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Jaundice

Jaundice is the most common of all liver disorders. Jaundice is a yellow color of the skin, the mucous membranes, sclera of eyes.
Icterus is defined as a sign in which yellow discoloration of sclera occurs where as jaundice is defined as a clinical condition diagnosed after laboratory investigation.
When red blood cells are removed from the bloodstream, hemoglobin, the molecule in red cells that carries oxygen, is broken down into bilirubin. The bilirubin is carried to the liver and excreted into the intestine as a component of bile.
Jaundice is a condition produced when excess amounts of bilirubin circulating in the blood stream dissolve in the subcutaneous fat (the layer of fat just beneath the skin), causing a yellowish appearance of the skin and the whites of the eyes. With the exception of physiologic jaundice in the newborn (normal newborn jaundice in the first week of life), all other jaundice indicates overload or damage to the liver, or inability to move bilirubin from the liver through the biliary tract to the gut.

Causes:
1.Pre- hepatic causes:
   Pre- hepatic jaundice is caused by increased hemolysis of red blood cells.
a.Malaria
b.Genetic diseases like- sickle cell anemia, spherocytosis, glucose 6-phosphate dehydrogenase deficiency.
c.Kidney disease like-hemolytic uremic syndrome.
2.Hepatic causes:
a.Acute hepatitis.
b.Autoimmune hepatitis
c.Alcoholic liver disease.
d.Viral hepatitis.
e.Primary biliary cirrhosis
f.Gilbert's syndrome (a genetic disorder of bilirubin metabolism)
g.Crigler-Najjar syndrome
3.Post- hepatic causes:
a.Gall stones in common bile ducts,
b.Carcinoma of head of pancreas.
Neonatal Jaundice
A common condition in newborns, when a baby has jaundice, either too much bilirubin is being produced or the liver does not get rid of it quickly enough. A newborn baby's liver is not fully matured, so jaundice is common during a baby's first few days of life.

There are following kinds of jaundice:
1.Physiological jaundice: It is common in newborn babies. It usually becomes noticeable during the baby's first three to five days of life. It disappears as the baby's liver matures. This type of jaundice is not harmful.
2.Pathological jaundice: In some situations, however, there is so much bilirubin in a baby's blood that it can be harmful. This condition is called pathological jaundice. If the level of bilirubin becomes very high, it may affect some of the baby's brain cells. This may cause a baby to be less active. In rare cases, a baby may have seizures (convulsions). Pathological jaundice may also lead to deafness, cerebral palsy and/or mental retardation. Pathologic jaundice can occur in children or adults. It arises for many reasons, including blood incompatibilities, blood diseases, genetic syndromes, hepatitis, cirrhosis, bile duct blockage, other liver diseases, infections, or medications.
3.Jaundice of pre-maturity: this occurs frequently in premature babies since they take longer to adjust to excreting bilirubin effectively.
4.Breast milk jaundice: In 1% to 2% of breastfed babies, jaundice can be caused by substances produced in their mother's breast milk that can cause the bilirubin level to rise above 20 mg. These substances can prevent the excretion of bilirubin through the intestines. It starts at 4 to 7 days and normally lasts from 3 to 10 weeks. The cause is thought to be inadequate milk intake, leading to dehydration or low caloric intake. It is a type of physiologic or exaggerated physiologic jaundice.
5.Not-enough-breast milk Jaundice: This may occur because the baby is not getting enough milk. This is because sometimes the mother's milk takes a longer than average time to "come in", or because the baby is poorly latched on and thus not getting the milk which is available.6. Blood group incompatibility (Rh or ABO problems): if a baby has a different blood type than the mother, the mother might produce antibodies that destroy the infant's red blood cells. This creates a sudden buildup of bilirubin in the baby's blood. Incompatibility jaundice usually begins during the first day of life.
6.Inadequate liver function: Jaundice may be related to inadequate liver function due to infection or other factors.
Symptoms:
Jaundice by themselves, causes few problems. Jaundice can turn the skin and sclerae yellow. In addition, stool can become light in color, even clay-colored because of the absence of bilirubin that normally gives stool its brown color. The urine may turn dark or brownish in color. This occurs when the bilirubin that is building up in the blood begins to be excreted from the body in the urine.
The symptom that is associated most frequently is itching, medically known as pruritus. The itching associated with jaundice can sometimes be so severe that it causes patients to scratch their skin "raw," have trouble sleeping.

It is the disease causing the jaundice that causes most problems associated with jaundice. Specifically, if the jaundice is due to liver disease, the patient may have symptoms or signs of liver disease or cirrhosis. The symptoms and signs of liver disease and cirrhosis include fatigue, swelling of the ankles, muscle wasting, ascites (fluid accumulation in the abdominal cavity), mental confusion or coma, and bleeding into the intestines.

If the jaundice is caused by blockage of the bile ducts, no bile enters the intestine. Bile is necessary for digesting fat in the intestine and releasing vitamins from within it so that the vitamins can be absorbed into the body. Therefore, blockage of the flow of bile can lead to deficiencies of certain vitamins. For example, there may be a deficiency of vitamin K that prevents proteins that are needed for normal clotting of blood to be made by the liver, and, as a result, uncontrolled bleeding may occur.

Investigations:
1.Complete Blood count
2.Blood serum Bilirubin
3.Ultrasound of whole abdomen
4.Liver function tests and cholesterol
5.Liver biopsy
6.CAT Scan Cholescintigraphy
7.ERCP-Endoscopic Retrograde Cholangio-Pancreatography
8.Magnetic Resonance Imaging (MRI Scan)

Laboratory Results
Laboratory Tests

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