Jaundice is the symptom of yellowish discoloration of the skin, mucous membrane and sclera due to accumulation of bile pigments in tissues associated with the increase in serum bilirubin level.Bilirubin is the breakdown product of hemoglobin during the end of life span of a red blood cells.The types of bilirubin are:1. unconjugated bilirubin which is toxic, fat soluble and cannot be excreted by the kidneys2. conjugated bilirubin which the hepatocytes in the liver has conjugated the unconjugated bilirubin and excretes in the bile.Conjugated bilirubin is water soluble and in high levels is also excreted in the urine as dark tea colored urine.What are the causes of Jaundice?The causes of jaundice are:1. Hemolytic anemia is due to the break up of red blood cellsHere the major form of bile pigment is unconjugated2. Hepatocellular or liver causes:a. Acute:1. viral hepatitis A to F,2. alcoholism,3. toxic chemical hepatitis including drugs and4. bacterial infections such as leptospirosis.More of conjugated bilirubin at early stages followed by unconjugated bilirubin.b. Chronic liver cirrhosis - mostly unconjugated bilirubin3. Obstructive jaundice: mainly conjugated bilirubin accumulatesa.Intrahepatic cholestasis due to drug sensitivityb. Extra hepatic gallstones, carcinoma of biliary systems or adjacent organs.What are the effects of Jaundice?The effects of jaundice:1. yellowing of the skin and white of eye and mucous membranes like inside of the lips2. liver enlargement and palpable gallbladder in blockage3. enlarged spleen especially in hemolytic anemia4. dark colored urine due to presence of bilirubin in the urine5. pale stools6. prolonged tiredness from anemia, loss of blood,7. encephalopathy from bilirubin affecting the brain8. nausea and vomiting.9. poor appetiteDiagnosis of causes:1. Hemolytic anemiaa. bilirubin raisedb. liver function tests normalc. urine and stools may be normal except for excess urobilinogend. blood hemorrhage tests for hemolytic anemia2. Hepatocellulara. liver function test normal except for increased liver enzymes, proteins normal but alkaline phosphates may be raisedb. tests for infections such as hepatitis, mononucleosis, and cytomegalovirusc. antinuclear antibody3. Obstructive:a. liver function tests-conjugated bilirubin raised, liver enzymes raised, alkaline phosphatase raisedb. previous attacks of jaundicec. biliary colicOther tests include:1. Utrasound of liver and gallbladder2. cholecytograms3. cholangiography4. MRI of liver and abdomen5. liver biopsyWhat is the treatment for Jaundice?Treatment usually includes:1. supportive treatment likea. restb. adequate fluids2. adequate nutrition and vitamin B3. treatment depends on the cause:a. blood transfusion or platelet transfusion for hemolytic anemiab. treatment of infectionsc. surgery for obstructive lesionsPrognosis:depends on the underlying cause.Prevention:1. Avoid seafood especially cockleshells which may cause hepatitis A2. Avoid casual sex which can spread hepatitis B and C3. Avoid reusage of syringes in drug addicts to prevent Hepatitis C and AIDS4. Avoid medicine which can cause obstructive jaundice.TABLE OF CONTENTChapter 1 JaundiceChapter 2 HepatitisChapter 3 Hepatitis AChapter 4 Hepatitis BChapter 5 Hepatitis CChapter 6 Liver CirrhosisChapter 7 Liver CancerEpilogue
