Jaundice: Causes, Signs, and Treatment of a Yellow Warning

Jaundice: Causes, Signs, and Treatment of a Yellow Warning

Question. Write a short note on jaundice.
Or
Write briefly on the signs and symptoms and treatment of jaundice.
Or
Write a short answer on jaundice.

Answer. Jaundice is a condition where there is yellow pigmentation of the skin or sclera due to an excess of bilirubin in the blood.

When levels of bilirubin exceed 2 mg above clinical jaundice becomes apparent.

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Classifiation jaundice

Hemolytic:

• Physiological: Jaundice of prematurity
• Congential: Spherocytosis, sickle cell anemia
• Parasitic destruction of erythocytes—malaria
• Toxins—heavy metals
• Poisons—snake venom
• Drugs—sulfonamides, nitrofurantoin
• Bacterial toxins: Septicemia
• Incompatible blood transfusions—ABO and Rh blood
• group incompatibility
• Extensive burns.

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Obstructive: jaundice

1. Extrahepatic:

• Obstruction within the bile ducts—gallstones, neoplasm, round worm.
• Obstruction due to changes in the wall of the ducts congenital obstruction (biliary atresia), traumatic (following surgery), sclerosing cholangitis.
• Pressure from without: Carcinoma of liver (primary / secondary) gumma, hydatidcyst, enlargedglands in porta hepatis (Hodgkin’s, leukemia, tuberculosis) carcinoma head of pancreas, cancer stomach.

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2. Intrahepatic (obstruction without mechanical cause):

• Drugs like chlorpromazine, antitubercular drugs,methyl testosterone, oral contraceptives.
• Viral hepatitis with prolonged cholestasis.
• Jaundice of pregnancy
• Primary biliary cirrhosis
• Hepatocellular:
  • Viral hepatitis
  • Infectious mononucleosis
  • Yellow fever
  • Bacterial diseases with fever, typhoid
  • Malaria
  • Weil’s disease
  • Chemicals like chloroform, halothane, trinitrotoluene, carbon tetrachloride.
  • Post­necrotic cirrhosis
  • Alcoholic hepatitis
  • Hemochromatosis.

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3. Congenital hyperbilirubinemia

1. Without liver pigment:
   • Gilbert’s disease
   • Crigler-Najjar syndrome.
2. With liver pigment:
   • Dubin-Johnson syndrome
   • Rotor syndrome.

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Symptoms jaundice

• Symptoms of a case of jaundice shall vary with the type of jaundice the patient is suffring from and the underlying condition.
• Most common form of jaundice is due to hepatitis where the patient may start with malaise, low grade fever, vomiting and loss of appetite.
• Person may take his / her morning breakfast normally and as the day passes, appetite for food almost disappears.
• In smokers, urge to smoke is the earliest to go. Yellowness appears fist in the conjunctiva and then the mucous membrane of the lips and palate became pale.
• Urine is high colored while in early stage, the stools may remain of normal color.
• When a person has got features of obstructive jaundice, color of conjunctiva is yellowish green. Stools become clay colored and there is severe degree of itching.
• Pulse becomes slow.
• Patient may suffr from bruises and bleeding from mucous surfaces due to lack of fat soluble vitamin­K.
• If jaundice remains for prolonged periods as in case of malignancy patient suffrs from marked asthenia and wasting.

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Signs jaundice

• Patient may show signs of anemia, malnutrition suggestive of malignancy or cirrhosis.
• In cirrhotics look for spider naevi, white nails, enlargement of parotid glands, testicular atrophy, palmar erythema, gynecomastia, edema over legs and feet, and ascites.
• There may be scratch marks on skin suggestive of cholestasis due to obstructive jaundice, bruising and petechial spots indicating prothrombin deficiency in alcoholic or Laennec’s cirrhosis may be observed.
• Liver may be palpable, smooth and tender in infective hepatitis, hard and nodular in malignancy.
• Gallbladder becomes palpable when obstruction at the level of common bile duct is incomplete. A hard, small nodular gall bladder may be palpated in carcinoma.
• In chronic cholecystitis, gallbladder may be palapable and tender (Murphy’s sign). In addition to looking for signs of disease ingeneral examination, lookspecifiallyinabdomen for ascites, liver, spleen and any lymphadenopathy.
• Rectal examination may be carried out for any primary growth in rectum.

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Treatment jaundice

• Treatment is directed towards the underlying cause:
• Patient should given small feeds of fat free, low protein and high carbohydrate diet which can be easily assimilated.
• Additionally Vitamin B and C are given orally in high dosages.
• In obstructive jaundice, vitamin K should be given 10 mg parentrally.