Procedure

Jaundice Treatment- Gastroenterology

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Patients with a yellowish tinge to the skin or whites of the eyes, as well as yellowish body fluids may have jaundice.

Before we exactly understand what exactly is jaundice, let us try and understand some basic terminology related to it.

Biliary System:

The main functions of the biliary system are drainage of waste products from the liver to the small intestine and helping in digestion with the controlled release of bile.

Bile: It is a complex fluid containing water, electrolytes bile acids, cholesterol, phospholipids and bilirubin

Bilirubin: It is a yellowish substance present in the blood. It is formed in the body when red blood cells are broken down. It passes through the liver, gallbladder and digestive tract before getting excreted. Bilirubin is of two types i.e. conjugated and unconjugated.

Pathology of Jaundice:

Jaundice is seen when there are high levels of bilirubin in the blood. Normally, bilirubin undergoes the process of conjugation within the liver, which makes it water-soluble. It is in the gastrointestinal tract via the bile. It is majorly excreted in the faeces as urobilinogen and stercobilin, which is metabolic breakdown product of urobilingoen. Some part of urobilinogen (10%) is reabsorbed into the blood and is then excreted through the kidneys. Disruption in the above mentioned pathway leads to development of jaundice.

Types of Jaundice:

There are 3 types of Jaundice:

  1. Pre -hepatic Jaundice
  2. Hepatocellular Jaundice
  3. Post-hepatic Jaundice

Pre- Hepatic Jaundice: Excess red cell breakdown is seen in pre-hepatic jaundice. This exhausts the liver's capacity to conjugate bilirubin and leads to an increase in unconjugated bilirubin, which in turn causes jaundice.

Hepatocellular Jaundice: In hepatocellular (or intrahepatic) jaundice, there is impaired functioning of the liver cells. As a result, the liver is unable to conjugate bilirubin. It is usually caused by liver failure, liver cirrhosis or hepatitis.

Post-hepatic Jaundice: This is also caused as obstructive jaundice. This is usually seen whenever there is obstruction whenever there is obstruction in the bile duct. This prevents the bilirubin, which is conjugated by the liver from leaving the liver. A gallstone, a tumor, or a cyst in the bile duct, or the pancreas usually causes obstructive jaundice.

Sign and Symptoms of Jaundice:

The severity of the symptoms depends on the underlying causes and how quickly or slowly the disease develops. The common symptoms of jaundice are as follows:

  • a yellow tinge to the skin and the whites of the eyes, normally starting at the head and spreading down the body
  • pale stools
  • dark urine
  • itchiness

Some other accompanying symptoms of jaundice resulting from low bilirubin levels are as follows:

  • Abdominal pain
  • Weight loss
  • Vomiting
  • Fever
  • Fatigue
  • Pale stools
  • Dark urine

Diagnosis:

Healthcare providers will take a detailed history of the patient and do a physical examination to confirm the diagnosis of jaundice.

Your physician may also order for the following laboratory investigations:

Liver Function Tests:

Under liver function tests, the following parameters are evaluated:

Marker

Significance

Bilirubin

Quantify degree of any suspected jaundice

Albumin

Marker of liver synthesizing function

AST and ALT

Markers of hepatocellular injury

Alkaline Phosphatase

Raised in biliary obstruction (as well as bone disease, during pregnancy, and certain malignancies)

Gamma-GT

More specific for biliary obstruction than ALP (however not routinely performed)

Table 1

(The above table can be accessed at https://teachmesurgery.com/hpb/presentations/jaundice/)

Liver Screen: Specialist blood tests performed for patients in whom there is no initial cause for liver dysfunction.

Imaging Studies:

The imaging studies to be performed will depend on the suspected etiology. Following imaging studies are usually performed.

1) Ultrasonography (USG) of the Abdomen: USG of the abdomen is generally the first investigation, which might be performed. It helps to identify if there is anything wrong with the liver or any extra-hepatic obstruction to the flow of bilirubin.

2) CT and MRI are alternative imaging investigations, which might be carried out

Liver Biopsy:

A liver biopsy is generally not required. It is helpful when liver enzyme abnormalities are not explained by other tests.

Treatment:

The treatment for jaundice depends on the underlying cause. The treatment administered targets the cause rather than jaundice symptoms

The following treatments are generally administered:

  • Boosting the amount of iron in the blood by either taking iron supplements or eating more iron-rich foods may treat anemia-induced jaundice.
  • Hepatitis-induced jaundice requires antiviral or steroid medications.
  • In case of obstructive jaundice, surgery may be performed to remove the obstruction.
  • If the jaundice has been caused by use of a medication, treatment involves changing to an alternative medication.

Prevention:

Impaired functioning of the hepatobiliary system results in jaundice. Hence it is essential that you maintain the health of your liver.

Avoiding excess consumption of alcohol, exercising regularly and eating a healthy balanced diet can achieve this.

Jaundice in Newborns:

Neonatal jaundice is very common and can occur when babies have a high level of bilirubin. Unlike adults and older babies, the liver in newborns may not be mature enough to remove the bilirubin. In most cases, the jaundice is resolved with 2-3 weeks.

Causes of Neonatal Jaundice:

Following babies are at the highest risk for developing neonatal jaundice:

  • Premature babies (babies born before 37 weeks’ gestation)
  • Babies who aren’t getting enough breast milk or formula, either because they’re having a hard time feeding or because their mother’s milk isn’t in yet
  • Babies whose blood type isn’t compatible with the blood type of their mother

Diagnosis of Neonatal Jaundice:

A distinct yellow coloring confirms that the baby has jaundice. Additional tests like complete blood count (CBC), blood type and Rhesus (Rh) factor incompatibility may be carried out to see if the jaundice is due to any underlying condition.

Treatment of Neonatal Jaundice:

Mild jaundice usually resolves by itself once the babies liver starts to mature. Phototherapy is used for treatment of more severe cases. In very severe cases, exchange transfusion may be necessary. In exchange transfusion, the baby receives small amounts of blood from a donor or a blood bank. 

References:

  • https://www.healthline.com/health/newborn-jaundice#treatment
  • https://www.medicalnewstoday.com/articles/165749#newborns
  • https://www.msdmanuals.com/en-in/professional/hepatic-and-biliary-disorders/approach-to-the-patient-with-liver-disease/jaundice#:~:text=Jaundice%20is%20a%20yellowish%20discoloration,Patient%20with%20a%20Liver%20Disorder.)
  • https://www.msdmanuals.com/en-in/professional/hepatic-and-biliary-disorders/approach-to-the-patient-with-liver-disease/liver-structure-and-function#v45110421
  • https://www.hopkinsmedicine.org/health/conditions-and-diseases/biliary-system-anatomy-and-functions
  • https://www.nursingtimes.net/archive/jaundice-12-02-2009/#:~:text=Hepatocellular%20jaundice&text=It%20occurs%20when%20bilirubin%20is,taking%20certain%20types%20of%20medication.
  • https://teachmesurgery.com/hpb/presentations/jaundice/
  • http://www.vivo.colostate.edu/hbooks/pathphys/digestion/liver/bile.html
  • https://med.libretexts.org/Bookshelves/Veterinary_Medicine/Book%3A_Veterinary_Histology_(Martin_Meek_and_Willebtry)/09%3A_Hepatobiliary_System
  • https://my.clevelandclinic.org/health/diseases/15367-adult-jaundice
  • https://www.healthline.com/health/high-bilirubin#warning-signs
About the Author:

Dr. Anand Lakhkar is a physician scientist from India. He completed his basic medical education from India and his postgraduate training in pharmacology from the United States. He has a MS degree in pharmacology from New York Medical College, a MS degree in Cancer/Neuro Pharmacology from Georgetown University and a PhD in Pharmacology from New York Medical College where he was the recipient of the Graduate Faculty Council Award for academic and research excellence. His research area of expertise is in pulmonary hypertension, traumatic brain injury and cardiovascular pharmacology.  He has multiple publications in international peer-reviewed journals and has presented his research at at prestigious conferences.

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