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Jaundice (Icterus) : Definition, Causes, Risks Factor And Treatment

Wednesday, September 26th 2012. | General

Jaundice Definition

Jaundice is one of the signs encountered a malfunction of the liver. It is a yellow discoloration of the skin, conjunctiva and other tissues due to increased levels of bilirubin in the blood.

The liver is the largest organ of the human body and its functioning is very complex. One of its functions is to produce bile, bilirubin more accurately, which is actively involved in the digestion of food in the intestine. The amount of bilirubin in the blood (serum bilirubin) is, in principle, stable and less than 10 mg per liter. Jaundice occurs when the rate exceeds 20 mg (hyper bilirubinemia).

Jaundice is usually seen with the naked eye, with the light on the skin and connective tissue (“white of the eye” in particular). Jaundice is often accompanied by very dark urine and stool clearer. Previously, it said “jaundice”

Jaundice_look_like

A strong jaundice can cause itching that is itchy skin.

It is easy to recognize the yellow color on the skin and conclude that there is jaundice, it is not so easy to say what caused it.

The causes are multiple, grouped among the diseases caused by disorders of bilirubin metabolism and those causing cholestasis (embarrassment to the flow of bile). The best known of these is hepatitis.

There is an arsenal of possible additional tests to examine the liver, jaundice in particular.There are medical imaging techniques (radiography special scanner, MRI, endoscopy …), biological techniques (blood samples and other), biopsies and even surgery in rare cases of unexplained jaundice.

Jaundice Causes

We distinguish between diseases caused by disorders of bilirubin metabolism and disease causing cholestasis (embarrassment to the flow of bile).

The formation of bilirubin is very complex and requires multiple biochemical reactions that can be done incorrectly and lead to diseases. In addition, the transport of bilirubin can be prevented by multiple causes. It accumulates in the liver and is forced to pass into the blood.

Disorders of bilirubin metabolism

Hyperhemolysis . It is the destruction of red blood cells abnormally high, the latter constituting the raw material for the production of bilirubin. This disease is accompanied by anemia. Urine remains clear.

Gilbert’s syndrome. hyper bilirubinemia This is a fairly common and not serious, which is detected in young adults. All tests are normal and treatment is unnecessary.

Syndrome Crigler-Najjar . It is a hereditary disease that can be fatal to infants. A less severe form is for adults.

Cholestasis

The main clinical signs of cholestasis are jaundice, dark urine, clay-colored stools and generalized pruritus. They are almost always present in cases of cholestasis, whatever the cause. The doctor will look for other signs to guide more specific diagnosis.

Viral hepatitis. The best known are hepatitis A, hepatitis B and hepatitis C, more or less serious depending on the virus involved. All three resulting from inflammation of the liver that prevents bilirubin from draining properly. It then passes into the blood.

Drug violations. Some medications can cause cholestasis. These are the phenothiazines (certain neuroleptics used in psychiatry) that also cause fever and certain oral contraceptives.

Diseases due to alcohol. These include alcoholic hepatitis that occurs after drinking long and important. Jaundice is never alone and there are other signs such as liver pain, fever

Lithiasis of the common bile duct. It is duct obstruction causing the bile from the liver and gall bladder into the intestine. The causes of such obstruction are many, but most often it is a gallstone, that is to say, the presence of stones in the channel. The pain is usually important.

Pancreatic cancerBorrows channel bile passes to the intestine, in its lower part, by the pancreas. When this body is suffering from cancer, the channel can be narrowed or compressed by the tumor and this then causes cholestasis.

What is the cause of jaundice at birth?

Jaundice baby

More than 50% of term newborns and 90% of premature jaundice in the neonatal period. The most common “physiological” however, it may be related to a disease.

At birth, a blood test is done to determine the baby’s heel bilirubin. Absent at birth, physiological jaundice usually appears after an interval of 24-36 hours with a maximum peak at 3 e -4 e days followed by a rapid decline and a loss to the 10 th day, the urine is color slightly. It is due to the destruction of excess red blood cells. These dead cells causing hemoglobin release the manufacture of a yellow pigment called bilirubin. It should be eliminated by the liver, but in some newborns, the liver is not able to do it immediately.

If the jaundice does not disappear after a few days the bilirubin level is too high, the child is a few hours per day under a blue light that is intended to destroy bilirubin. This therapy is absolutely not painful (it is only light).

However, while jaundice should lead to find a cause and not to limit the diagnosis of physiological jaundice and phototherapy. Of course, obstetric history (incompatibility, death in utero, suffering …), ethnicity, clinical (pale, bulky liver, hematoma), biology, will guide the diagnosis before seeking additional, more specific tests.

Jaundice Risks Factor

Risk factors for jaundice are related to those diseases that can cause jaundice.

For diseases related to a disorder of bilirubin metabolism, it is especially diseases that destroy red blood cells too much (hyperhemolysis)

  • Hypersplenism : malfunctioning of the spleen destroys red blood cells by filtering excessively;
  • Transfusions: incompatibility between two RBCs different bloods who destroy themselves by contact;
  • Abnormal red blood cells : red blood cells destroy abnormal easier, facilitating the occurrence of jaundice more or less important depending on the type of abnormality (sickle cell anemia, thalassemia some …).

For diseases causing cholestasis, the main risk factors are those related to viral infections:

  • Hepatitis A, the risk is related to water, especially in developing countries, there is a vaccine;
  • For hepatitis B transmission is rarely sexual and may be related to blood contact, there is a vaccine;
  • For hepatitis C transmission is through blood (transfusion) there is no vaccine;
  • Certain medications: these are the phenothiazines (certain neuroleptics used in psychiatry) and some oral contraceptives;
  • Prolonged and excessive consumption of alcohol;
  • The diet too rich in fats (bile duct stones).

Jaundice Treatment

Treatments are as varied as the course causes: phototherapy, drugs, surgery …

Disorders of bilirubin metabolism

The hyperhemolysis. Treatment depends on the cause of hemolysis and is ordered by a blood specialist (hematologist).

Gilbert’s syndrome. Any treatment is useless.

Cholestasis

Viral hepatitis. The treatment is usually rest (hepatitis A and B) but may appeal to very specific drugs in hepatitis C.

Drug violations. Stop the offending drug is generally only useful and effective treatment.

Diseases due to alcohol. Stopping drinking is obviously imperative.

Depending on the severity of the violation and its consequences, different treatments are offered and are not specifically the jaundice will disappear as soon as the liver will go a little better.

Lithiasis of the common bile duct. It may require surgery. But recent techniques allow, in some cases, to avoid surgery and promote the drainage of the biliary tract (including endoscopy).

Physiologic jaundice of birth, which does not disappear after a few days or whose bilirubin level is too high, is an indication of phototherapy: the child is a few hours per day under a blue light which aims destroy bilirubin.

How to live with Jaundice?

The rules of healthy lifestyle can prevent most diseases causing cholestasis:

  • Respect vaccinations (hepatitis A and B);
  • Pay attention to the consumption and use of water in developing countries, especially if you are not vaccinated against hepatitis A;
  • Respect drug prescriptions;
  • Consume alcohol in moderation;
  • Have a balanced diet, avoiding fats.

Ask and Questions

“Which doctor should I consult? ’

Your family doctor should remain the referring physician.However, it may advise you to consult a gastroenterologist.

“Is it serious? ’

In general, jaundice is not trivial, but if it occurs at birth. In this case, care is made directly to the maternity ward.

Jaundice may reveal or accompany a more serious condition, it is necessary to care quickly. In addition, a very important and prolonged jaundice can cause serious complications in the brain.

“What tests should I do? ’

Firstly, there are blood tests to determine the exact amount of bilirubin in the blood (bilirubin), about the situation of red blood cells (hemolysis downward) and also the liver.

Other tests tend to examine the liver and bile ducts. For this purpose, we use as appropriate radiographs of the abdomen, liver ultrasound, CT, MRI, ultrasound examination is a convenient, fast and inexpensive.

Liver biopsy is useful in some cases of cholestasis because it provides information on liver health and the importance of disease (degree of inflammation, for example).

Exceptionally, in some emergency situations, surgery (laparotomy) may be necessary to explore directly what is happening and begin treatment at the same time.

“Hospitalization is necessary? ’

It becomes necessary when jaundice is very important and there are other signs: pain, fever, vomiting … It is also useful to perform some tests can not be practiced in a hospital setting.Obviously, surgical treatment will be performed in a surgical environment.

“What is the treatment? ’

Treatments are as varied as the course causes: phototherapy, drugs, surgery.

Information to communicate to your doctor

  • Do you have dark urine, clay-colored stools?
  • Does it make you itch?
  • Are you vaccinated against hepatitis?
  • If you are not vaccinated, you come back from a trip abroad, you had unprotected sex, have you recently had a transfusion?
  • Do you have a fever?
  • Do you have abdominal pain, vomiting?
  • Do you consume alcohol? How much?
  • Do you cholesterol?
  • Do you have a blood disease?
  • Are you taking any medications at this time? If yes, which ones?
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