Jaundice: Types, Causes, Symptoms Diagnosis and Treatment

Definition: is the yellowish appearance of the skin and the sclera of the eyes.

It occurs when the blood contains an excess of pigment called bilirubin.

Bilirubin is a natural product derived from the normal breakdown of red blood cells in the body and is excreted in the bile, through the actions of the liver.

Although jaundice is most often the result of a disorder that affects the liver, it can be caused by a variety of other conditions that affect, for example, the blood or spleen.

It must be thoroughly investigated, so the underlying cause can be identified and treated.

 

Symptoms and signs

Yellowing of the skin, eyes and lining of the inside of body parts, such as the mouth and nose (mucous membrane).

  • Stool pale.
  • Dark colored urine.

Types of jaundice

There are three types of jaundice, depending on what is interrupting the normal elimination of bilirubin from the body. These are:

Pre-hepatic jaundice – the breakdown occurs before bilirubin has been transported from the blood to the liver; is caused by conditions such as sickle cell anemia and hemolytic anemia

Intra-hepatic jaundice (also known as hepatocellular or hepatic jaundice) – the breakdown occurs within the liver; is caused by conditions such as Gilbert’s syndrome, cirrhosis or other liver damage

Post-hepatic jaundice (also known as obstructive jaundice) – prevents the breakdown of bile (and bilirubin inside it) and drains it out of the gallbladder and into the digestive system; is caused by conditions such as gallstones or tumors

Who is at risk?

Intra-hepatic and post-hepatic jaundice is more common in middle-aged and elderly people than in young people.

Pre-hepatic jaundice can affect people of all ages, including children.

Certain changes in lifestyle can help prevent jaundice. For example, maintain a healthy weight, do not drink alcohol excessively, and minimize the risk of hepatitis.

How is it diagnosed?

If you have jaundice, you will have a series of initial tests to find out how severe it is and determine the underlying cause.

Clinical history and examination

It is likely that your trusted doctor or hospital doctor will take the detailed medical history to try to determine why you have jaundice.

Urine test

A urinalysis can be used to measure the levels of a substance called urobilinogen. It occurs when bacteria break down bilirubin inside the digestive system.

Higher-than-expected levels of urobilinogen in the urine may suggest pre-hepatic jaundice or intra-hepatic jaundice. Lower levels may suggest post-hepatic jaundice.

Liver function and blood tests

A liver function test is a type of blood test to help diagnose certain liver diseases including: hepatitis, cirrhosis, and alcoholic liver disease.

Image tests

If intra-hepatic or post-hepatic jaundice is suspected, imaging tests can be used to detect abnormalities within the bile duct systems of the liver.

These include: ultrasound scanning, computed tomography (CT), magnetic resonance imaging (MRI) and endoscopic retrograde cholangiopancreatography (ERCP).

Liver biopsy

A biopsy can be recommended to assess the state of liver tissue to establish whether it may have been damaged by a disease such as cirrhosis or liver cancer.

During a liver biopsy, your abdomen is numbed with a local anesthetic, and a thin needle is inserted so that a small sample of the liver cells is removed and sent to a laboratory for analysis under a microscope.

Treatment of jaundice

Pre-hepatic jaundice

In the treatment of pre-hepatic jaundice, the goal is to prevent the rapid breakdown of red blood cells that are causing bilirubin levels to accumulate in the blood.

In cases where pre-hepatic jaundice has been caused by an infection, such as malaria, medications are usually recommended to treat the underlying infection.

For genetic blood disorders, such as sickle cell anemia or thalassemia, blood transfusions may be necessary to replace red blood cells.

Gilbert’s syndrome usually does not require treatment because the jaundice associated with it is not particularly serious and does not pose a serious threat to health.

Intrahepatic jaundice

In cases of intra-hepatic jaundice, little can be done to repair any damage to the liver, although the liver can often repair itself over time. The goal of treatment is to prevent further damage to the liver.

For liver damage caused by the infection, such as viral hepatitis or glandular fever, antiviral medications can be used to help prevent further damage.

If the damage is caused by alcohol or exposure to harmful substances, reducing alcohol consumption or avoiding greater exposure to the substance.

In severe cases of liver disease, a liver transplant is another possible option. However, only a small number of people are good candidates for a transplant and the availability of donated livers is limited.

Post-hepatic jaundice

In most cases of post-hepatic jaundice, surgery is recommended to unblock the bile duct system.

During surgery, it may also be necessary to remove:

  • Gallbladder.
  • A section of the bile duct system.
  • A section of the pancreas to prevent new blockages from occurring.