The condition known as jaundice makes the skin and whites of the eyes yellow. It happens when the blood's bilirubin, a yellow pigment, builds up. When hemoglobin is decomposed, bilirubin is created, which interacts with bile in the liver and travels into the digestive tract before being primarily excreted in feces. Jaundice develops when bilirubin builds up in the blood and accumulates in the skin, eyes, and other tissues because the liver and bile ducts are unable to transport it quickly enough. Newborns frequently have jaundice, which typically goes away on its own. However, occasionally, jaundice can become severe and raise more serious issues. Adults may also experience it as a result of a specific illness.

Introduction on jaundice-

Jaundice is a condition in which skin, white of the eye, and mucus membrane turns yellow because of a high level of bilirubin, a yellow orange bile pigment. The body fluids may also change color. It indicates a problem with the liver or bile ducts. Waste products like bilirubin can accumulate in blood when the liver is not functioning properly. Jaundice can progress and turn green instead of yellow. Biliverdin, a green pigment found in bile, is what gives this color its green hue. While jaundice can affect people of any age, it is more common in babies and older persons.

Jaundice causes –

When bilirubin levels rise, red blood cells spontaneously degrade. This blood waste is filtered by the liver into a new form called conjugated bilirubin, which is eliminated in feces. Hyperbilirubinemia is the term for when the body accumulates too much bilirubin for the liver to handle. Other factors that might contribute to jaundice include drug interactions, gallstone disease, binge drinking, pancreatic or gallbladder malignancy, cirrhosis, hepatitis, and hemolytic anemia. Autoimmune diseases and hereditary metabolic abnormalities are other uncommon causes.

 

Jaundice symptoms-

Yellow tinge of skin, mucus membrane, white of eye, pale stools, dark urine, itchiness, pruritus etc. In infants, these symptoms start from the head like a yellow tinge and spread to the body and toes. Accompanying symptoms of jaundice include fatigue, abdominal pain, weight loss, fever, and vomiting. 

Types of jaundice-

• Pre-hepatic in which liver processes the waste and results in higher levels of unconjugated bilirubin levels
• Hepatic in which both higher levels of conjugated and unconjugated levels of bilirubin levels are there
• Post-hepatic in which liver processes waste resulting in higher levels of conjugated bilirubin levels 
• Jaundice in newborns which appears after 48 hours of birth in about 60 % of newborns. When a newborn baby is 3-5 days old, the levels of bilirubin are highest in his blood. Livers of infants are less developed so less effective filtering of bilirubin takes place from their body. In mild cases, symptoms resolve without taking treatment but in severe cases, blood transfusion and phototherapy is essential treatment. It’s important to treat newborn jaundice so that it does not develop into kernicterus. 

 

Jaundice causes in newborns include rhesus disease, blood group incompatibility, urinary tract infection, underactive thyroid gland, a syndrome called crigler-najjar syndrome, blockage of bile ducts or gall bladder etc.

Kernicterus – 

A complication that occurs as a rare type of brain damage in infants due to toxic levels of bilirubin in the blood of infants. This term Kernicterus was given by a scientist called Schmorl.

Types of neonatal jaundice-

PHYSIOLOGICAL JAUNDICE	PATHOLOGICAL JAUNDICE
Appears after 24 hours	Appears after 24 hours of age
Resolves without treatment	Needs treatment
Clinically not detectable after 14 days	Persist after 14 days and detected as white or clay colored stools, urine stains yellow

 

Bilirubin levels-

A person has jaundice if the level of bilirubin is 3 mg/dl. In infants, jaundice is diagnosed if bilirubin levels reach 5 mg/dl per day.

Diagnosis and jaundice tests-

First step by the doctor is to take the patient's history and do a physical examination. After this, if the doctor has doubt then asks for lab tests. Physical examination of abdomen, liver and skin is done. Jaundice tests include-

• Bilirubin tests where doctors compare bilirubin form levels. If a higher level of unconjugated bilirubin level is found then it confirms to the doctor that the patient has hemolytic jaundice.
• Complete blood count to note levels of red blood cells, white blood cells and platelets
• Hepatitis A, B, C tests to confirm range of liver infections.
• Imaging tests such as MRI, CT, x-Ray imaging is used to examine the structure of the liver if any obstruction is seen or not.
• A combined procedure involving endoscopy and x-Ray imaging is also done.
• Liver biopsy is done to check inflammation, cancer, cirrhosis, fatty liver. 
• Urine analysis is also done.
• Signs of liver disease are checked by bruising of skin, spider angiomas, palmar erythemas, size and tenderness of liver are also noted.

Treatment-

Treatment will depend on the underlying cause rather than the symptoms.

The following treatments are used:

 

• Anemia-induced jaundice may be treated by boosting iron in the blood by consuming iron supplements or iron-rich foods. 
• Hepatitis-induced jaundice requires steroids or antiviral medications.
• Obstruction-induced jaundice can be treated by surgery.
• For medication-induced jaundice, one needs to change to an alternative medication.

Side effects of jaundice treatment-

Constipation, bloating, stomach pain, gas, stomach upset, vomiting and diarrhea etc. 

Prevention of jaundice-

• Avoid hepatitis infection
• Get immunized
• Consume less alcohol
• Maintain healthy weight
• Manage cholesterol 
• Maintain healthy diet
• Exercise regularly
• Take medications carefully 

Fact Check-

Frequency: Jaundice is a major public health problem in India, with an annual incidence of 2.76 per 1000 people.

PGC Resolution: Building knowledge, developing attitudes, and spreading awareness with practices concerning jaundice in the country.