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Jaundice and its Types

Updated on April 12, 2017

Jaundice or yellowish discoloration of skin should never be ignored as a nominal symptom. It is not a disease, disorder or syndrome but a manifestation of some underlying pathology of the liver , gall bladder or cystic duct.It may turn out to be fatal at times if not treated early.

SO SPREAD AWARENESS , STAY WELL, KEEP WELL.

What is JAUNDICE?


Jaundice is defined as a yellowish discoloration of the skin, mucous membranes and sclera due to hyperbilirubinemia and deposition of bile pigments.

Normal bilirubin level: 0.3 – 1.2 mg/dl

Jaundice- When normal bilirubin level is between 2-2.5 mg/dl. In severe cases , the level reaches to 30-40mg/dl.

Yellowish discoloration of the skin, mucous membrane and sclera

Signs and Symptoms

  • Yellowish discoloration of the skin , mucous membrane.
  • Yellowish discoloration of the whites of the eyes.
  • Pale colored stool
  • Dark colored urine.
  • abdominal pain
  • fever
  • nausea and vomiting
  • loss of appetite
  • swelling of legs


Mechanism of jaundice

1)Unconjugated hyperbilirubinemia


  • Excessive extrahepatic production of bilirubin
  • Decreased hepatic uptake
  • Impaired conjugation

2)Conjugated hyperbilrubinamia


  • Decreased hepatocellular excretion
  • Impaired bile flow


Difference between conjugated and unconjugated bilrubin

  • Unconjugated bilirubin is insoluble in water and present in circulation tightly bound to albumin. Hence not excreted in urine even when it is present in excess in serum.
  • Conjugated bilirubin is water-soluble and loosely bound to albumin. Hence is is non-toxic and is excreted in urine when in excess in serum.

JAUNDICE causes and signs

Types of Jaundice

Based on underlying cause-

  • predominantly unconjugated hyperbilirubinemia.
  • predominantly conjugated hyperbilirubinemia.

Based on pathological mechanism-

  • haemolytic jaundice.
  • obstructive jaundice.
  • hepatocellular jaundice.


PRE-HEPATIC JAUNDICE-

  • Excessive amount of bilirubin .
  • Elevated unconjugated bilirubin in serum.


HEPATIC JAUNDICE-

  • Impaired hepatic uptake
  • Defective conjugation of bilirubin with albumin.
  • Abnormal secretion of bilirubin.
  • Both conjugated and unconjugated bilirubin is raised in serum commonly.


POST-HEPATIC JAUNDICE-

  • Impaired excretion due to obstruction of the bile flow due to gall stone or carcinoma head of pancreas( obstructive jaundice)
  • Conjugated bilirubin has increased levels in serum.

Types of Jaundice

ENTITY
PRE-HEPATIC
HEAPTIC
POST- HEPATIC
Urine color
normal
dark due to urobilinogen
dark due to urobilinogen
stool color
dark colored due to stercobilinogen
normal
pale or clay -colored
serum bilirubin
indirect negetive
biphasic due to presence of both conjugate and unconjugated bilirubin
direct positive
The table helps to diagnose the types of jaundice based on color of stool or urine.

Types of jaundice

Neonatal Jaundice/ physiologic jaundice of the newborn


It occurs when the IgG antibodies against the fetus passes from mother to fetus.


Two types- Rh incompatibility and ABO incompatibility.

Rh haemolytic disease of the new born

Occurs when mother is Rh negative and fetus is Rh positive. Sensitization occurs by fetal Rh positive RBCs when the mother develops anti- Rh antibodies. Sensitization occurs during delivery or during miscarriage. Hence the first pregnancy is not affected. In the second pregnancy, the anti-Rh antibodies coat the Rh positive RBCs and cause haemolysis and jaundice. Fetus may develop cardiac failure (hydrops fetal)

Clinical features-

  • Jaundice
  • The unconjugated bilirubin crosses the blood brain barrier
  • It gets deposited in the basal ganglia and cerebellum and causes neurologic problem called kernicterus. It may even cause death.



ABO heamolytic disease of the new born


  • It occurs when mother is of O blood group and fetus is of either A or B blood group. Haemolysis occurs in the first pregnancy.

Phototherapy is used for the treatment of neonatal jaundice

Obstuctive Jaundice

Obstructive jaundice is caused when there is obstruction the the bile duct . It may be caused by gall stones, carcinoma head of pancreas.

It has high mortality rates and is a serious condition.Its treatment is surgical and it should be detected early enough to continue treatment.

ERCP helps in diagnosis of obstructive jaundice.

Obstructive jaundice

HISTORY- onset , symptoms(whether there is dark urine, pale colored stool, weight loss) , intake of mushrooms, drug allergies, family history


CLINICAL EXAMINATION-

  1. pallor
  2. icterus
  3. edema
  4. abdominal pain checking


BLOOD TESTS- routine examination (haemoglobin %, total count , differential count. erythrocyte sedimentation rate, peripheral blood smear)


LIVER FUNCTION TESTS-

  • serum bilirubin
  • ALT
  • AST
  • GGT


SPECIAL TEST- coombs test, viral antigens


CT SCAN. MRI

URINE ROUTINE EXAMINATION AND STOOL ROUTINE EXAMINATION

BIOPSY.

How to See Icterus

TREATMENT

  1. Treatment depends on the underlying cause
  2. May involve the removal of the stone if the gall stone is obstructing the bile duct and causing jaundice. If is it due to carcinoma head of pancreas , it should be first diagnosed and the surgically removed under favourable conditions to relieve the patient from jaundice.
  3. Administration of anti-microbial drugs .
  4. Administration of drugs like phenobarbital orally.
  5. Intravenous injection of albumin to be given.
  6. Photo-therapy, exchange transfusion in neonatal jaundice.
  7. Dietary changes like eating food with low amount of saturated oils, spices, fatty food and having more of fruits.

Natural Treatment

Best home remedies for preventing jaundice

  1. Tomato juice- One glass of tomato juice to be taken early in the morning.
  2. Radish leaves- it induces appetite and regulates bowel movements.
  3. Papaya leaves- one table spoon of honey is added to papaya leaves and made a paste.
  4. Sugarcane- juice of sugarcane helps in early recovery from jaundice.
  5. Basil leaves- add basil leaves to vegetable soup (the main vegetable being radish).
  6. Gooseberry- rich in vitamin C.
  7. Lemon- it unblocks the bile duct and is very helpful in early stages of obstructive jaundice.
  8. Beetroot- very helpful in jaundice. Best when added to soup.
  9. Banana- To be taken daily.
  10. Carrot juice- Drink thrice a day for best results.

Home REMEDIES for jaundice for faster recovery

carrot juice is helpful in curing jaundice.
carrot juice is helpful in curing jaundice.
Gooseberry acts a good anti- oxidant, which destroy harmful free radicals which may further aggravate your liver. Drink gooseberry juice everyday.
Gooseberry acts a good anti- oxidant, which destroy harmful free radicals which may further aggravate your liver. Drink gooseberry juice everyday.

- Debangee Mandal ( Medical student studying ant College of Medicine and Sagore Dutta Hospital, INDIA.

Have you ever suffered from jaundice?

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