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Jaundice

Jaundice

Jaundice is a yellow discoloration of the skin, mucous membranes, and the whites of the eyes caused by increased amounts of bilirubin in the blood. Jaundice is a sign of an underlying disease process.

 

Bilirubin is a by-product of the daily natural breakdown and destruction of red blood cells in the body. The hemoglobin molecule that is released into the blood by this process is split, with the heme portion undergoing a chemical conversion to bilirubin.

 

Normally, the liver metabolizes and excretes the bilirubin in the form ofbile. However, if there is a disruption in this normal metabolism and/or production of bilirubin, jaundice may result.

 

The color of the skin and sclerae vary depending on the level of bilirubin. When the bilirubin level is mildly elevated, they are yellowish. When the bilirubin level is high, they tend to be brown.

Symptoms

Jaundice is a sign of an underlying disease process. 

 

Common signs and symptoms seen in individuals with jaundice include:

 

  • yellow discoloration of the skin, mucous membranes, and the whites of the eyes,
  • light-colored stools,
  • dark-colored urine,
  • itching of the skin.

 

The underlying disease process may result in additional signs and symptoms.

 

These may include:

 

  • nausea and vomiting,
  • abdominal pain,
  • fever,
  • weakness, 
  • loss of appetite,
  • headache,
  • confusion,
  • swelling of the legs and abdomen,
  • newborn jaundice.

 

In newborns, as the bilirubin level rises, jaundice will typically progress from the head to the trunk, and then to the hands and feet.

 

Additional signs and symptoms that may be seen in the newborn include:

 

  • poor feeding,
  • lethargy,
  • changes in muscle tone,
  • high-pitched crying, and 
  • seizures.

Causes

Bilirubin comes from red blood cells. When red blood cells get old, they are destroyed. Hemoglobin, the iron-containing chemical in red blood cells that carries oxygen, is released from the destroyed red blood cells after the iron it contains is removed. The chemical that remains in the blood after the iron is removed becomes bilirubin.

 

The liver has many functions. One of the liver's functions is to produce and secrete bile into the intestines to help digest dietary fat. Another is to remove toxic chemicals or waste products from the blood, and bilirubin is a waste product.

 

The liver removes bilirubin from the blood. After the bilirubin has entered the liver cells, the cells conjugate (attaching other chemicals, primarily glucuronic acid) to the bilirubin, and then secrete the bilirubin/glucuronic acid complex into bile.

 

The complex that is secreted in bile is called conjugated bilirubin. The conjugated bilirubin is eliminated in the feces. (Bilirubin is what gives feces its brown color.) Conjugated bilirubin is distinguished from the bilirubin that is released from the red blood cells and not yet removed from the blood which is termed unconjugated bilirubin.

 

Jaundice occurs when there is:

 

  1. too much bilirubin being produced for the liver to remove from the blood. For example, patients with hemolytic anemiahave an abnormally rapid rate of destruction of their red blood cells that releases large amounts of bilirubin into the blood,
  2. a defect in the liver that prevents bilirubin from being removed from the blood, converted to bilirubin/glucuronic acid (conjugated) or secreted in bile,
  3. blockage of the bile ducts that decreases the flow of bile and bilirubin from the liver into the intestines. For example, the bile ducts can be blocked by cancers, gallstones, or inflammation of the bile ducts.

 

The decreased conjugation, secretion, or flow of bile that can result in jaundice is referred to as cholestasis: however, cholestasis does not always result in jaundice.

Treatment

Treatment depends on the cause of the underlying condition leading to jaundice and any potential complications related to it. Once a diagnosis is made, treatment can then be directed to address that particular condition, and it may or may not require hospitalization.

 

  • Treatment may consist of expectant management (watchful waiting) at home with rest. 
  • Medical treatment with intravenous fluids, medications, antibiotics, or blood transfusions may be required.
  • If a drug/toxin is the cause, these must be discontinued. 
  • In certain cases of newborn jaundice, exposing the baby to special colored lights (phototherapy) or exchange blood transfusions may be required to decrease elevated bilirubin levels.
  • Surgical treatment may be required.

 

The objectives of home therapy include symptom relief and managing the medical condition causing the underlying jaundice.

 

The various measures that may be undertaken include:

 

  • Maintain adequate hydration by drinking fluids, and rest as needed.
  • Take medications only as instructed and prescribed by a health care practitioner. 
  • Avoid medications, herbs, or supplements which may cause detrimental side effects. Consult a health care practitioner for advice. 
  • Avoid drinking alcohol until the patient has discussed it with their health care practitioner.
  • Certain dietary restrictions may be recommended by a health care practitioner. In certain cases of newborn jaundice, the parents or caregivers can place the baby next to a well lit window a few times a day to decrease elevated bilirubin levels. In more severe cases, a health care practitioner may need to discharge the baby home from the hospital with home phototherapy. 
  • Provide adequate milk intake for the baby in cases of breastfeeding jaundice. 
  • If symptoms worsen or if any new symptoms arise, consult a health care practitioner.

 

Treatment varies based on the medical condition responsible for causing jaundice, and the associated symptoms and complications.

 

Treatments may include the following:

 

  • supportive care,
  • IV fluids in cases of dehydration,
  • medications for nausea/vomiting and pain,
  • antibiotics,
  • antiviral medications,
  • blood transfusions,
  • steroids,
  • chemotherapy/radiation therapy,
  • phototherapy (newborns).
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