Jaundice is not a disorder which is known in recent times. It is a liver disease present even in time immemorial. Though it is prevailing from many years, many of the people do not know What is Jaundice? So here we are providing the exact Jaundice Definition along with complete pathophysiology of Jaundice. Also, know the Diet for Jaundice, Home Remedies for Jaundice, Breast Milk Jaundice etc. We have also provided the Jaundice Bilirubin levels, Symptoms of Jaundice in Adults etc. So , have a glance at the complete pathophysiology.
What is Jaundice?
Another term for this disease is Icterus and is characterized by yellowish discoloration of the skin, sclera (white of the eyes), mucous membranes and nails. Icterus itself is not a disease, but it is a visible sign of any underlying disease that results in the increased level of bilirubin in the blood. So, before discussing details about this, it is critical to know what is Bilirubin? Bilirubin is a yellow-orange colored compound which is a waste product that is produced by the degradation of hemoglobin from red blood cells. Usually, the bilirubin normal level in the blood is below 1.0mg/dL but when this Bilirubin Levels in icterus is above 2-3mg/dL.
The excess of bilirubin leaks out into the surrounding tissues and causes the mucous membranes, sclera, and skin to turn yellow. As the liver is an organ responsible for processing bilirubin thus, it is considered as an indication of abnormal function or damage of the liver in adults. It is imperative to identify and treat its cause, or it may lead to liver failure. However, in infants if icterus peaks after 3 to 5 days or birth it is considered normal. This common condition affecting about half of the children is known as Neonatal jaundice and goes away on its own in a few days. It can occur at any age. In this article, we will discuss in detail about Infant jaundice and Adult jaundice separately.
Neonatal Jaundice Disease
Newborn Jaundice is common in most of the babies. Newborn babies have extra red blood cells that begin to break after the baby is born. Also, the liver of the babies is slow in processing bilirubin. It causes Jaundice in New Borns. In healthy newborns, icterus peaks three to five days after the birth and goes on its own. Thus it is not one of the leading causes of concern. You just need to make sure that the baby is breastfeeding properly. Also, a doctor may advise exposing the child to morning sunlight. Another type of icterus, known as “breastfeeding jaundice,”. The Breast Feeding Jaundice is caused due to inadequate intake of the milk.
There is one less common type of neonatal jaundice, known as Breast Milk Jaundice. It is caused due to a chemical in the mother’s milk that reduces the ability of the liver to process the bilirubin. However, it is apparent only after the baby is one week old and peaks during the second and third week after birth. The mother should not stop breastfeeding as Baby Jaundice goes away itself in a few days.
If it occurs within the first 24 hours after the baby’s birth, it is not normal. In such cases, consult your pediatrician immediately. The high bilirubin levels may affect the brain. This condition is known as kernicterus. Thus, when the baby is born their bilirubin level is checked to know whether they have icterus or not. In the case, it is found to be very high the baby is kept under “bili light” that causes breakdown of the excess of bilirubin.
Differences Between Physiological and Pathological Jaundice
The main differences between these two types of Jaundice in Infants are
- Physiological Jaundice occurs after 24 hours of birth and disappears without any treatment after 14 days whereas pathological Jaundice occurs within 24 hours of birth and persist ever after 14 days of birth.
Jaundice in adults
In adults, icterus is rare as compared to neonates, but may be caused due to several medical conditions that affect the normal metabolism or excretion of the bilirubin. On this basis of the cause that is disrupting the natural removal of bilirubin, icterus is classified into three types.
Types of Jaundice / Jaundice Types
There are 3 types of icterus. They are
- Pre-Hepatic/ Hemolytic Jaundice
- Intra Hepatic/ Hepato Cellular Jaundice
- Post-Hepatic/ Obstructive Jaundice
The disruption occurs before bilirubin is transported from the blood to the liver. This condition is caused due to infection or any other condition that enhances the breakdown of RBC. It elevates the bilirubin level in the blood. The rapid increase in the level of bilirubin in the bloodstream, in turn, overwhelms the capability of the liver to metabolize the bilirubin properly. It leads to increase in the levels of unconjugated bilirubin.
Causes of Hemolytic Jaundice:
- Sickle cell disease- An inherited blood disorder is causing the development of abnormal red blood cells.
- Glucose-6-phosphate dehydrogenase deficiency (G6PD),
- Drugs or other toxins
- Crigler-Najjar Syndrome- It is a genetic disorder where the enzyme that is needed to move bilirubin goes missing.
- Hereditary spherocytosis– It is a genetic disorder where the life span of the blood cells is shorter than the usual.
In Hepato Cellular Jaundice, the disruption occurs in the liver due to infection, liver damage, liver injury or any other liver disease that disrupts the ability of the liver to process and excrete bilirubin. It leads to increase in both conjugated and unconjugated bilirubin levels.
- Viral hepatitis [Hepatitis A, B, C, D, E]
- Alcoholic liver diseases caused due to drinking lots of alcohol
- Glandular fever- It is a kind of viral infection caused due to Epstein-Barr virus.
- Leptospirosis- It is a bacterial infection that is spread by the animals.
- Primary biliary cirrhosis- It is a rare condition that causes progressive liver damage.
- Drugs misuse or other toxins,
- Crigler-Najjar syndrome,
- Autoimmune disorders,
- Gilbert’s Syndrome- It is a genetic disorder where the breakdown of bilirubin by the liver is below standard rates.
- Liver Cancer- Although rare, but incurable.
- Autoimmune hepatitis- A rare condition where the body’s immune system starts attacking the liver
- Primary sclerosing cholangitis
- Dubin-Johnson Syndrome- It is a rare genetic disorder that prevents the bilirubin to move out of the liver.
- Exposure of liver to harmful substances such as phenol and carbon tetrachloride may also cause intra-hepatic jaundice
This condition arises due to the obstruction that prevents the proper drainage of bile from the liver into the digestive system. It results in the increase in the level of conjugated bilirubin in the bloodstream. It occurs due to obstructed, inflamed or damaged gallbladder.
Causes of Obstructive Jaundice:
- Pancreatic cancer
- Gallbladder cancer
- Bile duct cancer
- Strictures of the bile ducts
- Pancreatitis- Inflammation of pancreas. It may be acute or chronic.
- Parasites such as liver flukes.
Risk factors that may develop Icterus
- The risk factors that may promote this also vary according to the underlying cause. However, there are individuals with certain hereditary conditions such as hereditary spherocytosis or thalassemia who are more at the risk of developing it due to hemolysis.
- Heavy alcohol drinkers are in danger of developing cirrhosis, alcoholic hepatitis, and pancreatitis
- Individuals who are at the risk of different types of viral hepatitis exposure.
- It has been found that middle-aged and elderly are more likely to develop Intra-hepatic and post-hepatic jaundice in comparison to young people. But individuals of any age, even children may be affected by Pre-hepatic jaundice
What are the symptoms of Jaundice?
As mentioned above, Icterus itself is not a disease but a sign of any underlying disorder that is displayed by the yellow discoloration of the skin, sclera, and mucous membrane. The yellow discolouration is one of the distinct Jaundice Symptoms. It starts from the head and then spreads to other parts of the body. However, in the case of very high level of bilirubin the color may vary from yellow to brown. In some cases, yellowish discolouration is not seen. It is called as White Jaundice and if the yellow colouration persists it is called yellow jaundice.Other symptoms that a patient can experience depend on the underlying cause. In some individuals, the symptoms will be very few whereas some patients the symptoms may be more pronounced and severe.
Jaundice Symptoms or Signs of Jaundice includes the following
- Stools are paler than usual
- Itching of the skin that may so serve that it may cause insomnia.
- Loss of appetite
- Pain in abdomen
- Dark yellow colored urine
- Bleeding from the rectum
- Fever with chills
- Weight loss
- Swelling of the legs
- Ascites- It is the accumulation of the fluid in the abdomen, causing distension of the abdomen.
Diagnosis of Jaundice
The liver is the most hardworking body organ. It is responsible for flushing out various toxins from our body. So, if the functioning of the Liver decelerates, toxic accumulations increase in your body. It processes everything we eat or drink along with balancing hormones, cleansing the blood and maintaining metabolism. It is crucial to keep the liver healthy. If you suffer from above symptoms, you need to have an appointment with your doctor for the proper diagnosis of this disease that is hampering your liver.
Your doctor will ask you questions regarding current symptoms, history of alcohol misuse, any color change noticed in the stool or urine, any medications you are currently taking, your occupation or if you have recently traveled to a country where hepatitis and malaria are widespread. After conducting various physical examinations to check the swelling of legs, feet, ankles, or abdomen, your doctor may come to a conclusion. The doctor will prescribe a Jaundice Test which is nothing but Urine test and Blood test to know the Bilirubin levels.
1. Urine test– To measure the level of urobilinogen. It is high in pre-hepatic and intra-hepatic Icterus whereas may be lower in the case of post-hepatic jaundice.
2. Liver function test or blood test– This helps to diagnose the conditions such as hepatitis, cirrhosis, and alcoholic liver disease.
Other imaging tests done to check the abnormality inside the liver and bile duct are:
- Ultrasound scans
- CT scans
- MRI scans
3. A Liver biopsy to analyze the damage caused to the liver due to conditions such as liver cancer or cirrhosis.
Treatment of Jaundice
How to cure or How to treat? is the very first question that strikes your mind when you hear that you are positive for the disease. There is an Existing Jaundice treatment which can cure the disease within few days. The treatment of disease ultimately depends on the cause and the extent of damage caused to the liver. After a proper diagnosis, only the physician can estimate What causes Jaundice? And treats it. In some patients, the family can take care of them, and they do not require any hospitalization. But, in few cases, the physician should monitor the individual suffering from severe icterus disease. In such situations, the patient should stay in hospital as the in-patient.
The patients with Mild viral hepatitis can stay at home and should go for regular checkups. It only requires watchful waiting along with close monitoring by your health care provider. There are novel medications for hepatitis C that offers the cure. Patients with alcoholic hepatitis, acute pancreatitis and cirrhosis need to cease the intake of alcohol. In such case, certain medications or toxins will lead to icterus. The patient needs to discontinuation and avoids the offending agent.
Drugs used in the Treatment of Jaundice
- If the patient had the overdose of Acetaminophen (Tylenol), then the physician will provide them with Antidote N-acetylcysteine (Mucomyst).
- To treat Auto Immune Disorders, the doctor will prescribe Steroids in limited quantity. The treatment of Patients with cirrhosis includes lactulose and diuretics.
- The the patient should administer antibiotics as prescribed by a physician.
- Some patients in whom Icterus occurs due to hemolysis or the individuals with anemia needs a blood transfusion
- If cancer has lead to icterus disease, the patient should meet an oncologist as now the treatment will entirely depend on the stage of cancer.
- In particular cases such as the gallstone, the sufferer may need surgery and other invasive procedures. Individuals with liver failure or cirrhosis require a liver transplant.
In some severe cases the recovery process is slow, but in normal condition, the person will recover faster if you take care about what they eat. The diet for icterus patient should consist of liquid food which is easily digestible. Until the acute symptoms subside, the patient can have only the juice of carrot, grapes, sugar cane, oranges, lemons, pears, and beetroot. After which fruit diet is started where fruits are given for 3-time meals. Fruits you should prefer are apples, pears, oranges, grapes and pineapple. One should avoid eating Banana until they recover completely. After following this jaundice diet regimen for 3 to 5 days, the patients can have vegetable soup, buttermilk, skimmed milk and wheat tortilla are until complete recoveries.
The individual suffering from icterus should drink only boiled water even after recovery. So, the caretaker should follow this strictly and provide the patient with only those are prescribed by the doctor.
Avoid the Following
When a person has icterus disorder, then he/she should not consume the following foods. The reason behind this is they create irritation in stomach, increase load on liver functions which will aggravate the condition. So, the jaundice diet should be devoid of the following foods
- Spicy food
- Fried foods.
- Junk foods
- Refined sugars
- Carbohydrate-rich foods
- Tea and coffee.
- Non-pasteurized milk.
What are the complications of this Disease
Icterus itself is not responsible for the difficulties, but most of the complications are a result of the underlying cause. Also, the severity and the type of complexity varies according to the cause. In some cases, patients recover completely, and there may not be any long-term after effects. However, in others, this disease may be a clue of life-threatening conditions.
- Electrolyte abnormalities
- Chronic hepatitis
- Kidney failure
- Liver failure
- Brain dysfunction
Prevention of Jaundice
There is a broad range of circumstances through which we can acquire icterus. Thus Prevention is not possible completely. But by certain precautions for icterus and lifestyle changes you can minimize the risk of developing it. To keep this at bay, We should maintain the health of the liver. For this, you need to take the following steps.
- Eat a balanced and healthy diet.
- Exercise daily for at least 30 minutes.
- Do not drink too much of alcohol.
- Maintaining a healthy weight is also important.
- One should take vaccines against hepatitis A and hepatitis B especially if you are traveling to the areas of high risk.
- Do not share equipment for drug injecting to minimize the exposure to hepatitis C.
So, follow these simple steps for prevention of Jaundice. Know the Causes, Symptoms, Types and Jaundice Diet. Nowadays there are many advanced techniques and treatments available. So, don’t get panic. Instead of trying Home Remedies use medicine for icterus.