Jaundice is the yellowing of the skin and whites of the eyes when the quantity of bilirubin in the blood is high.
Most times, jaundice comes as a symptom of an underlying disease.
Bilirubin is a yellow compound that is produced from the breakdown of red blood cells in the body.
The bilirubin is taken from your blood by the liver, and then its chemical compounds are converted into bile. However, the disruption of this normal process of metabolism may lead to jaundice.
Signs and Symptoms of Jaundice
When you have jaundice, it means you have an underlying disease. Some signs and symptoms of jaundice include;
- Itching of the skin
- Light coloured stool
- Dark coloured urine
- Yellowing of the skin and whites of the eyes
Some signs and symptoms that may accompany underlying conditions include;
- Loss of appetite
- Abdominal pain
- Newborn jaundice
- Vomiting and nausea
- Swelling of abdomen and legs
Newborn babies also experience signs like;
- Changes in muscle tone
- Poor feeding
- High-pitched crying
Causes of Jaundice
A variety of disease processes can cause jaundice.
Pre-hepatic (before bile is made in the liver)
In this case, jaundice is caused by excessive breakdown of red cells which overwhelms the liver’s ability to conjugate bilirubin.
Examples of these conditions include;
- Autoimmune disorders
- Drugs and other toxins
- Sickle cell crisis
- Glucose 6 phosphate dehydrogenase deficiency(G6PD)
Hepatic(when the process happens within the liver)
In this case, jaundice is caused by the inability of the liver to metabolise and excrete bilirubin properly. The examples include;
- Gilbert’s syndrome
- Drugs or other toxins
- Crigler-Najjar syndrome
- Hepatitis(alcohol-related or commonly viral)
Post hepatic(after bile has been made in the liver)
In this case, jaundice is caused by certain conditions that tend to disrupt the drainage of conjugated bilirubin already in bile form from the liver to the intestine. It is also known as obstructive jaundice.
Causes of this kind of jaundice include;
- Stricture of the bile duct
- Gallstones in the bile duct
- Newborn jaundice
Jaundice in newborn babies
This is commonly a physiological result of the baby’s immature liver. But it could also be caused by different conditions. Jaundice in newborn babies is the most common condition that requires medical attention.
Although this condition is usually harmless in some cases, when the increase in the bilirubin levels is caused by other conditions and is not checked properly, newborns may suffer severe brain damage (kernicterus).
Some causes of newborn jaundice include;
Breast milk jaundice
This condition occurs in newborn babies that are being breastfed. Some particular chemicals in breast milk are considered to be responsible.
It does not mean mothers have to stop breastfeeding. The condition is harmless, and it would resolve with time.
This condition occurs when newborn babies do not consume enough breast milk. This may be due to poor feeding by the infant or because the mother is unable to produce sufficient milk.
If the newborn baby does not take in enough breast milk, it results in dehydration and most time reduced bilirubin excretion.
This kind of condition often comes up on the second or third day when the baby is born. It is usually harmless, and it is the most common cause of jaundice in a newborn. When the liver of the baby begins to mature, jaundice will go eventually.
Maternal-fetal blood group incompatibility(Rh, ABO)
This condition occurs when the blood types of the fetus and the mother is not compatible. This may lead to a spike in bilirubin levels which is from the breakdown of the red blood cells of the embryo (hemolysis).
Cephalohematoma (collection of blood under the scalp)
When babies are born, they sometimes have a bruise to their head which could result in blood clot under the scalp.
As the blood breaks down naturally, the newborn baby’s immature liver may be overwhelmed by a high level of bilirubin which results in jaundice.
When do you seek medical assistance?
If you or your baby develops a new case of jaundice, you should call a health care practitioner. Proceed to the emergency department for further examination if you’re not given immediate attention.
Questions to Ask Your Doctor About Jaundice
- What is the cause of your jaundice and how to learn more about it?
- The likely cause of the jaundice
- If you would need any imaging studies or blood test.
- Ask about the treatment options.
- What should you do if the symptoms suddenly get worse at home?
Exams and Test that diagnose Jaundice
After your doctor establishes a diagnosis, he will then decide if the underlying condition needs the attention of a specialist (for example, haematologist/oncologist, gastroenterologist).
Whatever recommendations and treatment regimen given to you by the doctor or specialist should be strictly followed. Treatment is based on the underlying condition that caused jaundice and any other complications related to it.
Once a diagnosis has been made, treatment will begin to resolve the particular underlying condition. Hospitalisation may or may not be necessary.
The doctor will need to see the patient’s medical history of illness and the patient will also be checked to know the cause of jaundice.
Some further test may be conducted to pinpoint the underlying condition leading to jaundice. The following imaging studies and examination may be obtained:
It is an analysis of the urine, and it helps in diagnosing several diseases.
Computerised Tomography(CT)- A CT scan is an imaging study that closely resembles an x-ray that provides additional details of all the abdominal organs.
Though it doesn’t detect gallstones as good as an ultra scan, it can detect various abnormalities in the pancreas, liver and other abdominal organs as well.
This is a painless and safe imaging study that examines the gallbladder, pancreas and liver using sound waves. It helps in detecting dilated bile ducts and gall stones. It also helps in detecting abnormalities of pancreas and liver.
Magnetic resonance imaging(MRI)
It is an imaging study which examined abdominal organs using a magnetic field. It is handy for obtaining detailed imaging of the bile ducts.
It is an imaging study that evaluates the bile ducts and gall bladder using a radioactive substance.
Endoscopic retrograde cholangiopancreatography(ERCP)
this is a procedure that is done by passing an endoscope (a tube with a camera at the tip) through the mouth down to the small intestine.
After that, a dye is injected into the bile ducts, and an X-ray will be taken. It is useful for identifying tumours, stones or narrowing of the bile duct.
This procedure is done by inserting a needle into the liver after administering a local anaesthetic to the patient. Sometimes the placement of the needle is guided using ultrasound.
The small tissue sample nothing from the liver will be sent to The Laboratory for examination. A liver biopsy can also be useful for the diagnosis of cirrhosis, liver inflammation and cancer.
Blood tests may initially include liver function tests (plus bilirubin levels), a complete blood count (CBC), amylase/lipase level to detect pancreatitis (inflammation of the pancreas), and an electrolytes panel.
A pregnancy test may be obtained in women. Some other blood tests may also be needed depending on the medical history and initial results obtained by your doctor.
What are the treatments for Jaundice?
Treatment is based on the underlying condition that caused jaundice and any other complications related to it.
Once the diagnosis has been made, treatment will begin to tackle the particular underlying condition. Hospitalisation may or may not be necessary.
- You can receive medical treatment with antibiotics, intravenous fluids, medications or blood transfusion.
- You may require surgical treatment
- Drugs/toxin must be discontinued if that is the cause
- You may receive treatment by watchful waiting (expectant management) at home with rest
Depending on the condition that caused rejoinders, a patient may require long-term close supervision by Physicians, or they may require only a short-term follow-up with periodic visits to the hospital.
If symptoms persist or worsen after treatment, make sure to see your doctor immediately.
Other medical treatments for jaundice
Jaundice can also be treated based on the symptoms associated with the underlying condition responsible for the ailment. Treatments include the following
- Antiviral medications
- Phototherapy(for a newborn)
- Blood transfusion
- Supportive care
- Medication for pain and nausea
- IV fluid(for dehydration)
Self Care at home for Jaundice
Various measures can be taken at home;
- Always drink fluids and rest well
- Medications should be taken as instructed by your doctor.
- Do not drink alcohol except you have talked about it with your doctor
- You should avoid herbs or medications that have serious side effects.
- Your health practitioner may also give you some diet restrictions.
Is Surgery Needed?
Certain cases may require surgical treatment. Cases such as abnormalities of the spleen, congenital malfunction, cancer, obstruction of the gallstones and bile duct.
A liver transplant may be needed in extreme cases.
How to Prevent Jaundice
Some of the underlying conditions can be prevented. Ways to prevent include;
- Vaccine for hepatitis(both hepatitis A and B)
- Avoid too much intake of alcohol(cirrhosis, alcoholic hepatitis, and pancreatitis)
- Take anti-malaria drugs before travelling to regions with high risk
- You should avoid medications that can cause hemolysis.
- You should maintain proper food hygiene(hepatitis A) and also avoid water or food that is contaminated.
- Symptoms and signs of jaundice (in adult and newborn) – emedicineHealth