The Digestive System|
Synonyms : icterus, Yellow skin
Jaundice (icterus) refers to the yellow appearance of the skin, sclerae and mucous membranes resulting from the increased bilirubin concentration in body fluids. Internal tissues are coloured yellow except the brain, as bilirubin does not cross the blood-brain barrier, other than in the immediate period after birth when it can cause brain damage. Jaundice can be caused by increased bilirubin production (e.g., haemolysis) or by impaired bilirubin metabolism and decreased bilirubin clearance.
results from increased destruction of red blood cells in the spleen or
circulation, or their precursors in the bone marrow, causing increased
bilirubin production through metabolism of the haem component of haemoglobin.
Common causes are hereditary spherocytosis, sickle cell disease and various
forms of thalassaemia. Jaundice due to haemolysis is usually mild
because a healthy liver can increase uptake and metabolism of unconjugated
bilirubin, which is conjugated and then excretex Hyperbilirubinaemia in
haemolytic jaundice is unconjugated
in type, reflecting increased delivery of unconjugated bilirubin to the liver.
Clinical features: < BACK TO TOP >
usually only mild jaundice.
stools due to increased delivery of pigments into the intestine can be noticed,
as well as darker urine due to increased excretion of urobilinogen that is
converted to urobilin (recall that unconjugated bilirubin is not excreted in the
symptoms of anaemia are present (lassitude, fatigue, breathlessness on exertion,
palpitations, throbbing in the head and ears, dizziness, headaches,
dimness of vision, pallor of skin and mucous membranes).
of spleen (splenomegaly) may be found if excessive erythrocyte destruction takes
place in the spleen.
Chronic overproduction of bilirubin may result in the formation of gallstones composed predominantly of bilirubin (‘pigment stones? due to oversaturation of bile with bilirubin.
Diagnosis: < BACK TO TOP >
plasma bilirubin is elevated but is usually less than 100 mmol/L (normal is up to 17 mmol/L); hyperbilirubinaemia is dominantly
is no bilirubinuria because unconjugated bilirubin can not pass into the
urine, but there is increased amount of urobilinogen in the urine.
liver function tests are normal because there is no liver damage.
blood count shows reduced haemoglobin and red blood cell count with increased
number of reticulocytes (young red blood cells that still have some residual
The peripheral blood shows signs of haemolytic anaemia (a moderate macrocytosis and polychromasia due to reticulocytosis, with red cell abnormalities specific for the type of haemolytic disease, e.g., round spherical erythrocytes in hereditary spherocytosis, or banana-shaped ones in sickle cell disease).
Management < BACK TO TOP >
The management varies and is specific to the haemolytic disease (further discussion in the section about haemolytic anaemia)
Prognosis < BACK TO TOP >
type of jaundice results from inability of the liver to metabolise and
transport bilirubin into the bile as a result of liver cell damage.
Concentration in the blood of both unconjugated and conjugated bilirubin is
increased since swelling of hepatocytes leads to compression of tiny
intrahepatic bile ducts and impaired bile drainage. Acute parenchymal liver
diseases, usually due to the hepatic viruses or to drugs, are common causes.
Prolonged alcohol abuse is a very important cause as well.
is of various intensity depending on the severity of the underlying condition.
features also vary with the underlying disease (discussed later).
with the underlying disease (e.g., hepatitis or cirrhosis) and are discussed
Cholestasis is a failure of bile flow, and its cause may lie anywhere between the
liver cell (hepatocyte) and the duodenum. Cholestasis may be due to failure of
the hepatocytes to generate bile flow (certain rare inherited defects such as
Dubin-Johnson syndrome where the main problem appears to be impaired transport
of bilirubin across the cell membrane), obstruction to bile flow in the
intrahepatic bile ducts (a rare condition of unknown cause called primary
biliary cirrhosis), or obstruction to bile flow in the extrahepatic bile ducts
(stones, tumours especially of the pancreas, strictures). The last one is the
most important cause of cholestatic jaundice. Hyperbilirubinaemia is conjugated
in type since conjugation of bilirubin proceeds undisturbed but the bile
returns into the blood.
is jaundice of various intensity, static or fluctuating, reflecting the
mechanism and severity of cholestasis.
are pale or clay-coloured due to deficiency of pigments (bilirubin is not
delivered into the gut).
is dark urine from the renal excretion of conjugated bilirubin.
pruritus (itch), probably due to skin deposition of bile salts is commonly
reported; sometimes scratch marks are visible.
hard lipid deposits in the skin over joints and tendons (xanthomas) and around
the eyes (xanthelasmas) develop due to protracted elevation of serum
cholesterol (bile cholesterol is returned to blood).
can be weight loss due to marked malabsorption (bile salts are required for
fat digestion and indirectly for absorption of lipid soluble vitamins).
tendency (easy bruising) is sometimes noted due to vitamin K deficiency
(vitamin K is a lipid soluble vitamin).
of the bones due to vitamin D deficiency (vitamin D is also a lipid soluble
vitamin) can also be a problem.
in individual patients are determined by the clinical findings. It is usual to
find elevated levels of conjugated bilirubin in blood together with raised
there is no obvious cause for cholestasis, initial efforts are directed to
identifying a large biliary duct obstruction, and ultrasound should be carried
(endoscopic retrograde cholangiopancreatography) is the best investigation if
the biliary tract is dilated, as demonstrated on ultrasound.
biopsy is performed when there is strong evidence of liver damage such as in
biliary cirrhosis or inherited abnormalities of bilirubin transport into
intrahepatic bile ducts.
depends on the underlying cause of the cholestasis.
The summary of findings in different types of jaundice
Nutrition < BACK TO TOP >
Nutrition that alleviate or prevent Jaundice :-
Herbs < BACK TO TOP >
Herbs that alleviate or prevent Jaundice :-
(source : -)
12 August 20096December 2005
speaker Mr NgThian Watt the Principal Trainer from
Napoleon Hill Associates MalaysiaDetails
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