Jaundice refers to the yellow discolouration of the skin, mucous membrane, conjunctiva and sclera due to raised serum bilirubin. It is first detected in sclera which has an affinity to bind with bilirubin and also provides white background.
Yellow discolouration of skin but not of sclera could be due to hypercarotenemia. Normal serum bilirubin concentration ranges from 0.3 – 1.2 mg/dl. Jaundice became clinically detectable when serum bilirubin is raised to 2.5 mg/dl or more
Causes Of Beyond The Color
Jaundice occurs either due to excessive destruction of RBCs with overproduction of bilirubin or due to decreased uptake, conjugation in the liver due to impaired excretion through liver. Causes can be explored on the basis of two types of bilirubin that are conjugated and unconjugated bilirubin.
Causes based on predominantly unconjugated hyperbilirubinemia
- Excessive destruction of RBCs with over projection of unconjugated bilirubin.
- Decreased uptake of bilirubin.
- Decreased conjugation of bilirubin.
Causes based on predominantly conjugated hyperbilirubinemia
- Obstruction to canaliculi or ductules.
- Extra-hepatic biliary obstruction.
Some possible underlying conditions of jaundice include :
- Gilbert’s syndrome
- Gallstone disease
- Pancreatic cancer
- Bile duct stone
- Hodkin’s lymphoma
- Excessive alcohol consumption
- Sickle cell anemia
Symptoms Of Jaundice
Rarely can jaundice be found accidentally in which a person may not have symptoms of it.
In short term case of jaundice, symptoms include :
- Abdominal pain
- Distaste to food
- Change in skin color
- Dark coloured urine.
In long term case of jaundice, symptoms include :
- Blood in vomit
- Tarry black stools
- Extreme abdominal pain
- Abnormal weight loss
- Lack of hunger
Exploring types And Variations
Patients complain of it with dark coloured stools and urine. Anemia is present. There is no pruritus or itching. Enlargement of liver and spleen is present due anemia haemolysis. There are many disorders that can be associated with haemolysis which are sickle cell disease, autoimmune haemolytic anemia etc. Haemolytic jaundice is highly common in patients suffering from malaria, where the malaria parasites attack the red blood cells at a fast pace leading to a high concentration of bilirubin present in the blood.
It is associated with hepatomegaly. In this kind of jaundice in which usually mixed type with conjugated and unconjugated bilirubin being raised equally or either may be dominant depending upon the cause. Urine is dark in color.
It takes place due to liver diseases. Some common causes of it are medication, hepatitis, acute or chronic liver injury, alpha – 1 antitrypsin deficiency, infection, liver cirrhosis and exposure to toxic material. Common symptoms include itching, weight loss, fever with chills, weakness, anxiety, fatigue and vomiting. Laboratory tests like blood tests, liver function tests, imaging and biopsy are required for the proper diagnosis of the disease.
These patients have greenish yellow or deep yellow jaundice. Itching is present due to bile salts being there. Urine is dark coloured. There may be associated pain in the abdomen, severe if stone is the cause. Common symptoms include fever with chills, severe abdominal pain and vomiting. Diagnosis includes blood tests and imaging, which leads to exploring the various causes of it. Definitive treatment will depend on the cause of it.
Testing options include :
- Imaging Tests – Ultrasonography of the abdomen should be done. It helps to detect blockage in the bile ducts. CT scan and MRI to evaluate the flow of bile through the liver.
- Blood Tests – Blood tests are very helpful to detect the cause of disease.
- Liver Biopsy – It is required, when viral hepatitis is present.
- ERCP – It is a procedure that looks at the bile ducts through an endoscope
Jaundice which occurs as a side effect to consuming certain medicines. Alternative medicines can be prescribed by doctors. Depending on the underlying cause of it, treatment will be provided. For example
- Hepatocellular jaundice can be treated with anti – viral medications
- Haemolytic jaundice can be treated with iron supplements
- Obstructive jaundice is treated with surgery to remove the obstruction followed by medication
Generally, it occurs when the liver cannot keep up with the demand to process waste in the blood or when the liver becomes damaged. By understanding the various types of it, we gain a clearer perspective on the underlying processes driving this condition. By prioritising its types, causes, symptoms and treatment options, we can take informed steps towards comprehensive well-being.