Jaundice: Symptoms, Causes, Traetment
Introduction
Jaundice also known as icterus, is a yellowish or greenish pigment of the skin and sclera due to the high bilirubin levels in the blood.
Normal level of bilirubin: 1.0 mg/dl
Hyperbilirubinemia: 2-3 mg/dl.
Epidemiology
Jaundice in adults is rare.
Under the five year DISCOVERY programme in the UK, annual incidence of jaundice was 0.74 per 1000 individuals over age 45.
Jaundice is commonly associated with severity of disease with an incidence of up to 40% of patients requiring intensive care in ICU experiencing jaundice.
Aetiology
Pre-hepatic/hemolytic:
The pathology occurs prior to the liver metabolism, due to either intrinsic causes to red blood cell rupture or extrinsic causes to red blood
cell rupture.
Hepatic/hepatocellular:
The pathology is due to damage of parenchymal liver cells.
Post-hepatic/cholestatic:
The pathology occurs after bilirubin conjugation in the liver, due to obstruction of the biliary tract and/or decreased bilirubin excretion.
Pathogenesis
Pre hepatic causes
Pre-hepatic jaundice is most commonly caused by a pathological increased rate of red blood cell (erythrocyte) hemolysis.
The increased breakdown of erythrocytes → increased unconjugated serum
bilirubin → increased deposition of unconjugated bilirubin into mucosal tissue.
The following diseases may cause jaundice due to increased erythrocyte
hemolysis:
Sickle cell anemia
Thalassemia
Pyruvate kinase deficiency
Haemolytic anemia.
Hepatic causes
Hepatic jaundice is caused by abnormal liver metabolism of bilirubin.
The major causes of hepatic jaundice are significant damage to hepatocytes — due to infectious, drug/medication-induced, auto-immune aetiology — or, less
commonly, due to inheritable genetic diseases.
The following is a non-exhaustive list of hepatic causes of jaundice:
Acute and chronic hepatitis
Hepatotoxicity
Drug-induced hepatitis
Alcoholic liver disease
Cirrhosis
Post hepatic causes
Post-hepatic jaundice (obstructive jaundice), is caused by a blockage of bile ducts which transport bile-containing conjugated bilirubin out of the liver for excretion.
The following is a list of conditions that can cause post-hepatic jaundice:
Acute and chronic pancreatitis
Choledocholithiasis
Biliary atresia
Pancreatic cancer
Cholangitis
Diagnosis
Bilirubin test
Viral test for hepatitis
Liver function test
Blood count
Abdominal CT scan
Abdominal Ultrasound
Liver biopsy
Cholesterol level estimation
Treatment
Iron supplements for anaemia-induced jaundice.
Anti viral drugs for Hepatitis.
Iv fluid administration
Diet and vitamin D, and K supplements.
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