Jaundice is a yellow pigmentation of the skin, the conjunctival membranes over the whites of the eyes or other mucous membranes. It is caused by increased levels of bilirubin in the blood.
This hyperbilirubinemia causes increased levels of bilirubin in the fluid outside of the cells as well. Typically, the concentration of bilirubin in in the blood must exceed three times its normal value for the yellowed coloration to be easily visible so, it can be but is not always, a sign of a fairly serious condition.
Jaundice is often seen in liver disease such as hepatitis or liver cancer. It may also indicate obstruction of the biliary tract by gallstones or pancreatic cancer or, less commonly, be congenital in origin.
The whites of the eye are one of the first places to turn yellow as bilirubin levels rise.
Types of Jaundice
When the normal functioning of the metabolism and excretion of bilirubin are interfered with, jaundice may be the result.
Jaundice is classified into three categories, depending on which part of the physiological mechanism the pathology affects. The three categories are:
Pre-hepatic jaundice is caused by anything which causes an increased rate of breakdown of red blood cells. Malaria is an example. also, certain genetic diseases such as sickle cell anemia, spherocytosis, thalassemia and glucose 6-phosphate dehydrogenase deficiency can lead to increased red cell lysis and then hemolytic jaundice.
Diseases of the kidney, such as hemolytic uremic syndrome and defects in bilirubin metabolism also show up as jaundice. Gilbert’s syndrome or Crigler-najjar syndrome are examples.
Hepatocellular (hepatic) jaundice can be caused by acute hepatitis, hepatotoxicity, and liver disease caused by alcoholism. Cell death in the liver reduces it’s ability to metabolize and excrete bilirubin leading to a buildup of unconjugated bilirubin in the blood.
Neonatal Jaundice seen in many newborns, is common because hepatic machinery for the conjugation and excretion of bilirubin does not fully mature until approximately two weeks of age.
Rat fever, Leptospirosis, can also cause hepatic jaundice.
Post-hepatic jaundice, also called obstructive jaundice, is caused by any blockage to the drainage of bile in the biliary system. The most common causes are gallstones in the common bile duct and pancreatic cancer in the head of the pancreas.
A parasite known as the liver fluke can live in the common bile duct causing obstructive jaundice. Other causes include strictures of the common bile duct, biliary atresia, ductal carcinoma, pancreatitis and pancreatic pseudocysts. A rare cause of obstructive jaundice is Mirizzi’s syndrome. No single test can differentiate between various types of jaundice. A combination of liver function tests is usually used to give a diagnosis.
Neonatal jaundice is usually harmless. This condition is often seen in infants around the second day of life, lasting about a week to 2 weeks if the baby was premature. The jaundice is thought to be a consequence of metabolic and physiological adjustments after birth.
In extreme cases, a brain-damaging condition known as kernicterus can occur, leading to significant lifelong disability. Bilirubin count is lowered through bowel movements and urination so regular and proper feedings are especially important. Adequate and extra sunlight or phototherapy light exposure is the normal treatment.
Jaundice itself is not a disease, but rather a sign of one of many possible issues that are occurring at some point along the normal physiological pathway of the metabolism of bilirubin.
Jaundice will probably disappear in about 2 weeks, on average.
For more serious, life threatening cases, especially where the liver is not producing protein, add on:
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