Jaundice: Symptoms, Complications, and Treatment

Contents

In this article we will look at:

• What is jaundice?
• How does jaundice occur?
• Who is prone to jaundice?
• What are the symptoms of jaundice? How is jaundice diagnosed?
• What are the complications of jaundice?
• What is the treatment for jaundice?

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What is jaundice?

Jaundice is a disease which causes the colour of the skin and the whites of the eye to turn yellow. The yellowing happens due to an excess of bilirubin in the blood, which can occur due to liver disease, excessive breakdown of red blood cells, or obstruction of the bile duct.

If you notice symptoms such as yellowing of the skin and the whites of the eyes, vomiting, fever and very dark urine, do consult your family physician or a general practitioner immediately.

How does jaundice occur?

Jaundice occurs when there is too much of bilirubin in the blood. Bilirubin is created when in the body when old red blood cells carrying oxygen to all parts of our body breakdown. This breakdown of the red blood cells is a normal process. The red blood cells have a lifespan of 120 days and new red blood cells are manufactured to replace the dying ones. The bilirubin which gets created when the old red blood cells break down, circulate through the bloodstream and travels to the liver.  From the liver, it is excreted into the bile duct, and stored in the gallbladder. From the gallbladder, the bilirubin is released in small quantities, as bile, into the small intestine. Here,  it helps to digest fats and then is eventually excreted from the body with stool.

When the liver is not metabolizing bilirubin the way it is supposed to, jaundice occurs.
There could be three major reasons for this liver malfunction, which lead to three different kinds of jaundice:

• Hemolytic jaundice: which occurs when there is excessive red blood cell breakdown called haemolysis. Usually, there is a perfect balance between the breakdown of existing red blood cells and the manufacturing of new red blood cells. If for some reason the breakdown is more than the manufacturing, the liver is not able to remove the excess amount of bilirubin. A classic example is Malaria, where the parasites live within red blood cells and finally kill them. The new red blood cells are not formed in time to take the place of the old ones. Therefore, people with malaria have a high risk of contracting jaundice.
  
  
  
• Hepatocellular jaundice: This occurs when the liver suffer from damage or infection. Examples are a viral infection of the liver, also known as hepatitis, liver cancer, and scarring of the liver causing liver damage also known as cirrhosis, which occurs due to alcohol abuse.

• Obstructive jaundice: which can occur as a result of an obstruction in the bile duct preventing bilirubin from leaving the liver. The bile duct consists of a system of tubes which carry bile from the liver to the gallbladder and the small intestine. Examples can be a cyst, gallstones in the ducts of the biliary system, scar tissue due to a previous surgery or infection, and swollen lymph glands.

There is also infant jaundice which usually occurs in preterm babies. Infant jaundice occurs due to the fact that the baby’s liver is not mature enough to quickly remove bilirubin from the system, causing an excess of bilirubin.

Who is prone to jaundice?

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• Babies Suffer More From Jaundice: Almost 60% of the newborn babies suffer from jaundice after the second or third day of their birth. Among them, 80% of the premature babies suffer from jaundice within the first few days after their birth.
  
  
• Obstructive Jaundice More Common in India: Among the adolescents and adults Hepatocellular jaundice (Hepatitis) and Obstructive Jaundice are more common in India. Both men and women are equally susceptible to this disease.
  
  
  
• Common Causes: The most common causes of jaundice encountered in Indian adults are Viral Hepatitis (Hepatitis A, B, C), obstruction to bile ducts by gallstones or tumours, alcoholic liver disease and drugs.

What are the symptoms of jaundice? How is jaundice diagnosed?

The symptoms of jaundice include:

• yellow tinge on the skin and in the whites of the eyes
  
  
  
• vomiting
  
  
  
• high fever
  
  
  
• dark coloured urine
  
  
  
• loss of appetite
  
  
  
• pale coloured stool
  
  
  
• abdominal pain (especially in the liver region)
  
  
  
• weakness
  
  
  
• weight loss
  
  
  
• swelling of the abdomen due to the accumulation of fluid

Diagnosis

A blood test is usually performed to confirm the diagnosis of jaundice, which includes, bilirubin tests, full blood count of red blood cells, white blood cells, and platelets, and Hepatitis A, B, and C tests.

The doctor will enquire about your personal medical history, and do a physical exam to feel for tumours in your abdomen, or check the firmness of your liver. A firm liver indicates liver cirrhosis and a hard liver indicates liver cancer.

Other tests that you may be asked to undergo to find out the cause of the jaundice are :

• Magnetic resonance imaging (MRI)
• Abdominal ultrasonography (ultrasound)
• Computerized tomography (CT) scan, or computerized axial tomography (CAT) scan
• Endoscopic retrograde cholangiopancreatography (ERCP)
• Liver Biopsy

What are the complications of jaundice?

The complications of jaundice will depend on your medical conditions, the jaundice type and severity. Some common complications include:

• bleeding
• anemia
• infections
• abdominal bloating
• swelling of legs
• liver failure
• kidney failure
• constipation
• stomach pain
• flatulence
• diarrhoea

If it is Infant Jaundice or jaundice in a baby, the complications that may affect the infant include:

• fever
• vomiting
• dazedness
• difficulty waking up or being alert
• continuous high pitched crying

Severe jaundice in an infant may lead to permanent brain damage, apart from hearing loss, uncontrolled bodily movements, and improper development of tooth enamel.

What is the treatment for 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 treatments include:

• Phototherapy
• Blood transfusion