Understanding Gastroesophageal Reflux Disease(GERD)

Adult Jaundice: Causes, Symptoms, Diagnosis & Treatment

Jaundice In Adults

Jaundice

A condition known as jaundice causes the white part of the eyes, mucous membranes, and skin to appear yellowish. The color of body fluids can also change.

Jaundice is a disease that typically arises from an underlying condition such as a problem with the bile ducts or liver. When the liver is not functioning as it should, bilirubin, a waste product, can form in the blood.

A buildup of the chemical bilirubin in the body's tissues causes jaundice. Bilirubin is a chemical that occurs naturally in the body but can rise to abnormally high levels in several diseases.

At moderate levels of bilirubin, the skin, eyes, and mucous membranes may turn yellow. As it progresses, the color can also change from yellow to green. The color comes from biliverdin, a green pigment in the bile.

People of any age can develop jaundice. The highest risk of developing jaundice is seen in older adults and newborns. It usually goes away in the newborn after the first week.  

The Role Of Bilirubin In Jaundice

Jaundice is mostly caused by hyperbilirubinemia or too much bilirubin. Hemoglobin, the substance that carries oxygen throughout your red blood cells, contains bilirubin, a yellow chemical. Your body creates new cells to take their place as red blood cells break down. The liver processes the old ones. Bilirubin builds up in the body and can cause your skin to appear yellow if the liver is unable to handle the breakdown of blood cells.

Bilirubin travels throughout the bloodstream. The liver cells absorb the bilirubin as the blood moves through the organ. To make the bilirubin water-soluble, chemicals in the liver cells slightly alter its structure. Conjugated bilirubin is the name of this bilirubin that dissolves in water. Unconjugated bilirubin is the bilirubin that is present in the blood before being absorbed by liver cells.

The conjugated bilirubin is expelled by liver cells into bile ducts, which are small tubes. As a result, the bilirubin is now a part of the bile. Bile is a mixture of various waste chemicals that liver cells expel. A variety of waste chemicals are eliminated from the bile by liver cells.

Bile ducts run throughout the structure of the liver. Bile continuously drips into the common bile duct and duodenum. Under the liver is the gallbladder that stores bile. When we eat, the gallbladder contracts. The stored bile is discharged back into the common bile duct and into the duodenum as a result of this. The typical brown color of the stools is due to the bilirubin in the bile.

Consequently, the elimination of bilirubin is typical. When bilirubin levels in the blood are too high, jaundice occurs. This can happen for many different reasons.

Causes Of Jaundice

It is efficacious to classify the four main causes of jaundice as follows:

1. Conditions that affect the cells in the liver or damaged or overworked liver. For example, hepatitis, cirrhosis, Dubin-Johnson syndrome, Rotor's syndrome, and  Gilbert's syndrome. 
2. Diseases affecting the red blood cells such as a large amount of red blood cells are breaking down or dying. Consequently, more bilirubin is produced than usual, which circulates in the blood. The liver cells are unable to keep up with the increase in bilirubin and process it. The diseases affecting the red blood cells are Haemolytic uraemic syndrome, Malaria, Thalassemia, Spherocytosis, Glucose 6-phosphate dehydrogenase deficiency, and Sickle cell anemia. 
3. Conditions that affect the liver's tiny bile ducts. The liver's tiny bile ducts can become damaged or narrowed, preventing the flow of bile. The bilirubin-rich backlog of bile then enters the bloodstream. The bile ducts can be affected or damaged in this way by a variety of conditions. For instance, primary sclerosing cholangitis, primary biliary cirrhosis, and as a side effect of some medications.
4. Problems with the common bile duct outside of the liver. The common bile duct receives bile from all of the liver's tiny bile ducts. The bile that contains bilirubin can seep into the bloodstream and cause jaundice if the common bile duct becomes narrowed or blocked. Post-hepatic jaundice and obstructive jaundice are two other names for this condition. Conditions affecting the common bile ducts are Pancreatitis, Pancreatic cancer, Gallstones, and Gallbladder cancer.

Jaundice can occur during bilirubin production by:

1. Viruses like Hepatitis A, chronic Hepatitis B, and C, and Epstein-Barr virus infection 
2. Alcohol
3. Autoimmune conditions
4. Genetic  metabolic defects
5. Certain medications such as oral contraceptives, chlorpromazine, acetaminophen toxicity, penicillin, and estrogenic or anabolic steroids

Jaundice can result from bile duct obstruction (blockage) from the following conditions:

1. Gallstones
2. Gallbladder swelling and inflammation.
3. Cancer of the gallbladder
4. Pancreatic cancer

Types Of Jaundice

Depending on where they occur during the liver's process of absorbing and removing bilirubin, different types of jaundice are categorized. They consist of the following three types: 

1. Hepatic Jaundice: Hepatic jaundice happens when your liver tissue turns out to be less powerful or less effective in the filtration of bilirubin from your blood.
2. Pre-Hepatic Jaundice: Diseases influencing the blood's pace of red blood cell breakdown cause prehepatic jaundice. This increases the flow of bilirubin into the body tissues and organs. This happens before the blood reaches the liver. 
3. Post-Hepatic Jaundice: When blood bilirubin cannot properly drain into the bile ducts or digestive tract to be eliminated from the body, this type of jaundice occurs. It occurs as a result of a blockage and after the liver filters bilirubin.

Symptoms Of Jaundice

The symptoms of jaundice vary depending upon the type of jaundice.

Symptoms Of Hepatic Jaundice

The most common symptoms of hepatic jaundice are listed below.

• Yellowish skin or eyes
• Dark urine or pale stools
• Appetite loss
• Bloody nose
• Skin itching
• Weakness
• Weight loss that is not normal
• Swelling of the abdomen or legs
• Pain in the muscles or joints
• Fever
• Feeling sick
• Vomiting

Symptoms Of Pre-Hepatic Jaundice

Patients suffering from pre-hepatic jaundice report the following symptoms, 

• Yellowing of skin and eyes
• Fever
• Abdominal pain
• Cold sweats or chills
• Irritation 
• Dark urine or pale stools

Symptoms Of Post-Hepatic Jaundice

Post-hepatic jaundice consists of the following symptoms,

• Yellowing of the skin and eyes
• Fever
• Abdominal pain and swelling
• Dark urine or pale stools
• Nausea and vomiting
• Irritation of the skin
• Abnormal weight loss
• Diarrhea

Risk Factors Of Jaundice

Some of the risk factors for jaundice include:

• Addiction to alcohol
• Using illegal drugs
• Taking medications that could harm the liver
• Hepatitis A, B, or C,
• Exposure to certain industrial chemicals

Diagnosis Of Jaundice

Doctors typically begin with a physical examination and the patient's medical history for the diagnosis of jaundice. They might order lab tests later on. They will pay close attention to the skin, liver, and abdomen during an examination.

To assist in determining the underlying cause of jaundice, the doctor may frequently order lab tests. These are some:

1. Bilirubin tests: Hemolytic jaundice is indicated by a higher level of unconjugated bilirubin than conjugated bilirubin.
2. Complete blood count (CBC) or full blood count (FBC).
3. Tests for hepatitis A, B, and C.
4. Urine tests.
5. If they think there is an obstruction, the doctor will also examine the liver’s structure. In these cases, they will utilize imaging tests, including X-ray, CT, and ultrasound.
6. Endoscopic Retrograde Cholangiopancreatography (ERCP) may also be performed. This is a procedure that combines X-ray imaging with endoscopy.
7. A liver biopsy for the diagnosis of cancer cirrhosis, and fatty liver. During a biopsy, a tissue sample is taken by inserting a needle into the liver. The sample will then be examined under a microscope by a healthcare professional.
8. Magnetic Resonance Imaging (MRI) of the liver.

Treatment Of Jaundice 

Jaundice itself is rarely treated in adults. However, the condition that is causing it will be treated by your doctor.

Jaundice resolves on its own as the liver begins to heal. Your doctor may recommend surgery to open a bile duct if it's blocked. Jaundice can be treated for its symptoms and complications. Cholestyramine, for instance, may alleviate itching if bothersome.

Complications Of Jaundice

Your medical conditions, the type of jaundice, and its severity will all play a role in the complications of jaundice. The most common complications of jaundice are:

• Anemia
• Infections
• Bloating
• Liver or kidney failure
• Leg swelling
• Diarrhea or constipation
• Abdominal pain
• Flatulence
• Bleeding
• Kernicterus in infants (Rare type of brain damage)
• Hepatic encephalopathy

Prevention Of Jaundice

Jaundice is a condition due to problems with bile ducts or the liver. The prevention of jaundice aims to maintain the health of your liver. Several modifications to one's lifestyle can assist in liver health:

1. A balanced eating regimen should be followed.
2. You must exercise routinely.
3. You must manage your drugs cautiously.
4. Herbal medicines should be avoided.
5. You must avoid intravenous drugs, smoking, and alcohol; taking more than the recommended dose of prescribed medications.
6. You must take the recommended vaccinations before traveling.
7. Safe sex, such as using methods of contraception.