Jaundice, also called icterus, is a sign (and not a disease, per say) resulting from the deposition of bilirubin in the skin or the sclera (the outer white layer of the eye).
What is bilirubin, and how is it related to jaundice?
When the old red blood cells complete their life span (of about 120 days), they are destroyed in the spleen, bone marrow or liver. This destruction further causes the formation of a substance called biliverdin, which ultimately produces bilirubin.
Bilirubin is made water soluble in the liver, turning it into conjugated bilirubin (often seen in your liver function test reports). It goes into your intestines, and is responsible for the yellowish-brown colour of the stools (stercobilinogen) and light yellow colour of the urine (urobilinogen).
What are the accompanying symptoms of jaundice?
The person may be asymptomatic, and the presence of yellowish discolouration may be recognised by chance on a general examination. Some people may experience fever, chills, abdominal pain, the presence of fluid in the abdomen, flu-like symptoms and even clay-like faeces. A history of weight loss and itchy skin may be seen.
What are the causes of jaundice?
Increased bilirubin production: This may be observed in cases where the red blood cells are being destroyed at an increased rate, like sickle cell anemia and blood transfusions. It may also be seen in scenarios where the production of RBCs becomes ineffective.
Premature infants are predisposed to increased bilirubin production, and such babies are often given phototherapy to reverse this.
Obstruction of the bile duct: Any biliary obstruction (medically called cholestasis) often due to gallstones, cancer of the pancreas (the head part) or any tumour of the bile duct can result in jaundice. Inflammation may also block the release of bile, thus causing icterus.
Physiological jaundice in newborns: In the newborn babies, the liver is not very well developed, and hence may be unable to remove bilirubin at the same rate as that in an adult, resulting in an elevation of this compound in the serum. It can be treated by phototherapy and is not a cause of alarm in most cases.
Other causes: Some hereditary conditions like Gilbert’s syndrome, Crigler-Najjar syndrome can also cause a disruption in the routine metabolism of bilirubin. Infection by hepatitis viruses may be a predisposing factor, along with long-term alcohol consumption.
How can jaundice be diagnosed?
A thorough history will be taken by the medical healthcare professional, especially about the presence of any congenital problems or chronic alcohol consumption.
A visual general examination of the eyes can reveal a yellowish discolouration, pointing towards icterus. A urine analysis may be advised for checking the levels of bilirubin in the sample, and a complete blood count (CBC) may show raised levels of total serum bilirubin (more than 2 mg/dl). An ultrasound can also be done to check any enlargement of the liver.
What can you do to prevent it?
General measures must be taken like preventing infection by hepatitis viruses, (like A, B, C) and abstaining from excessive alcohol consumption. Routine health check ups and maintenance of a healthy weight are also recommended.
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