Jaundice
Jaundice is a yellowing of the skin and eyes caused by an excess of bilirubin in the blood, which is a pigment formed from the breakdown of hemoglobin in red blood cells. It is important to note that jaundice is not a disease itself, but rather a symptom of various underlying health conditions affecting the liver or blood. The increase in bilirubin can result from several factors, including increased breakdown of red blood cells, liver dysfunction, or blockage of bile ducts. The initial visible signs often appear in the sclera of the eyes, transitioning to the skin as bilirubin levels rise.
Diagnosis typically involves determining whether the bilirubin is conjugated or unconjugated, which helps identify the underlying cause. Conditions leading to high unconjugated bilirubin levels often involve hemolysis, while elevated conjugated bilirubin may indicate blockages or liver diseases. Newborns frequently experience a common form known as physiologic jaundice. Treatment is tailored to the cause and may involve addressing the underlying conditions responsible for the bilirubin buildup. Cultural sensitivity is vital when discussing jaundice, particularly in understanding its implications and management across diverse populations and medical practices.
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Subject Terms
Jaundice
Anatomy or system affected:Blood, liver, skin, eyes
Definition:Yellow discoloration of skin and eyes resulting from increased levels of bilirubin in the blood.
Causes and Symptoms
Jaundice is not a disease but rather a common sign of various disorders in the liver or the blood. Bilirubin is a pigment formed by the breakdown of hemoglobin, the oxygen-carrying molecule in red blood cells. Bilirubin is then transported to the liver, where it is processed into a water-soluble form. This process is known as conjugation. Conjugated bilirubin is secreted into the bile ducts and eventually excreted in feces. An increase in red blood cell breakdown, impairment in liver function, or blockage of the bile ducts can all result in the buildup of bilirubin. The first visible manifestation of this is often scleral icterus, a yellowing of the white part of the eyes. When levels of conjugated bilirubin are abnormally high, it may be seen in the urine as urobilinogen, which causes a darkening of the urine.
Once the bilirubin level in the blood exceeds two and a half milligrams per deciliter, the yellow skin discoloration of jaundice can be seen. It is apparent first at the bottom of the tongue and later throughout the skin. Jaundice is sometimes associated with itching, presumably because of the deposition of bilirubin under the skin.
Treatment and Therapy
The treatment of jaundice depends on its cause. The first step is to determine whether there is an excess of conjugated bilirubin or unconjugated bilirubin. High levels of unconjugated bilirubin suggest an increase in red blood cell breakdown, known as hemolysis. This condition can be confirmed by examination of a peripheral blood smear and other laboratory studies. Most cases of hemolysis are the result of another underlying cause, such as infection or drugs. Hemolysis can also result from the body’s immune system attacking its own red blood cells. Unconjugated bilirubin is also elevated in inherited disorders such as Gilbert’s syndrome and Crigler-Najjar syndrome. These disorders are usually detected in early childhood.
Excess conjugated bilirubin, on the other hand, suggests a blockage in the biliary tree, which can be attributable to gallstones or, less commonly, a tumor. Gallstones can be confirmed with ultrasonography and may require surgery if they cause symptoms. Rarer causes of blockage in the biliary tree include strictures and sclerosing cholangitis. Disorders of the liver itself can also result in high levels of conjugated bilirubin, but oftentimes both types of bilirubin are elevated. Liver diseases include viral hepatitis (hepatitis A, B, or C), as well as alcohol and drug-induced hepatitis.
Jaundice in newborn babies is a widespread condition, and 60 percent of babies are born with a form of jaundice called physiologic jaundice. Spending time under a bili-light usually clears this type of jaundice in the hospital. However, jaundice in newborns can indicate an underlying condition such as Rh disease, genetic conditions, sepsis, or internal bleeding.
Bibliography
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