubinemia), or post-hepatic (conjugated hyperbilirubinemia). Jaundice can be diagnosed by checking for any signs of liver disease and it includes: 

1. Physical examination and history

A detailed alcohol and drug use history can help identify intrahepatic disorders such as alcoholic liver disease, viral hepatitis, chronic liver disease, drug-induced liver injury or any underlying malignancies.

The physical examination should include the following: 

• Evaluating encephalopathy by testing for asterixis (motor control disorder) and changes in the mental status.

• Assessing for any signs of chronic liver disease including bruising.

• Looking for abnormal collection of blood vessels near the surface of the skin (spider angiomas), redness of palms and hands (palmar erythema), and an increased amount of breast tissues in men (gynecomastia).

• Examining the abdomen completely to evaluate for enlargements of the liver and spleen, right upper quadrant tenderness, and ascites (fluid build-up in the stomach).

2. Laboratory evaluation

The laboratory evaluation to determine the etiology of jaundice should include:

• Fractionated bilirubin: Used in the diagnosis and treatment of liver diseases, hemolytic disorders, hematologic disorders, and metabolic disorders, including hepatitis and gallbladder obstructive disease.

• Complete blood count (CBC): To identify hemolysis and evaluate for anemia of chronic disease and thrombocytopenia, which is common in acute deterioration of liver function.

• Alanine transaminase test and aspartate transaminase test: To check for hepatocellular damage.

• γ-Glutamyltransferase test: An elevated γ-glutamyltransferase level can be associated with biliary obstruction and hepatocellular damage. 

• Alkaline phosphatase test: An elevated alkaline phosphatase level can be associated with biliary obstruction and parenchymal liver disease, but it is also associated with several other physiologic and non-biliary pathologic processes in bone, kidney, intestine, and placenta 

• Other tests: Low levels of prothrombin time (INR), albumin, and protein can indicate decreased synthetic function and liver decompensation.

Note: If the jaundice etiology is unknown after the initial laboratory evaluation, it is necessary to perform additional tests including hepatitis panle and autoimmune panel such as antinuclear, smooth muscle, and liver-kidney microsomal antibodies.

3. Imaging

Noninvasive imaging modalities in individuals with jaundice include:

• Ultrasonography and dual phased computed tomography (CT): These are used to evaluate obstruction, cirrhosis, and vessel patency of the liver.

• Magnetic resonance cholangiopancreatography: To visualize the intra and extrahepatic biliary tree.

4. Liver biopsy

It is done in cases of jaundice in which the diagnosis is unclear after the initial history and physical examination, laboratory studies, and imaging tests.

Prevention Of Jaundice

Jaundice is related to liver function. Since there are numerous causes for jaundice, there are no perfect prevention guidelines. The basic way to prevent jaundice is by taking care of the liver with several lifestyle changes such as:

• Avoiding hepatitis infections

• Keeping the weight in check to prevent being overweight or obese

• Monitoring cholesterol levels

• Eating a well-balanced diet

• Exercising regularly

• Controlling the alcohol consumption

• Making sure that toxins from chemicals and other sources, both inhaled and touched are avoided

• Managing medications carefully by avoiding taking more than the recommended dose

• Consulting a doctor before starting on any herbal therapies

• Quitting smoking and avoiding recreational drugs

• Getting the recommended vaccinations before traveling

• Practicing safe sex and using condoms to avoid chances of infections

• Getting a full body checkup, if family history of autoimmune conditions is present

Specialist To Visit

Jaundice is when your skin or the whites of your eyes turn yellow. It can be a sign of something serious such as a liver disease. The doctors that can help diagnose and treat jaundice are:

• General physician

• Gastroenterologist 

• Internal medicine specialist

Seek medical help if you notice the following:

• Skin or the white part of the eyes looks yellow.

• Itching in the skin, darker urine, and paler stool than usual.

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Treatment Of Jaundice

Jaundice usually does not require any treatment in adults, but the treatment is majorly based on the cause of jaundice. The treatment of choice for jaundice is the correction of the underlying hepatobiliary or hematological disease. Here are some of the options for the treatment and management of jaundice: 

• If the cause of jaundice is acute viral hepatitis, then it will go away on its own as the liver begins to heal.

• Surgery may be required if the cause of jaundice is a blocked bile duct.

• Pruritus (itchy skin) associated with cholestasis (liver disease when the flow of bile from the liver is reduced or blocked) can be managed based on the severity.

• For mild pruritus, warm baths or oatmeal baths help in relieving the discomfort. 

• Antihistamines can also help with pruritus.

• Patients with moderate to severe pruritus can benefit from medications like cholestyramine or colestipol.

• Other less effective therapies include:

  • Rifampin

  • Naltrexone 

  • Sertraline 

  • Phenobarbital 

• Hemolytic jaundice is treated with iron medication. Including iron-rich foods in the diet is also effective.

• Steroids also prove effective in treating jaundice.

• Liver transplantation may be the only effective therapy for pruritus if all the medical treatments fail. A liver transplant is also suggested if jaundice is due to liver decomposition, depending on the severity of the liver injury.

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Home-care For Jaundice

Individuals suffering from jaundice generally feel fatigued, have a low appetite, and have itchy skin. It usually gets better on its own, but, it is important to treat the underlying cause of jaundice. However, to manage the disease at home several measures can be taken like:

• Eating pleasant-tasting bland food

• Having a well-balanced diet with low-fat

• Avoiding supplements, herbs, or medications that can cause side effects

• Drinking fluids and juices as much as possible

• Taking adequate amounts of rest

• Following the instructions given the doctor

• Avoiding any herbal medication or therapy

• Taking medications (if any) by the doctor

• Applying moisturizer for itchy skin

• Taking warm water baths

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Complications Of Jaundice

These vary depending on the medical conditions, the type of jaundice, and severity. Some common complications include: 

• Bleeding

• Constipation

• Abdominal pain

• Gastritis

• Diarrhea

• Anemia

• Infections

• Bloating of the stomach

• Swelling in the legs

• Liver cirrhosis

• Kidney failure 

Some of the uncommon complications seen in severe conditions include:

• Primary sclerosing cholangitis (disease of the bile duct)

• Cholangiocarcinoma (cancer of the bile duct)

• Hepatic amyloid (amyloid deposits in the liver)

• Chronic hepatitis (inflammation of the liver)

• Cholangitis (inflammation of the bile duct)

Alternative Therapies For Jaundice

Jaundice may indicate another condition or disease. Diagnosing the cause and getting proper treatment can be the key to a healthy recovery. Here are some of the alternative therapies:

Unani

Unani is a traditional medicine practiced in South Asia and modern-day Central Asia. According to this therapy, an oil-free and bland diet along with adequate rest is essential for recovery from jaundice. Here are some helpful dietary tips for those affected by yarqaan (jaundice). They are:

• Eating a diet that is easily digestible, usually a liquid diet.

• Incorporating a high carbohydrate diet without spices and fat.

• Drink enough fluids and always drink boiled water. 

• Eating vegetables and fruit juices that are raw or steamed.

• Adding fruits, yogurt and porridge to the diet.

• Karela (bitter gourd) and saijan ki phalli (drumsticks or moringa) are very beneficial for jaundice patients.

• Increasing the intake of foods rich in calcium and other minerals like iron and magnesium.

• Consuming smaller and frequent meals.

• Fasting with fruit juice for about one week is very effective for the patients.

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Home remedies

Some of the popular food items that can help in the treatment of jaundice are:

1. Sugarcane (Ganna) juice: It aids in strengthening the liver and helps in its proper functioning.

2. Yogurt (Dahi):The probiotics in it help in decreasing the bilirubin levels by fighting against harmful bacteria and increasing immunity.

3. Tomatoes (Tamatar): They contain a compound called lycopene, which is a potent antioxidant and helps with detoxification of the liver.

4. Indian gooseberry (Amla): It is filled with Vitamin C and other essential nutrients that help in combating jaundice by improving liver functioning and balancing the serum bilirubin levels.

5. Goat’s milk: It is easy to digest and contains antibodies that can help in curing jaundice.

6. Grape (Angoor) juice: Grapes, especially the green ones, help in improving liver function and balance the serum bilirubin levels.

7. Ginger (Adrak): Ginger has excellent antioxidative and can help in reducing cholesterol levels, thus aiding liver recovery.

8. Garlic (Lahsun): Garlic is a powerful antioxidant. This helps with liver detoxification and thus contributes to curing jaundice.

9. Lemon (Nimbu): Lemon juice helps in enhancing immunity and stops further damage to the liver by unblocking the bile ducts as it has antioxidant properties. 

10. Holy basil (Tulsi): It is perfect for the liver as it protects the liver, increases immunity, and fights against infections.

11. Papaya (Papita) leaves:They are rich in enzymes that support digestion and improve liver health. 

Living With Jaundice

All the conditions associated with jaundice require medical diagnosis and treatment. In some cases, the only treatment needed may be observed. Jaundice can be managed with certain modifications in lifestyle like:

• Maintaining proper hygiene to avoid infections

• Decreasing alcohol consumption

• Focusing on eating a well-balanced diet

• Consulting the doctors before starting any herbal therapies

• Avoiding medications that have ill-effect on the liver

• Drinking adequate fluids 

• Exercising regularly

• Getting vaccinated for hepatitis B and hepatitis C infections

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