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Jaundice

In medical terminology Jaundice is defined as yellowish discoloration of skin and mucous


membranes . Infact it is not a disease itself but a Sign of some underlying disease.


Pic 1. Yellowish discoloration of Eye (Conjuctiva)
Pathology :-
When red blood cells break down naturally in a 120-day cycle, bilirubin is produced
as a waste by-product.

The journey bilirubin takes out of the body's waste disposal systems takes it carried
by blood to the liver. There is it combined with bile (digestive fluid) from the
gallbladder

This mixture exits the body through faeces and urine. If everything is working well,
faeces should be brown and urine light yellow.

Infections or damage can disrupt this process, leading to jaundice.
Symptoms :-
-Classic yellow tinge to the skin and whites of the eyes (Refer pic1&2)

Pic 2 Change in colour of skin from pink to yellow
-yellowing of mucous membranes in the mouth and nose.
-Stools (faeces) can be pale in colour and urine dark in colour.
-Some underlying conditions, which lead to jaundice, may feel like flu, and may also result in fever,
chills (shivering), itching or weight-loss or be without an explanation such as a diet.



Based on the place where pathology is , Jaundice is divided into three types :
Pre-Hepatic(Hepatic = Liver) - If an infection or medical condition makes the red blood
cells break down sooner than usual, bilirubin levels rise. This is known as pre-hepatic
jaundice.E.g malaria sickle cell anaemia, thalassaemia.

Intra-Hepatic -If the liver is damaged, it may be less able to process bilirubin. This
causes what doctors call intra-hepatic jaundice.

The liver damage may be a result of causes that include hepatitisA,B,C.E, alcoholic liver
disease, glandular fever, liver cancer, illegal drug use including ecstasy, and paracetamol
overdose.

Post- Hepatic - Gallstones, pancreatitis, pancreatic cancer and cancers of the
gallbladder or bile duct may also disrupt the bilirubin removal process leading to jaundice.
This is called post-hepatic jaundice. Eating a high-fat diet can raise your cholesterol
levels and increase the risk of having gallstones.



Pic.2 (Depicting causes of Hepatitis C which causes Jaundice)

Diagnosis - The yellowing of skin and eyes are likely to be the main clues a doctor will
use before confirming a jaundice diagnosis.

A person will be asked about other symptoms and risks, such as foreign travel or illegal drug
use.

A physical examination will be carried out to look for signs of swelling of the liver and
legs, ankles or feet which might indicate cirrhosis of the liver.

Urine can be tested for urobilinogen, which is produced when bilirubin is broken down.
Finding high or low levels can help pinpoint the type of jaundice.

Blood tests may be used to check for conditions like malaria or hepatitis.

A liver function blood test may indicate hepatitis, cirrhosis or alcoholic liver disease.
Sometimes a liver biopsy - removal of small tissue sample - is needed to confirm or rule out
conditions such as cirrhosis or liver cancer.

Doctors may also need to look inside the body for problems with the liver or bile duct
using ultrasound, X-ray with contrast, MRI or CT scans



Prevention of Jaundice
Because of the wide range of potential causes, it's not possible to prevent all cases of
jaundice. However, you can take precautions to minimise your risk of developing the condition.
Here I am specifically emphasizing preventive measures of jaundice due to water borne /food borne
Components (Hepatits E virus)
The risk of infection and transmission can be reduced by:

maintaining quality standards for public water supplies;

Establishing proper disposal systems to eliminate sanitary waste.


On an individual level, infection risk can be reduced by:

maintaining hygienic practices such as hand washing with
safe water, particularly before handling food;

avoiding drinking water and/or ice of unknown purity

avoiding eating uncooked shellfish, and uncooked fruits or vegetables
that are not peeled or that are prepared by people living in or travelling
in highly endemic countries.

(In 2011, the first vaccine to prevent hepatitis E infection was registered in China. Although it is not
available globally, it could potentially become available in a number of other countries)

Other important measures to prevent jaundice are
Avoid heavy alcohol use (alcoholic hepatitis, cirrhosis, and pancreatitis).
Vaccines for hepatitis (hepatitis A, hepatitis B)
Take medications which prevent malaria before travelling to high-risk regions.
Avoid high-risk behaviours such as intravenous drug use or unprotected intercourse (hepatitis B).
Avoid potentially contaminated food/water and maintain good hygiene (hepatitis A and E).
Avoid medications that can cause haemolysis (breakdown of red blood cells) in susceptible
individuals (such as those with G6PD deficiency, a condition that leads to red blood cell breakdown
after consumption of certain substances).
Avoid medications and toxins which can cause haemolysis or directly damage the liver.


Thank you