24th Sept 2020
Yellowish discolouration of eyes, skin and body fluids (Jaundice) has been long known to mankind as an ominous marker of disease. Jaundice is often accompanied by followed symptoms
- loss of appetite (Anorexia),
- itching all over the body (Pruritus),
- high coloured urine,
- pale white clay coloured stools.
Etymology of word “Jaundice”:
The term jaundice has its origins in the French word “jaune “meaning yellow. The technical term for jaundice in medical parlance is “Icterus”. It comes from modification of the greek word ikteros. Icteria (Yellow-breasted chat) is a songbird. In ancient days it was believed that sight of this bird will cure jaundice. Also the yellow colour of breast of Icteria is similar to appearance of eyes in jaundice.
How jaundice occurs:
Blood in our body has small disc shaped units (cells) called RBCs. Their main function is to transport oxygen. After completion of life span when these cells are broken down, the waste is discarded from body in form of a yellow coloured pigment called “Bilirubin”. Bilirubin and its derivatives are responsible for yellow colour of urine and the brown colour of stools. Liver takes up bilirubin from blood and processes it further. Liver secretions (bile) carry it to intestine from where it is excreted out of body.
Disturbance at any of the above mentioned processes can lead to abnormal accumulation of Bilirubin and its derivatives. The accumulated yellow pigment gets deposited in skin, white part of eyes and other areas. This leads to yellowish discolouration of eyes and skin which is Jaundice.
Jaundice is a manifestation of underlying disease and not the disease itself.
Various common causes of jaundice are:
- Increased production of bilirubin (Increased breakdown of RBCs):
In some hereditary diseases, RBCs produced are abnormal and fragile leading to increased breakdown (Haemolytic anemias). Increased breakdown can also be due to toxins, drugs, infections, etc.
- Abnormal function of Liver:
Deranged liver function limits the ability to clear bilirubin from blood, process it in liver and excrete it in bile. Ingestion of excess alcohol is a common cause of liver damage. With prolonged alcohol abuse irreversible changes occur and liver becomes cirrhotic. Viral hepatitis (especially Hepatitis B and C) is also a common cause of jaundice and liver cirrhosis.
- Obstruction to flow of bile:
Obstruction can occur due to stones or strictures in bile ducts (ducts which carry bile from liver to intestine). Stones are relatively easy to manage. Strictures which are often due to cancers, pose a challenge to the treating doctor. Often complicated prolonged surgeries are required.
As we have seen, the causes of jaundice are varied. Management of jaundice often requires multidisciplinary approach. Expertise of doctors of various specialities is used to form a comprehensive individualised treatment plan.
As a treating doctor we can do best justice to our patients when the disease is diagnosed at early stages before secondary complications set in. Whenever there is a doubt of jaundice, getting oneself evaluated at the earliest helps.
Dr Hemant Jain.
MS MCH (GI Surgery).
Laparoscopic and GI Cancer surgeon.
Nanavati hospital. Bombay Hospital. Criticare Hospital Andheri. Upasani Hospital Mulund (W).