Jaundice aka Icterus
Definition of Jaundice
Jaundice or icterus refers to the yellow pigmentation of the skin or sclerae by bilirubin.
Bilirubin :- It is the normal non-iron containing pigment present in the bile. It is derived from porphyrin ring of the hemoglobin.
-> Normal level of bilirubin in blood is < 1mg/dl. Excess of bilirubin or hyperbilirubinemia causes an important clinical condition Jaundice.
Etiology of Jaundice
- Jaundice is caused by a buildup of bilirubin, a waste material in the blood.
- An inflamed liver or obstructed bile duct can lead to jaundice.
- Other common reasons for Jaundice are mentioned below :-
- Presence of Gallstones
- Kernicterus (Damage to brain due to increased bilirubin levels)
- Sickle cell anemia and haemolytic anemia
- Obstructive of bile ducts which leads to retention of bile in hepatocytes.
- Excess bilirubin production
- Decreased hepatic uptake of bilirubin
- Impaired bilirubin conjugation
Risk factors of Jaundice
- Hepatitis (Acute and Chronic)
- Drug induced liver damage
- Liver failure (Acute and Chronic)
- Pancreatic/Biliary malignacy
- Parasitic infestations
Classification of Jaundice (Age-old classification)
- Pre-hepatic (haemolytic) – When there is excessive destruction of red blood cells.
- Hepatic – It results from failure of hepatocytes to conjugate bilirubin and inability of bilirubin to pass from the liver to intestine.
- Post hepatic or obstructive – Which results from obstruction to the outflow of conjugated bilirubin.
Current classification –
It is based on predominance of the type of hyperbilirubinemia.
Normal Metabolism of Bilirubin
Pathogenesis of Jaundice
The mechanisms which lead to jaundice are as follows:
- Unconjunguted Hyperbilirubinaemia :
a) Increased Bilirubin Production :
Increased bilirubin levels is due to,
(i) Ineffective erythropoiesis (RBC production)
(ii) Excessive RBC destruction. The normal life span of RCB is 120 days. Premature destruction of RBC leads to production of large amounts of hemoglobin which results in increased bilirubin production.
b) Decreased Hepatocellular uptake :
Upon hepatic uptake, bilirubin dissociates from albumin and binds of ligandin. This hepatocellurar uptake is disrupted by few drugs, upon prolonged starvation or by sepsis.
c) Decreased hepatic conjugation :
It occurs due to deficiency or defect in the enzyme bilirubin-UDP-glucuronosy transferace which is essential for conjugation. Decreased in hepatic conjugation occurs due to drugs, hepatitis, cirrhosis and genetic disords like Gilbert’s syndrome.
- Conjugated Hyperbilirubinaemia :
Cholestasis refers to accumulation of bile in hepatocytes and biliary passages.
(a) Decreased Hepatocellular Excretion into Bile :
Decreases or defects in excretion of bile may occur within the hepatic bile canals and bile ducts.(b) Impaired Bile flow into the intestine :
It occurs due to mechanical obstruction of the extra-hepatic biliary apparatus and impairment of bile canaliculi.
Symptoms of Jaundice
- Yellow skin.
- Yellowing of the sclera of eye.
- Dark yellow or reddish urine (due to increased amounts of bilirubin).
- Anorexia (Loss of appetite).
- Bitter taste in mouth.
- Pale (due to absence of stercobilin) and foul-smelling faeces.
- Dull pain in liver region.
- Lethargy and confusion.
- Pruritus (itchy skin due to cutaneous deposition of bile salts).
Complications of Jaundice
- High levels of bilirubin – Usually above 25 mg can cause deafness, cerbral palsy, or other forms of brain damage in some babies.
- Risk that the fat soluble bilirubin crosses to the brain to cause Bilirubin Encephalopathy known as Kerincterus.
Prevention of Jaundice
- Say within recommended alcohol limits.
- Maintain a healthy weight and height.
- Manage your cholesterol.
- Stay hydrated and hygiene.
- Vaccination against hepatitis A and B.
- Avoid medications and toxins which can cause haemolysis or directly damage the liver.
Treatment of Jaundice
The medical treatment of jaundice targets the specific cause, rather than the jaundice itself. For example:
- Hepatocellular jaundice is treated with anti-viral medications and steroids.
- Hemolytic jaundice is treated with iron supplements.
- Obstructive jaundice is treated with surgery to remove the obstruction followed by medication.
- There is also medication induced jaundice, in other words, jaundice which occurs as a side effect to consuming certain medicines. In such cases the medicines are discontinued and alternative medicines are prescribed.
For infants with jaundice the treatment include:
- Photo therapy
- Blood transfusion
Some more related diseases can be found below :
Ischemic Heart Disease – http://pharmadiagnosis.com/ischemic-heart-disease/
Hypertension (High Blood Pressure) – http://pharmadiagnosis.com/hypertension-high-blood-pressure/
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