Jaudice: More than just yellowing of the skin

Jaundice in a newborn

Types of Jaundice

  • Pre-hepatic Jaundice

      • Occurs when the body produces excessive bilirubin, and the liver is unable to process it.
      • Bilirubin builds up in tissues, causing yellowing of the skin.

  • Hepatic Jaundice

    • Caused by liver damage, which prevents the liver from filtering bilirubin from the blood.

  • Post-hepatic Jaundice (Obstructive Jaundice)

    • Occurs when bile flow is blocked, preventing bilirubin from draining into the digestive system.

Causes of Jaundice

  • Pre-Hepatic Jaundice

    • Hemolytic anemia
    • Malaria
    • Defective hemoglobin structure
    • Dyserythropoiesis

  • Hepatic Jaundice

    • Cirrhosis
    • Viral infections (e.g., Hepatitis)
    • Liver cancer
    • Bacterial infections (e.g., Leptospirosis)
    • Wilson’s disease
    • Alpha-1 antitrypsin deficiency

  • Post-Hepatic Jaundice

    • Tumors
    • Gallstones
    • Liver disease
    • Pancreatitis
    • Biliary Atresia (a condition where bile ducts are narrow or absent)

Symptoms and Features of jaundice

  • Pre-Hepatic Jaundice

    • Yellowing of skin, eyes, and mucous membranes
    • Itchy skin
    • Dark urine
    • Pale stools
    • Swollen abdomen

  • Hepatic Jaundice

    • Nausea
    • Vomiting
    • Weight loss
    • Fever
    • Chills
    • Yellowing of the skin

  • Post-Hepatic Jaundice

    • Pruritus (itching)
    • Bloody nose
    • Muscle and joint pain
    • Cancer
    • Cholestasis

Diagnosis and Tests for jaundice

    • Normal serum bilirubin levels are less than 1 mg/dl. Jaundice becomes clinically noticeable (scleral icterus) when levels exceed 3 mg/dl.

  • Tests:

    • Liver Function Test (LFT) – To check serum levels of AST, ALT, ALP, serum albumin, protein, and bilirubin.
    • If AST, ALT, and ALP levels are normal, the jaundice is likely not due to liver or bile duct injury and may be pre-hepatic in origin.

Treatment Options for Jaundice

  • Treatment depends on the cause and the patient’s age.
    • For children:
      • Phototherapy
      • Exchange transfusion
      • Discontinuation of breastfeeding
    • For adults:
      • Surgery for obstructive jaundice
      • Cholestyramine (for itching)
      • Iron supplements (for anemia)
      • Antibiotics (if necessary)

Prevention

  • Limit alcohol consumption within recommended guidelines.
  • Maintain a healthy weight.
  • Avoid using natural or herbal supplements without medical advice.
  • Manage cholesterol levels effectively.

Additional Information

Jaundice can also result from various congenital and genetic disorders, such as: