Jaundice- new approach | liver

                   Jaundice-new approach

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 In one line, Jaundice is a yellow discoloration of the skin and or mucosa.

Keywords: Icterus|dark brown |colored stoolPale stool| Clay stool| Neonatal Jaundice|Gilbert syndrome|Hepatotoxic|Hepatitis|Conjugated|Unconjugated

Table of content

Introduction

Causes

Types of jaundice

Types of bilirubin

Incidence

Diagnosis

Investigation

Prognosis

Prevention

Introduction

Jaundice is a yellow discoloration of the skin and or mucosa. Jaundice is also known as icterus. The root of  Jaundice is the French word 'Jaune' meaning yellow, and 'jaundice' stands for yellow disease. The word icterus is derived from the Greek word 'ikteros.' In ancient times, there was a false belief that looking at the yellow bird icteria could cure Jaundice.

Causes:

Jaundice is due to an increased bilirubin level in the blood. The average total bilirubin level is 1.2 mg/dl of blood in an adult. When its level in blood increases up to 2mg/dl of blood, it is known as hyperbilirubinemia, and Jaundice appears when the bilirubin level in blood is more than 2.5mg/dl of blood.

Types of bilirubin:

1.     Unconjugated bilirubin 0.9mg%  

2.     Conjugated bilirubin 0.3 mg% and

3.     Delta bilirubin in a small amount of  bilirubin

High-conjugated bilirubin is present  in

1. Hepatitis, cirrhosis,

2. Hepatotoxic drugs,

3. Obstruction of bile duct-carcinoma, gallstone.

High unconjugated bilirubin is present  in

1. Large bruises and hemolysis,

2. Jaundice of the newborn,

3. Prolonged fasting and

4. Congenital diseases, e.g., Gilbert syndrome.

 Types of Jaundice:

1. Pre hepatic

2. Hepatic 

3. Post hepatic.

Another way of classification is:

1. Hemolytic= Pre hepatic

2. Hepatocellular= hepatic, and

3. Obstructive.= post hepatic.

In neonates, jaundice appears, which may be Physiological or Pathological.

Physiological Jaundice appears 48-72 hours after birth. In infants, red blood cell count is 7-8 million per cubic millimeter of blood. After birth, rapid destruction of red blood cells occurs in infants, increasing bilirubin production. The enzymes concerned with bilirubin metabolism are not well-developed in neonates.

The infant's immature liver fails to conjugate the excess bilirubin, resulting in the rise of unconjugated bilirubin in the blood. The increase may be up to 12 mg/dl or more. In 7-10 days, enzymes concerned with bilirubin metabolism mature, and physiological Jaundice resolves by itself, but it is treated with phototherapy if the level is more.

Pathological jaundice in infants from birth is due to some serious disorder and needs immediate treatment. Usually, it is due to 'hemolytic diseases of newborns'.

Incidence:

Jaundice is common in males, alcoholics, and smokers.

The most common cause of jaundice in developed countries is obstruction of the common bile duct or drugs.

And in developing countries, the most common causes are viral hepatitis, leptospirosis, and malaria.

Pre hepatic Jaundice: Isolated raised bilirubin level may be due to:

1. Haemolytic cause –A healthy liver can conjugate bilirubin load six times greater than usual, raising the conjugated bilirubin level.

2. Non-haemolytic Jaundice occurs in some congenital disorders. However, the most common hereditary disease is Gilbert syndrome, in which the conjugated bilirubin level is raised.

Hepatocellular Jaundice may be acute or chronic and is multifactorial. It may be due to :

1.     The inability of hepatocytes uptake of unconjugated bilirubin into the cells.

2.     The failure of hepatocytes to transport conjugated bilirubin into the bile canaliculi.

3.     Obstruction of the bile canaliculi due to swelling of hepatocytes due to diseases.

In this type of Jaundice, conjugated and unconjugated bilirubin are raised.

Obstructive Jaundice or cholestatic Jaundice may as a result of 

1. Failure of hepatocytes  to initiate bile flow

1.    Obstruction of a) bile duct, b) Portal tracts, c) Hepatic duct, common hepatic duct, common bile duct, sphincter of Oddi.

Causes of obstructive jaundice  are divided into :

A. Intrahepatic causes –Defect in hepatocytes.  

 1. Congenital-Primary biliary cirrhosis, cystic fibrosis, etc

 2. Non-congenital - due to drugs, infections, toxins- alcohol,  chronic heart failure, hepatic infiltration, pregnancy.

B. Extra hepatic: trauma, parasitic infection, choledocholithiasis(stone) , chronic pancreatitis and carcinoma of the gall bladder, bile duct, ampulla of Vater. 

In obstructive Jaundice, hepatocytes fail to conjugate unconjugated bilirubin into conjugated bilirubin. In addition to that, the conjugated bilirubin fails to enter the bile canaliculi and returns to the blood. Therefore, serum conjugated bilirubin level is raised.

Diagnosis

The history of the patient is helpful in the diagnosis of Jaundice.

Alcohol or drug intake –hepatocellular cause.

Pregnancy- and Itching

Abdominal pain –Stone –obstruction

Dark urine in hepatic and post-hepatic Jaundice.

Pale stool hepatic Jaundice-reduced amount of conjugated bilirubin so the decreased amount of stercobilinogen in the stool.

Clay-colored stool in post hepatic Jaundice due to the absence of stercobilinogen in the stool.

The dark brown colored stool is seen in prehepatic jaundice due to increased stercobilinogen in the stool.

The pale, greasy, foul-smelling large stool in hepatic and post hepatic Jaundice.

Jaundice is diagnosed by yellow discoloration of skin and mucosa, especially in the upper eye cornea. A history of the patient's symptoms will help in diagnosis. 

Differential diagnosis

carotenemia: The yellowish discoloration of the skin occurs in carotenemia due to eating large amounts of food containing carotene for a long time. This carotenemia is differentiated from Jaundice by the absence of an increased bilirubin. 

Drugs: This condition may be due to drugs, e.g., rifampicin.

Investigations will confirm the diagnosis.

  serum bilirubin estimation

 Urine bilirubin, urobilinogen, and 

 Liver function tests - 

Alanine aminotransferase (ALT)

Aspartate aminotransferase (AST)

Alkaline Phosphatase (ASP)

Gamma Glutamyl transferase (GGT)

Ultrasound examination of the whole abdomen,

MRI

Cholecystography

Liver Biopsy

Prognosis

The prognosis depends on the cause of jaundice and the duration or complication of jaundice.

Prevention 

Healthy lifestyle
Avoid alcohol, and stop smoking.

Avoid junk food. Eat a healthy diet.

Protect yourself from Hepatitis A, B, C, and other infections. 

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Hashtags:

Healthy life # Healthy diet # healthy lifestyle # Pale stool # Clay stool|# Neonatal Jaundice#Gilbert syndrome#Hepatotoxic#Hepatiti#Conjugated#Unconjugated

Internal link:

https:// totalphysiology.com/2022/08/save-liver-stay-healthy.html

https://totalphysiology.com/2021/05/liver-introduction-we-must-know.html

https://totalphysiology.com/2021/05/liver-structure-we-must-know.html

https://totalphysiology.com/2021/05/liver-functions-we-must-know.html

https://total physiology.com/2021/05/bilirubin-we-must-know.html

https://total physiology.com/2021/05/liver-function-test-we-must-know.html

External Link

https://en.wikipedia.org/wiki/Jaundice

https://my.clevelandclinic.org/health/diseases/15367-adult-jaundice

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