Jaundice is the condition that causes the yellowing of the skin and the whites of the eyes. This develops as the result of the accumulation of bilirubin in the blood and the tissues of the body. Normally, bilirubin develops from the breakdown of red blood cells which is transported to the liver for further metabolism and exits the body. Jaundice occurs when the normal metabolism and the excretion of the bilirubin are disrupted. It can be caused by various conditions that affect the transport of the bilirubin. Depending on the stage of this metabolic disruption, the jaundice is divided as pre-hepatic jaundice, intra-hepatic jaundice and post-hepatic jaundice.
Pre-hepatic jaundice
This develops when various conditions or infections increases the rate of red blood cells metabolism which causes the increase in the level of bilirubin resulting in jaundice. This can be caused by various conditions such as malaria, crigler-najjar syndrome, sickle cells anemia and hereditary spherocytosis.
Intra-hepatic jaundice
This occurs when certain problems in the liver affect its ability to metabolize bilirubin. Some of the causes of this include alcoholic liver disease, glandular fever, leptospirosis, viral hepatitis, liver cancer and gilbert’s syndrome
Post-hepatic jaundice
This occurs when the bile ducts are damaged or obstructed resulting in the gallbladder unable to transport the bile into the digestive system. Some of the causes of this can include gallbladder cancer, bile duct cancer, pancreatitis and gallstones.
Symptoms
The severity of the symptoms depends on the causes and the progression of the disease. Some of the common signs of jaundice include the yellowing of the skin, the whites of the eyes and the inside of the body parts such as the mouth. Additional symptoms can also include pale-colored stools, dark-colored urine, flu-like symptoms, fever, chills and abdominal pain.
Diagnosis
The diagnosis is based on the evaluation of the signs of liver disease and with the medical history of the individual. A positive result for bilirubin in the urinalysis is an indication of conjugated jaundice. This can be confirmed by the serum testing that can include complete blood count and bilirubin levels. The liver function tests can look for liver conditions such as cirrhosis, hepatitis and alcoholic liver disease. When the intra-hepatic and post-hepatic jaundice is suspected, various imaging tests may be necessary to identify the presence of abnormalities in the liver of the bile duct system. This can include ultrasound, magnetic resonance imaging (MRI) scan, computerized tomography (CT) scan and endoscopic retrograde cholangiopancreatography (ERCP). In some of the cases, a live biopsy may be required to determine conditions such as liver cancer or cirrhosis.
Treatment
The treatment of jaundice is based on the underlying cause. If pre-hepatic jaundice is caused by an infection such as malaria, the underlying infection is treated with medications. The treatment of intra-hepatic jaundice focuses in the prevention of further liver damage by treating the infection such as viral hepatitis with anti-viral medications. In the case of post-hepatic jaundice, this can be treated with surgery to unblock the bile-duct system.
References
http://www.nhs.uk/Conditions/Jaundice/Pages/Treatment.aspx
http://my.clevelandclinic.org/health/articles/adult-jaundice-hyperbilirubinemia
