A symptom, not a disease
Diagnosis of jaundice need not create panic. it is important to identify the underlying cause and treat it appropriately, writes Dr. G. RAMAR.
DETECTION of jaundice in a person frightens the patient and his/her family. It is important to realise that jaundice itself is not a disease. It is only a symptom of diseases affecting the liver and biliary system. The yellow discolouration of the eyes and skin with the high coloured urine is due to increased amount of a bile pigment, Bilirubin, in the blood stream. In healthy persons, the level of bilirubin is kept under check (below one mg/dl). The bilirubin pigment is the breakdown product of old Red Blood Corpuscles (RBCs) in the blood. When the liver is diseased, bilirubin is not cleared resulting in jaundice. On the other hand, when the bile passages (ducts) are blocked by gallstones or by tumours, it results in obstructive jaundice.
Since jaundice is a symptom, it is important to identify whether the liver is involved or the biliary passages are blocked. Most cases are a consequence of viral infections of the liver and are often self-limiting. The treatment of jaundice is the treatment of the underlying disease.
Three groups of liver diseases are common. They are viral infections; alcoholic liver disease; drug induced Hepatitis.
Types of Viral Hepatitis include Type A to Type E. Type A and Type E occurs mainly by drinking contaminated water. The first occurs mainly in children and uneventful recovery is common. Type E also runs a mild course and total recovery is the rule, except in some pregnant women.
Type B infection is transmitted through blood and blood products (Common means include needle stick injuries and in apparent percutaneous transmission); From infected mother to infant at the time of delivery; By sexual route.
Ninety to 95 per cent suffering from Acute Viral Hepatitis Type B recover completely. Five per cent end up with progressive chronic disease and are likely to develop end stage liver failure requiring transplants.
Hepatitis C is transmitted via blood and blood products. Majority of those affected with Hepatitis C run a chronic course leading to end stage liver failure and in some cases, cancer.
Hepatitis D cannot occur independently. It occurs in persons suffering from Hepatitis B infection. In India, there are an estimated 40 million people carrying Hepatitis B infection without overt or covert manifestations of liver disease. They serve as a reservoir of infections responsible for the spread of Hepatitis B. Unfortunately no effective treatment is available for carriers of Hepatitis B infection. Hence the susceptible population need to be protected by vaccination.
Some drugs used to treat other diseases may also affect the liver and lead to jaundice. This is known as drug-induced Hepatitis.
The physician needs to detect the offending drugs early and they should be withdrawn promptly to prevent serious liver injury.
Obstruction of biliary passages is usually due to gallstones and tumours. They occur mostly in elderly people. Treatment involves removal of stones by surgery and by endoscopic means. Obstructive jaundice due to tumours (cancer) is serious and fatal. Only palliative treatment can be offered for malignant biliary obstruction.
In India, most of the jaundice occurring due to viral infections is self-limiting. There is no need for unwarranted stringent diet restrictions in treating these patients. Unpalatable restrictive diets can adversely affect the nutritional status of the patients, leading to complications.
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