Jaundice: Causes, Symptoms, Diagnosis, and Management Explained

Jaundice: Causes, Symptoms, Diagnosis, and Management Explained

Question. Describe causes, clinical features, diagnosis, and management of jaundice

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

Causes of jaundice: The causes are based on the type of jaundice:

Hemolytic jaundice:

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In hemolytic jaundice, there is excessive breakdown of RBC due to which bilirubin is produced in excess from hemoglobin. The causes of hemolytic jaundice are:

• Jaundice of prematurity, physiological jaundice
• Defects in the shape of erythrocytes, i.e. spherocytes and sickle cell anemia
• There is parasitic destruction of erythrocyte
• Toxic agents, i.e. metal like lead, poison like snake venom
• Incompatible blood transfusion
• ABO and Rh­incompatibility
• Excessive burns on the body
• Bacterial toxins, septicemia.

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Obstructive jaundice:

In obstructive jaundice, bilirubin conjugation takes place normally in the liver, but it does not reach into the intestine and goes into the bloodstream, the result is a rise in bilirubin level. The causes of obstructive jaundice are:

1. Extrahepatic:
   • Obstruction within the bile ducts: The common cause is gallstone.
   • Obstruction due to change in wall of ducts:
   • Congenital obliteration of ducts during operation procedure, sclerosing cholangitis, etc.
   • Due to pressure on the bile ducts: Pressure on the bile duct occurs in a number of diseases, e.g. carcinoma of the liver, hydatid cyst or fever, etc.
2. Intrahepatic: In it, there is no mechanical obstruction in bile ducts and it is due to the intake of drugs like oral contraceptives, antitubercular drugs, and chlorpromazine.
3. Hepatocellular jaundice: In this liver cells fall to conjugate and excrete all the bile pigments. The causes of hepatocellular jaundice are:
   • Infections like viral hepatitis, yellow fever, malaria, typhoid, etc.
   • Chemical poisons like chloroform, halothane, CCl₄, etc.
   • Alcoholic hepatitis, postnecrotic cirrhosis, etc.

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Symptoms jaundice

• Symptoms of a case of jaundice shall vary with the type of jaundice the patient is suffering from and the underlying condition.
• The commonest form of jaundice is due to hepatitis where the patient may start with malaise, low-grade fever, vomiting, and loss of appetite.
• A person may take his / her morning breakfast normally and as the day passes, appetite for food almost disappears.
• In smokers, the 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 highly colored while in the 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 vitamin K.
• 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 rothrombin 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 gallbladder 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 in general examination, look specifially in abdomen for ascites, liver, spleen and any lymphadenopathy.
• Rectal examination may be carried out for any primary growth in rectum.

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Diagnosis jaundice

Biochemical test: jaundice

• White cell count: Leukopenia is present in the hepatocellular jaundice. Eosinophilia is present in drug hepatitis.
• Urine: Urobilinogen is absent in the obstructive jaundice and is in excess in hemolytic jaundice.
• Bilirubin is in excess in urine in obstructive jaundice.
• Liver function test: Serum bilirubin estimation is done to asses level of jaundice. The flcculation test is positive for hepatocellular and is negative for hemolytic and obstructive jaundice. Serum albumin levels are low and globulin levels are high in chronic hepatocellular jaundice.
• Hematology: In hemolytic jaundice blood fim shows immature cells and spherocytosis, erythrocyte fragility is increased and Coombs test is positive.

Radiology: jaundice

• Imaging of liver by ultrasound technique should be initial technique for all the jaundiced patients.
• Imaging of liver through CT scan is done. The dilated bile ducts are seen during obstructive jaundice while imaging through CT scan.

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Aspiration needle biopsy of liver: 

• It is done cautiously in jaundice. Menghini needle is used. The histological appearance of hemolytic,hepatocellular and obstructive jaundice is distinctive.

Management jaundice

• Treatment is directed towards the underlying cause Patient should be 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.