Jaundice

The largest organ in the body is LIVER. It is located in the upper right side of the abdomen and is protected by ribs.  It carries out more than 500 functions of which 22 are vital functions.
The liver is the body’s main detoxifier and it removes and neutralises poisons, drugs, nicotine and alcohol in the bloodstream.
It secretes bile juice which is stored in the gall bladder temporarily and passes into duodenum of small intestine for fat digestion. It breaks down fats into tiny globules to make them digestible.
The functions of liver are impaired due to severe liver diseases that are most commonly caused by infections or by drugs such as alcohol.
Bile juice contains yellow pigment called bile pigment (bilirubin). Bile pigment is formed due to the breakdown of old RBC in the liver and it is normally removed through the stool.
In liver malfunction, bile juice accumulates in the blood and the yellow pigment of bile juice causes yellowing of the skin and the whites of the eyes.
The yellow staining of the skin and the whites of the eyes by abnormally high blood levels of the bile pigment, bilirubin is called Jaundice, also known as icterus.
Jaundice itself is not a disease but it is a symptom of several possible underlying illnesses.
It indicates a serious problem with the function of red blood cells, liver, gallbladder, or pancreas.
Some babies develop jaundice during the first few days after birth and such form of jaundice is called physiological jaundice. This type of jaundice is due to the immature liver which is unable to excrete bilirubin efficiently. It is harmless and clears up by the end of the first week.
Another, more serious type of jaundice that affects new born babies is haemolytic, where, the mother blood and baby blood types are incompatible. It causes the break down of the red blood cells of the foetus. A blood transfusion may be needed before or after birth.
Liver-cell or obstructive jaundice occurs in adults, where the secretion of bile is hindered, so bilirubin passes directly into the blood stream causing yellowing of the skin.

Causes

Jaundice results from liver or gall bladder disease where the removal of bilirubin from blood is impaired. The main causes are,

• alcohol abuse,
• liver infection,
• liver cancer,
• cirrhosis (scarring of the liver, usually due to alcohol),
• gallstones (cholesterol stones made of hardened fat material or pigment stones made of bilirubin),
• hepatitis (disease and swelling of the liver that decreases its ability to function),
• pancreatic cancer,
• parasites in the liver, which can block the excretion or removal of bilirubin from the body,
• blood disorders such as haemolytic anaemia (the rupture or destruction of red blood cells that lead to a decreased amount of red blood cells in blood circulation which leads to fatigue and weakness),
• an adverse reaction to or overdose of a medication.

Diagnosis

Blood tests are conducted to determine the cause of jaundice. A blood test can not only determine the total amount of bilirubin in the body, but it can also help detect indicators of other diseases such as hepatitis.
Related tests are
Liver function test; Bilirubin tests ; Hepatitis A; Hepatitis B; Hepatitis C; Complete Blood Count (CBC); Urinalysis; Direct Antiglobulin Test; Haptoglobin; Reticulocyte Count
If an obstruction of the liver is suspected, the liver's structure will be looked at with the help of imaging tests such as MRI scan, abdominal ultrasonography (ultrasound), CT or CAT scan, Endoscopic retrograde cholangiopancreatography (ERCP)
Liver biopsies: small samples of liver tissue are removed for testing and microscopic examination.

Treatment

To treat jaundice, diagnosis is essential to select suitable treatment options.

• Haemolytic jaundice may be treated by increasing the amount of iron in the blood; either by taking proteins, B vitamins and iron supplements or eating more iron-rich foods, such as fish, poultry, eggs, dairy products or soya bean products which are also good sources of protein, and B vitamins.
• Hepatitis-induced jaundice may be treated with anti-viral or steroid medications.
• Obstruction-induced jaundice may be treated through surgery to remove the obstruction.
• Medication-induced jaundice is treated by selecting an alternative medication and by discontinuing medications that caused jaundice.
• Severe cases of jaundice are treated with blood transfusions to remove bilirubin.
• For all forms of jaundice, it is best to avoid alcohol and spicy food.
• Fat intake should be lowered to avoid undue strain on the liver.
• Eating little and often, choosing a plain diet rich in carbohydrates will help the liver to recover.
• Oats and unsweetened muesli will avoid constipation, which often accompanies jaundice.