Jaundice

Jaundice otherwise called icterus, which may occurs due to high bilirubin level in blood. The slides here explains the epidemiology, metabolism of bilirubin, types of jaundice, their etiology, risk factors involved, symptoms diagnosis and treatment.

1. JAUNDICE JAUNDICE IS ALSO KNOWN AS ICTERUS .

2. JAUNDICE Jaundice is characterized by the yellowish or greenish pigmentation of the skin and whites of the eyes due to high bilirubin level. Normal levels of bilirubin in blood are below 1.0mg/dl, while levels over 2-3mg/dl typically results in jaundice. Jaundice is not a disease, but rather a sign that can occur in many different diseases.

3. EPIDEMIOLOGY The incidence of jaundice is approximately 40,000 per 100,000 individuals of intensive care unit patients. The prevalence of jaundice in adults is rare, while jaundice in babies is common, with an estimated 80% affected during their first week of life.

4. Depending upon gender, Male are more commonly affected by hepatocellular jaundice and liver cancer than female. While, Female are more commonly affected by hemolytic jaundice. Depending upon age, Hepatocellular jaundice, particularly from viral hepatitis, commonly affects young patients Cholestatic jaundice, particularly from liver cancer, hepatitis, and liver cirrhosis, commonly affects older patients

5. METABOLISM OF BILIRUBIN

6. TYPES OF JAUNDICE

7. Pre-hepatic jaundice – Here, the bilirubin level is disrupted prior to transportation of blood to the liver. Examples of conditions that cause this type of jaundice are hemolytic anemia and sickle cell disease . Hepatocellular jaundice – Here, the disrupted bilirubin is caused by disease in the liver and examples of conditions that cause this include liver cirrhosis and Gilbert’s syndrome . Post-hepatic jaundice or obstructive jaundice – Here, bile and therefore the bilirubin contained inside, is obstructed and prevented from draining into the digestive system from the gallbladder. Examples of factors that may cause this are tumors and gallstones

8. Infant Jaundice There is also infant jaundice which usually occurs in preterm babies. Infant jaundice occurs due to the fact that the baby’s liver is not mature enough to quickly remove bilirubin from the system, causing an excess of bilirubin .

9. AETIOLOGY

10. RISK FACTORS Some of the common risk factors for contracting jaundice are : Cholestasis- This is a condition that can disrupt bile flow coming from the liver. The conjugated bilirubin contained in bile stays behind in the liver without being taken out . Gilbert’s Syndrome- This form of the condition is inherited which can lead to an impaired enzyme ability to continue the bile’s excretion process . Hemolytic Anemia- Bilirubin production can increase when increased levels of blood cells (red) go through a breakdown process .

11. Bile Duct Obstruction- This kind of condition can contribute to the liver being prevented from excreting bilirubin Bile duct inflammation- This can have the bile removal and secretion prevented resulting in jaundice . Acute liver inflammation- This can lead to the impairment of the liver in the conjugation and secretion of bilirubin which can lead to waste accumulation.

12. DIAGNOSIS A blood test is usually performed to confirm the diagnosis of jaundice, which includes, bilirubin tests, full blood count of red blood cells, white blood cells, and platelets, and Hepatitis A, B, and C tests. The doctor will enquire about your personal medical history, and do a physical exam to feel for tumours in your abdomen, or check the firmness of your liver. A firm liver indicates liver cirrhosis and a hard liver indicates liver cancer.

13. However, tests are usually needed to confirm an exact diagnosis: Various blood tests are usually done: These will show whether the raised level of bilirubin is unconjugated or conjugated . This can help to narrow down the possible causes of jaundice . Blood tests, called liver function tests, can also measure various liver enzymes which help to show if the liver is inflamed or working well . Blood tests can also detect certain viruses or markers of other infections that can affect the liver . Urine tests may help to show if the levels of various chemicals in the blood are raised. This can help to narrow down the possible causes of jaundice . An ultrasound scan of the liver, common bile duct and pancreas may identify a cause. In particular, it can often identify the cause of any blockage to the common bile duct. For example, a gallstone or cancer of the pancreas . A magnetic resonance imaging (MRI) scan of the liver may be useful . A liver biopsy Other more complex tests may be needed if the diagnosis is still in doubt.

14. TREATMENT The medical treatment of jaundice targets the specific cause, rather than the jaundice itself. For example: Hepatocellular jaundice is treated with anti-viral medications and steroids Hemolytic jaundice is treated with iron supplements Obstructive jaundice is treated with surgery to remove the obstruction followed by medication

15. There is also medication induced jaundice, in other words, jaundice which occurs as a side effect to consuming certain medicines. In such cases the medicines are discontinued and alternative medicines are prescribed. For infants with jaundice the treatments include: Phototherapy Blood transfusion

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