Jaundice Causes Definition Symptoms And Prevention
Jaundice is considered as a symptoms not a disease , It is a french word which clinically accepted by yellow colour of the sclerae of eye and skin,
Yellow colouration of (sclera) skin eye, nail.
It is seen in child after birth, out of 3 children in the world one suffer from jaundice,Incidence is higher in East Asians and American Indians and lower in Africans.
Firstly you must know some basic idea about bilirubin in our body to understand the jaundice properly.
YOU MUST KNOW ABOUT
- Production of bilirubin
- Conjugation of bilirubin
- Intermediate enzymes involves
Normal level of bilirubin 0.2gm/dl to 1.2gm/dl
Symptoms associated with jaundice:-
- Dark urine
- Weight loss
- abdominal pin
Different cause of increase bilirubin in our body:-
- Excessive release of un-conjugated bilirubin in circulation, the liver can not handle or uptake the higher level of bilirubin.
- Bilirubin uptake is not normal but production is normal.
- Bilirubin uptake is normal but problem is in conjugation process in liver
- Active transport of conjugated bilirubin in the biliar canaliculi surface of the hepatocytes to the biliar system is disturbed. conjugated bilirubin back to the circulation and level of conjugated bilirubin increase.
- Intrahepatic or extrahepatic obstruction to the bile outflow.
On the basis of the following point we divide jaundice in three major types,
- Hemolytic jaundice
- Hepatic jaundice
- obstructive jaundice
How can we know the malfunctioning location in jaundice
We can estimates the particular point of problem due to which it causes increase in bilirubin level.
- By diagnose which type of bilirubin is increase in the serum ie, conjugated or un-conjugated. so that we can know where is the defect present.
- Diagnose the urine and feces , estimate the amount of urobilinogen and stercobilinogen present in them.
- Bilirubin level in urine and serum
- Hemolytic jaundice
Over production of bilirubin due to hemolysis
Causes of these-
- Excessive hemolysis of erythrocyte-
Incompatible blood transfusion, sickle cell RBC, malaria
- Excessive intramedullary hemolysis-
- Breakdown of Hb in excessive extent-
In these conditions, larger production of bilirubin occur from breakdown of Hb which overcome the ability of liver to conjugate bilirubin. (3.0mg/day conjugate bilirubin by liver and 0.3mg/day production of bilirubin)
So as the liver can not handle the excessive production of bilirubin so the un-conjugated bilirubin in the serum increases.
So, as we see, by diagnose the level of two type of bilirubin we can estimate the problem in some extent.
Sign and diagnosis of hemolytic jaundice;-
- Increase in un-conjugated bilirubin level in serum
- Higher content of stercobilinogen in feces.
- Increase urine urobilinogen level.
- Dark brown colour of feces
- Hb count decrease
- RBC count decrease
- 5-6gm/dl – mild jaundice
- More than 6gm/dl – liver may effected.
- Urinary bilirubin is absent.
If there are intra vascular hemolysis(in the blood) then the Hb bind with the heptaglobin
so the level of free heptaglobin decrease in serum,
By the level of the heptaglobin we can estimate the intravascular hemolysis.
More commonly , inflammation of liver cell ,more accurately damage in the parenchymal cells.
In children’s glucuronyltransferase enzyme deficiency is observed due to less efficient gene activation in children,which In turn lower the power of conjugation of liver.
Increase in un-conjugated bilirubin level in serum
Cause of dysfunction of hepatic cell;-
- Viral infection (most common and dangerous)
- Toxins -chloroform, carbon tetrachloride,alcohol
- Cirrhosis of liver
- Cardiac failure
These problem causes both bilirubin uptake and bilirubin conjugation in the liver cell
Sign and diagnosis;-
- Elevation of both conjugated and un-conjugated bilirubin in the serum, as it hamper both uptake and conjugation
- Rise of urobilinogen and bilirubin in urine, dark coloration.
- Due to damage of the hepatocytes rise in level of SGPT and SGOT.
- Loss of petite
- Clay color stools,due to absent of stercobilinogen
Breast milk jaundice;- in milk glucuronylase enzymes are present. Which break the conjugated bilirubin into un-conjugated bilirubin.
- Un-conjugated bilirubin level increase in serum
Some clinical evidence of hepatitis;-
- No features of excessive hemolysis
- Total bilirubin level increase, more un-conjugated bilirubin than conjugated bilirubin.
- ALT and AST slightly increase.
- albumin level normal
- Mild increase in alkaline phosphate.
When bile duct obstruction prevents outflow of bile into the intestine. Obstructions may be gall bladder stone or tumor.
As outflow of bile stops, conjugated bilirubin from liver enter into the blood circulation.
There are two types of obstructive jaundice
- Intrahepatic obstructive jaundice
- Extrahepatic obstructive jaundice
Evidence of obstructive jaundice
- Total bilirubin level increase in serum
- Conjugated bilirubin increase more than un-conjugated bilirubin.
- AST and ALT slightly elevated.
- Serum alkaline phosphate increase strongly. from the cell of damage bile duct.
- Urinary bilirubin level is increase greatly. Dark colouration of urine.
- Stool is pale and light color, absent of stercobilinogen.
- Nausea and abdominal pain.
- absents of urobilinogen.
How can we differentiate between the intra and extra – hepatic jaundice-
By ultrasound, if common bile duct dilated then it is extra hepatic obstruction, if not dilated then it is intra hepatic obstruction.
Treatment of jaundice
- If there is a obstructive jaundice then it can be remove by surgery.
- In hemolytic jaundice , supplement of iron and vitamins are really helpfull.
- It it is caused by hepatitis virus then, anti-hepatitis vaccine is used.
Treatment for jaundice is not specific, it is given as per particular kind of case,such as
- If due to alcoholic liver disease
- Non alcoholic cirrhosis of liver
- May be autoimmune hepatitis
- Liver cancer
- Stone formation
- Crigler-najjar syndrome type I
- Crigler-najjar syndrome type II
- Glibert’s disease
- Maintain proper iron diet.
- Stay within alcohol limit
- Control your cholesterol
- Enough water intake
- Eat fruits
- Avoid contraceptive pills
- Eat vegetable
- Papaya , mango and pineapple
- Grapes for liver
- Fat and sugar control
- Low salt
- don’t use sugar in tea and coffee
Penned by – Pallab