Jaundice or icterus is a disease in which the bilirubin count in the blood increases (often referred as hyperbilirubinemia) causing yellowish pigmentation of the skin, whites of the eyes (sclerae) and other mucous membranes.

The hyperbilirubinemia consequently leads to the rise of bilirubin in the extracellular fluid also. The change in color depends upon the level of bilirubin. If the level of bilirubin is slightly increased then the color of skin and sclerae changes to yellow and if it is highly raised then the color changes to brown. The name jaundice has come from French word jaune which means yellow.

Bilirubin is a yellow pigment present in bile. It is a by-product formed during the natural breakdown of red blood cells which takes place daily. A small amount of old red blood cells are removed and replaced with new blood cells. The liver helps in the excretion of the bilirubin in the form of bile. Any disruption in this normal formation of bilirubin results into jaundice. The stool obtains brown color because of the bilirubin present in it. People who eat more carrots or beta-carotene tablets exhibit yellow color in the skin which is called carotenemia. They should not get confused and presume it as jaundice because in this case, the whites of the eyes do not change their color to yellow as in jaundice.

Causes of Jaundice:

• Hepatocellular or Hepatic jaundice occurs due to injury or liver disease. The liver is unable to metabolize and as a result, the bilirubin remains in the liver itself. It can be due to drugs, toxins, cirrhosis, hepatitis, Gilbert's syndrome or cancer.
• Pre-hepatic jaundice is caused due to the rapid breakdown and destruction of red blood cells which makes the liver unable to remove bilirubin from the blood. It can happen in thalassemia, malaria, spherocytosis and other autoimmune disorders.
• Post-hepatic or Obstructive jaundice occurs due to the obstruction in the bile duct. Bile is formed in the liver and is carried to the gallbladder and small intestine through this bile duct.Any blockage in the bile duct does not allow the bilirubin to leave the liver.
• Cholestasis in which the bile with conjugated bilirubin gets interrupted and it remains in the liver itself.
• Inflammation of liver.
• Swelling in the bile duct.

Symptoms of Jaundice:

• Yellowing of the white part of the eyes (sclera)
• Yellowish tinge in the skin
• Itchiness in the skin
• Fatigue
• Weight loss
• Diarrhea
• Pain in stomach due to blockage in bile duct
• Vomiting and nausea
• Fever
• Loss of appetite
• Stools are waterier and pale-colored than usual
• Urine color changes to dark
• Bleeding in rectum
• Headache
• Mucous membranes in the mouth and nose turns yellow

Risk factors of Jaundice:

In new-born babies:

Most of the babies develop jaundice after birth but new-borns with certain risk factors have more risk of suffering from neonatal jaundice.

These may include:

• Premature birth
• New-borns with poor feeding
• Mother having diabetes
• Blood group mismatch
• New-borns with bruising
• Genetic infection
• Siblings with history of neonatal jaundice
• Parents of East Asian or Mediterranean origin

In adults:

The risk factors for developing jaundice in adults depend upon the primary cause:

• People with hereditary conditions like thalassemia or hereditary
• People with alcohol addiction can develop alcoholic hepatitis, pancreatitis, and cirrhosis which can lead to jaundice.
• People who are exposed to viral hepatitis like hepatitis B and hepatitis C.

Diagnosis of Jaundice:

The yellow color of the skin is the main clue for the early diagnosis of jaundice. The doctors may further enquire about any intake or illegal drug or toxins. The urine test is done for urobilinogen which is the by-product of bilirubin breakdown. Blood is tested to diagnose other complications like malaria, cirrhosis or hepatitis. Physical examination is done to detect swelling on the liver and other body parts such as legs, ankles, and feet. In few cases, a liver biopsy is recommended in which a small tissue sample is taken to detect cirrhosis or liver cancer. Doctors can also recommend for an ultrasound and MRI, X-ray or CT scans to have a detailed look of the liver or bile duct.

Treatments for Jaundice:

Treatment of jaundice depends upon the complications and causes related to it. After the diagnosis, treatment is directed to cure the particular problem. Hospitalization is not always required. Effective treatment can be given at home also but you need to be vigilant regarding the health of a patient.

Sometimes the patient needs intravenous fluids in case of less intake. Medications and antibiotics are required for curing vomiting and nausea. In few cases, blood transfusions may be required. Drug or toxin must be discontinued if it is the cause of jaundice. Surgery may be needed in extreme cases.

The follow-up sessions depend upon the cause of patient's jaundice. The patient may require only a short-term follow-up or lifelong supervision by the doctor. The patient should not hesitate to discuss any complications regarding health with his/her health practitioner and seek treatment if the symptoms of jaundice persist.

Jaundice in different cases:

Jaundice in pregnancy is rare but can pose serious problems for the mother and baby. Around 3-5% of pregnant women show abnormal liver function signs.

The Causes of jaundice in pregnancy include:

• Intrahepatic cholestasis in women during pregnancy.
• Hyperemesis gravidarum.
• Gilbert's syndrome in which the enzymes are unable in processing the excretion of bile.
• Pre-eclampsia related to HELLP syndrome (Haemolysis Elevated Liver enzymes and Low Platelet count).
• Acute fatty liver of pregnancy.

Symptoms:

• Itching particularly increases in evening and does not respond to anti-itch remedies.
• Darker urine
• Increased clotting time
• Fatigue
• Light stools
• nausea
• loss of appetite

Doctors may prescribe Ursodeoxycholic Acid for a cure. For blood clotting function Vitamin K can help for avoiding hemorrhage at the time of delivery. If not treated on time, can cause complications during childbirth like premature labor or stillbirth.

Jaundice in newborn babies

New-born or Neonatal jaundice occurs in babies with a high level of bilirubin. It is seen in infants after the second day of birth. It lasts for about 1 week in case of normal delivery and for about 2 weeks in case of premature delivery of babies. The newborn baby's liver is not fully developed to remove the waste product bilirubin which leads to increase in its level. It is usually harmless and goes away in 2 to 3 weeks in most of the cases as the liver starts developing. But if it is persistent for longer weeks then it can lead to a risk of other complications like deafness, brain damage or cerebral palsy.

Babies who are at higher risk for developing new-born jaundice can be premature babies, babies deprived of enough breast milk or babies whose blood group are different from that of their mothers. Other causes include infection, internal bleeding, liver damage or any other abnormality in baby's blood

A Bili light treatment is used for initial treatment of new-born jaundice. The baby is exposed to intensive photo therapy. In this therapy blue light of about 420 - 470 nm is used which converts bilirubin that is further excreted through urination and faces. For this treatment effective feedings are essential. The eyes of the baby are protected from damage by soft eye shields. Sunbathing is another way to treat newborn jaundice as the early morning sun rays have ultraviolet B which helps in vitamin D formation.

Diet for jaundice:

Jaundice can be cured rapidly by opting diet therapy and simple exercises. Recovery depends on the severity of the disease. Rest is advised until the patient gets cured completely. The patient should consume many fresh fruits and vegetables. For the initial one week, the patient is advised to take only juices made of any of the fruits like oranges, grapes, lemons, pears, raw apples, beets, sugarcane, and carrots. Regular bowel elimination is essential so hot water enema is recommended generally.

Food containing too much of fats like oil, butter, cream, and ghee should be avoided during jaundice. A weak liver cannot digest oily food. Detoxification of liver is needed during this period so detox foods are a must in your diet. After 2 weeks a small quantity of butter and olive oil can be added to your diet. Barley water is a good cure for jaundice and if consumed several times in a day gives best results. You can make it by adding one cup of barley to six pints of water then boil it for about 3 hours. Pulses and legumes can cause a digestive disturbance in the lower intestine so they should be avoided. Drink lot of lemon water to protect the liver cells from additional loss. The patient should be exposed to fresh air and sunshine for fast recovery.

Jaundice can be prevented if some preventive measures are followed:

• Vaccines for hepatitis A and B are available
• Stop alcohol addiction
• Before traveling to regions with high risk of malaria take medications
• Avoid use of intravenous drug use and have safe intercourse.
• Stay away from impure food and water
• good hygiene is important
• Individuals with G6PD deficiency should avoid medications that can cause hemolysis.
• Avoid medications that can damage the liver.

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