Jaundice

Some individuals may present certain signs and symptoms while others do not. Here are common symptoms of jaundice:

• A yellow tinge to the skin, mucous membranes, and the whites of the eyes
• Pale or clay-colored stools
• Dark urine
• Itchiness in the skin
• Weight loss
• Vomiting
• Nausea
• Loss of appetite

Other symptoms that may accompany jaundice include:

• Fatigue, tiredness, and drowsiness
• Abdominal pain and tenderness
• Blood in vomit or stool
• Dark or tarry stool
• Flu-like symptoms (fever and chills)
• Agitation or confusion
• Easy bruising or bleeding, causing tiny reddish-purple rashes

On the basis of causes, jaundice can be classified into three types. They are:

• Pre-hepatic jaundice
• Hepatic jaundice
• Post-hepatic jaundice

1. Pre-hepatic jaundice

This type of jaundice is caused due to hemolysis (destruction of red blood cells); therefore, it is also known as hemolytic jaundice. The causes of prehepatic/hemolytic jaundice are classified into:

Congenital causes (present at birth)

• Spherocytosis: This condition affects the red blood cells (RBCs) and is characterized by anemia, jaundice, and enlarged spleen.
• Elliptocytosis: A hereditary disorder in which the RBCs are elliptical in shape rather than the normal round shape.
• Congenital LCAT deficiency: A genetic disorder that affects the body's ability to process cholesterol, characterized by corneal opacities, hemolytic anemia, and kidney failure.
• Thalassemia: An inherited blood disorder caused by insufficient hemoglobin production.
• Sickle cell anemia: A group of inherited disorders known as sickle cell disease that affects the shape of RBCs.
• Stomatocytosis: A rare condition of RBCs characterized by a mouthlike or slitlike pattern rather than the normal shape.
• Acanthocytosis: A red cell phenotype indicative of various underlying conditions.
• Echinocytes: In this condition, the RBCs are crenated and resemble a hedgehog or sea urchin.
• GSH synthetase deficiency: A disorder that prevents the production of glutathione, which is required to prevent cell damage.
• Pyruvate kinase deficiency: An inherited lack of the enzyme pyruvate kinase, leading to hemolytic anemia.
• G6PD deficiency: A genetic disorder where glucose-6-phosphate dehydrogenase is less, protecting RBCs from harmful substances.
• Erythroblastosis fetalis: Hemolytic anemia in the fetus or neonate.

Acquired causes

• Microangiopathy: A disease of the microvessels and small blood vessels in the microcirculation system.
• Hemolytic uremic syndrome: A condition where small blood vessels in the kidneys become damaged and inflamed.
• Disseminated intravascular coagulation: A disorder where the proteins controlling blood clotting become overactive.
• Paroxysmal nocturnal hemoglobinuria: A rare disorder where RBCs break apart prematurely.
• Thrombotic thrombocytopenic purpura: Characterized by the formation of blood clots in small blood vessels.
• Hypophosphatemia: A condition with low levels of phosphorus in the blood, leading to muscle weakness and other complications.

Other causes

• Resorption of extensive hematomas
• Autoimmune hemolysis
• Long-distance running
• Infections like malaria
• Chemicals like nitrites and aniline dyes
• Toxins such as snake venoms
• Transfusion reactions
• Trauma
• Vitamin B12 deficiency
• Folic acid deficiency

Vitamins are essential nutrients for our various bodily functions like immunity, digestion, and metabolism.

2. Hepatic jaundice

This type of jaundice is characterized by defects within the liver, primarily in the hepatocytes. The causes include:

Congenital causes

• Wilson’s disease: A rare inherited disorder causing copper accumulation in the liver, brain, and other vital organs.
• Rotor’s syndrome: A mild condition characterized by elevated bilirubin levels in the blood.
• Hemochromatosis: An inherited condition where iron levels in the body build up over many years.
• Crigler Najjar syndrome: A severe condition characterized by hyperbilirubinemia.
• Gilbert’s syndrome: A common, harmless liver condition where the liver doesn't properly process bilirubin.
• Dubin-Johnson’s syndrome: Characterized by jaundice appearing during adolescence or early adulthood.

Acquired causes

• Drug-related hepatitis (e.g., NSAIDs)
• Sepsis
• Pregnancy
• Malnutrition
• Physical trauma
• Hepatic adenoma (non-cancerous liver tumor)
• Viral hepatitis
• Alcoholic hepatitis
• Autoimmune hepatitis

3. Post-hepatic jaundice

This type of jaundice is caused by issues in the biliary portion of the hepatobiliary system (liver, gallbladder, and bile ducts), primarily due to biliary obstruction outside the liver, also known as obstructive jaundice. The causes include:

Congenital causes

• Biliary atresia: A condition with blockage in the tubes carrying bile from the liver to the gallbladder.
• Cystic fibrosis: An inherited disorder affecting mucus, sweat, and digestive juice production.
• Idiopathic dilatation of the common bile duct: An indicator for obstructive jaundice.
• Pancreatic biliary malfunction: A condition resulting from the inability of the sphincter to contract and relax normally.
• Choledochal cyst: A congenital anomaly of the duct transporting bile.

Acquired causes

• Portal biliopathy: Abnormalities seen in bile duct imaging in patients with portal cavernoma.
• Strictures: Abnormal narrowing of bodily passages.
• Choledocholithiasis: Presence of at least one gallstone in the common bile duct.
• Intra-abdominal tuberculosis (TB): A type of TB affecting the gut and abdominal organs.

Other causes include trauma, AIDS, tumors, cholecystitis (inflammation of the gallbladder), and pancreatitis (inflammation of the pancreas).

Pancreatitis is inflammation of the pancreas, occurring when digestive enzymes start digesting the pancreas itself.

• Autoimmune disorders
• Extensive use of medications that may damage the liver
• Infections such as hepatitis A, hepatitis B, or hepatitis C
• Exposure to certain industrial chemicals
• Presence of congenital abnormalities
• Trauma to the liver
• Obstruction in the bile duct
• Deficiencies of certain vitamins and enzymes
• Excessive alcohol consumption

The differential diagnosis for jaundice is based on whether the disease responsible for jaundice is pre-hepatic (primarily unconjugated hyperbilirubinemia), hepatic (mixed hyperbilirubinemia), or post-hepatic (conjugated hyperbilirubinemia). Jaundice can be diagnosed by checking for any signs of liver disease and it includes:

1. Physical examination and history

   A detailed alcohol and drug use history can help identify intrahepatic disorders such as alcoholic liver disease, viral hepatitis, chronic liver disease, drug-induced liver injury, or any underlying malignancies. The physical examination should include the following:

   • Evaluating encephalopathy by testing for asterixis (motor control disorder) and changes in mental status.
   • Assessing for any signs of chronic liver disease, including bruising.
   • Looking for abnormal collections of blood vessels near the surface of the skin (spider angiomas), redness of palms and hands (palmar erythema), and an increased amount of breast tissue in men (gynecomastia).
   • Examining the abdomen completely to evaluate for enlargements of the liver and spleen, right upper quadrant tenderness, and ascites (fluid build-up in the stomach).
2. Laboratory evaluation

   The laboratory evaluation to determine the etiology of jaundice should include:

   • Fractionated bilirubin: Used in the diagnosis and treatment of liver diseases, hemolytic disorders, hematologic disorders, and metabolic disorders, including hepatitis and gallbladder obstructive disease.
   • Complete blood count (CBC): To identify hemolysis and evaluate for anemia of chronic disease and thrombocytopenia, which is common in acute deterioration of liver function.
   • Alanine transaminase test and aspartate transaminase test: To check for hepatocellular damage.
   • γ-Glutamyltransferase test: An elevated γ-glutamyltransferase level can be associated with biliary obstruction and hepatocellular damage.
   • Alkaline phosphatase test: An elevated alkaline phosphatase level can be associated with biliary obstruction and parenchymal liver disease, but it is also associated with several other physiologic and non-biliary pathologic processes in bone, kidney, intestine, and placenta.
   • Other tests: Low levels of prothrombin time (INR), albumin, and protein can indicate decreased synthetic function and liver decompensation.

   Note: If the etiology of jaundice is unknown after the initial laboratory evaluation, it is necessary to perform additional tests including hepatitis panel and autoimmune panel such as antinuclear, smooth muscle, and liver-kidney microsomal antibodies.

3. Imaging

   Noninvasive imaging modalities in individuals with jaundice include:

   • Ultrasonography and dual phased computed tomography (CT): These are used to evaluate obstruction, cirrhosis, and vessel patency of the liver.
   • Magnetic resonance cholangiopancreatography: To visualize the intra and extrahepatic biliary tree.
4. Liver biopsy

   Liver biopsy is performed in cases of jaundice where the diagnosis remains unclear after the initial history and physical examination, laboratory studies, and imaging tests.

Jaundice is related to liver function. Since there are numerous causes for jaundice, there are no perfect prevention guidelines. The basic way to prevent jaundice is by taking care of the liver with several lifestyle changes such as:

• Avoiding hepatitis infections
• Maintaining a healthy weight to prevent being overweight or obese
• Monitoring cholesterol levels
• Eating a well-balanced diet
• Exercising regularly
• Controlling alcohol consumption
• Avoiding exposure to toxins from chemicals and other sources, both inhaled and touched
• Managing medications carefully by not exceeding the recommended dose
• Consulting a doctor before starting any herbal therapies
• Quitting smoking and avoiding recreational drugs
• Getting the recommended vaccinations before traveling
• Practicing safe sex and using condoms to reduce the risk of infections
• Undergoing a full body checkup if there is a family history of autoimmune conditions

Jaundice usually does not require treatment in adults; however, the management is primarily based on the underlying cause of jaundice. The treatment of choice is the correction of the underlying hepatobiliary or hematological disease. Below are some options for the treatment and management of jaundice:

• If the cause of jaundice is acute viral hepatitis, it typically resolves on its own as the liver begins to heal.
• Surgery may be necessary if the cause of jaundice is a blocked bile duct.
• Pruritus (itchy skin) associated with cholestasis can be managed based on severity.
• For mild pruritus, warm baths or oatmeal baths can help relieve discomfort.
• Antihistamines may also alleviate pruritus.
• Patients with moderate to severe pruritus can benefit from medications such as cholestyramine or colestipol.
• Other less effective therapies include:
• Rifampin
• Naltrexone
• Sertraline
• Phenobarbital
• Hemolytic jaundice is treated with iron supplements. Including iron-rich foods in the diet is also beneficial.
• Steroids can also be effective in treating jaundice.
• Liver transplantation may be the only effective therapy for pruritus if all medical treatments fail. A liver transplant is also suggested if jaundice is due to liver decomposition, depending on the severity of liver injury.

Iron helps build hemoglobin levels, making individuals more energetic and active.

Individuals suffering from jaundice generally feel fatigued, have a low appetite, and experience itchy skin. It usually improves on its own; however, it is important to address the underlying cause of jaundice. To manage the condition at home, several measures can be taken:

• Eat pleasant-tasting bland food.
• Maintain a well-balanced diet that is low in fat.
• Avoid supplements, herbs, or medications that may cause side effects.
• Drink fluids and juices as much as possible.
• Ensure adequate amounts of rest.
• Follow the instructions provided by the doctor.
• Avoid any herbal medications or therapies.
• Take prescribed medications as directed by the doctor.
• Apply moisturizer for itchy skin.
• Take warm water baths.

The food you eat plays a vital role in your mental and physical wellness. Read more about 6 tips to reap the benefits of a healthy diet.

These vary depending on the medical conditions, the type of jaundice, and severity. Some common complications include:

• Bleeding
• Constipation
• Abdominal pain
• Gastritis
• Diarrhea
• Anemia
• Infections
• Bloating of the stomach
• Swelling in the legs
• Liver cirrhosis
• Kidney failure

Some of the uncommon complications seen in severe conditions include:

• Primary sclerosing cholangitis (disease of the bile duct)
• Cholangiocarcinoma (cancer of the bile duct)
• Hepatic amyloid (amyloid deposits in the liver)
• Chronic hepatitis (inflammation of the liver)
• Cholangitis (inflammation of the bile duct)

Jaundice may indicate another condition or disease. Diagnosing the cause and obtaining proper treatment can be key to a healthy recovery. Here are some of the alternative therapies:

Unani
Unani is a traditional medicine practiced in South Asia and modern-day Central Asia. According to this therapy, an oil-free and bland diet along with adequate rest is essential for recovery from jaundice. Here are some helpful dietary tips for those affected by jaundice:

• Eat a diet that is easily digestible, usually a liquid diet.
• Incorporate a high-carbohydrate diet without spices and fat.
• Drink enough fluids and always consume boiled water.
• Eat vegetables and fruit juices that are raw or steamed.
• Add fruits, yogurt, and porridge to the diet.
• Karela (bitter gourd) and saijan ki phalli (drumsticks or moringa) are very beneficial for jaundice patients.
• Increase the intake of foods rich in calcium and other minerals like iron and magnesium.
• Consume smaller, more frequent meals.
• Fasting with fruit juice for about one week is very effective for patients.
• Fruits are natural laxatives, diuretics, and fat burners. They are a powerhouse of fiber, energy, vitamins, minerals, and antioxidants.

Home Remedies
Some of the popular food items that can help in the treatment of jaundice are:

1. Sugarcane (Ganna) juice: It aids in strengthening the liver and helps in its proper functioning.
2. Yogurt (Dahi): The probiotics in yogurt help in decreasing bilirubin levels by fighting against harmful bacteria and increasing immunity.
3. Tomatoes (Tamatar): They contain lycopene, a potent antioxidant that assists in liver detoxification.
4. Indian gooseberry (Amla): Rich in Vitamin C and essential nutrients, it helps improve liver function and balance serum bilirubin levels.
5. Goat’s milk: It is easy to digest and contains antibodies that can help in curing jaundice.
6. Grape (Angoor) juice: Grapes, especially green ones, help improve liver function and balance serum bilirubin levels.
7. Ginger (Adrak): Ginger has excellent antioxidative properties and can help reduce cholesterol levels, aiding liver recovery.
8. Garlic (Lahsun): A powerful antioxidant, garlic helps with liver detoxification and contributes to curing jaundice.
9. Lemon (Nimbu): Lemon juice enhances immunity and prevents further liver damage by unblocking bile ducts due to its antioxidant properties.
10. Holy basil (Tulsi): It protects the liver, increases immunity, and fights infections.
11. Papaya (Papita) leaves: They are rich in enzymes that support digestion and improve liver health.

All the conditions associated with jaundice require medical diagnosis and treatment. In some cases, the only treatment needed may be observation. Jaundice can be managed with certain lifestyle modifications, including:

• Maintaining proper hygiene to avoid infections
• Decreasing alcohol consumption
• Focusing on eating a well-balanced diet
• Consulting doctors before starting any herbal therapies
• Avoiding medications that have adverse effects on the liver
• Drinking adequate fluids
• Exercising regularly
• Getting vaccinated for hepatitis B and hepatitis C infections