High level of bilirubin in serum is a root cause for the incidence of jaundice among adults. It may be noted that smokers (with an acute dependence on tobacco) are known to have a higher level of bilirubin. Among the various races, Mexican-Americans as well as white, non-Hispanics are known to have high levels of bilirubin. Also, when your bile duct gets blocked, it may lead to jaundice. This actually remains as one leading cause for jaundice among people living in developed countries. In the developing nations, it is caused by malarial infections or hepatitis (inflammation of liver) caused by viral infections. In general, men are more vulnerable to incidence of jaundice than women. In order to become familiar with what really causes jaundice, you may need to have a proper understanding of the bile, bilirubin and a deeper knowledge about the functioning of your liver.
Bilirubin is formed while your body clears waste formed by the breakdown of older red cells in your blood. Standard or usual level of bilirubin in your blood is under 1.0 mg / dL. If this level reaches more than 2 or 3 mg / dL, it can lead to a medical condition called jaundice. In essence, jaundice is associated with the abnormal metabolism of bilirubin.
Bilirubin is of two types – namely, conjugated or unconjugated bilirubin.
Conjugated genre of bilirubin (in excessive quantities) may form when you have hepatic disorders such as inflammation of liver (popularly known as hepatitis), cirrhosis of liver, etc. It can also get triggered by internal blockages in the duct of your bile. There are a few medical conditions that may also lead to incidence of jaundice. For instance, cancers in your pancreas, inflammation of pancreas (also called as pancreatitis) or formation of gallstones may trigger a blockage in your biliary duct. A few viral infections or intake of a few types of drugs are also known to trigger a high level of bilirubin in your body.
High concentration of unconjugated forms of bilirubin is triggered due to congenital conditions such as Gilbert’s disorder or syndrome (a condition wherein your liver is unable to process or breakdown bilirubin). It can also show up when you suffer bruises (of fairly large sizes), catabolism (breaking down) of a large amount of red cells of your blood, thyroid related disorders, etc. This form of jaundice can also form among newly born babies as well as those who skip eating for a longer span of time.
Types of jaundice
As mentioned above, jaundice is linked to an improper breakdown of bilirubin, development of internal blockages in your duct carrying bile or due to a few problems in your liver (such as hepatitis or cirrhosis). The most common indicator – across most of these conditions – is the presence of bilirubin at more than 3 mg / dL. Based on the part of your body that stands affected, jaundice is categorized into three distinctive types.
Hepatocellular or simply, hepatic form of jaundice – This shows up as damage of your liver cells. These cells are commonly referred to as hepatocytes. Damages occur when your liver has problems in processing bilirubin. This condition can show up due to a variety of triggers such as intake of a few drugs, infections in the liver as well as due to a few autoimmune conditions. Common reasons include excessive intake of alcohol (or, dependence on alcohol), liver cirrhosis, inflammation of liver (hepatitis – both as a chronic condition and in an acute form), medications-induced inflammation of liver, etc. A few genetic disorders such as Crigler – Najjar syndromes (both types of this condition)are also found responsible for hepatic genre of jaundice.
Hemolytic or pre-hepatic form of jaundice – This is known to show up because of the rupture of red cells in your blood. There can be either intrinsic or extrinsic reasons for this rupture. This is named so as it shows up before your liver starts metabolic processes. The rupture of red cells increases the presence of bilirubin (especially, the unconjugated genre); this it eventually leads to accumulation of excessive bilirubin in your mucus. Such rupture of red cells in your blood can be observed in conditions like thalassemia (reduced production of hemoglobin), acute spells of malaria, a certain forms of anemia (sickle-cell genre), etc.
Cholestatic or post-hepatic form of jaundice – This condition is observed while your body finds it difficult to excrete bilirubin or if there is a blockage in your biliary duct. As this occurs soon after the breakdown of bilirubin in your liver, it is called as a post-hepatic condition. This post-hepatic condition is associated with formation of stones in your bile duct (called as gallstones), cancers in the pancreatic region, presence of parasites, pregnancy (especially during the third term – which can harm both the baby and mother), infectious conditions of your biliary duct, etc.
Symptoms and diagnosis of jaundice
The most widely observed sign of jaundice among adults is the discoloration of your skin and eyes. This distinctive sign indicates that bilirubin in serum has reached 3 mg / dL or more. As bilirubin irritates your skin, those who have high levels of it may experience a persistent spell of acute itchiness. High bilirubin often deposits in the sclera (which forms part of your eye); this is because of the high level of elastin in your eye which draws excessive bilirubin towards it. As a result, the white areas of your eyes may turn yellow. The other noteworthy symptoms associated with jaundice include fatty stools, darkening of urine, etc.
A panel of tests to understand the functioning of your liver is a common approach to detect the incidence of liver. The chief function of these tests is to help your doctor understand the condition of your liver as well as how it works. These can be inferred from the level of a few proteins and enzymes in the blood. The tests are done by taking a sample of your blood. Blood samples are usually taken from the arm, closer to your elbow. This blood test is not a one-time investigation; your treating doctor will tell you to go for another test after a few weeks. With such tests done over a period of time, your doctor assesses the functioning of your liver (i.e., from the levels of enzymes or proteins measured over several time intervals spanning many weeks). Most of the liver functioning tests focus on measuring the levels of enzymes as well as proteins such as –
This is secreted from the bile as well as from your urine. As mentioned, the tests focus on reading the levels of the 2 known variants namely of bilirubin – namely, unconjugated and conjugated bilirubin. Unconjugated bilirubin is a substance which is soluble in fat. It is formed when your red cells break down. A safer range of unconjugated bilirubin varies between 0.1 to 0.65 mg / dL. On the other hand, conjugated bilirubin is soluble in water.
Liver damage or swelling of your liver can lead to an increase in the presence of the conjugated form of bilirubin. Its safe range is observed as 0.05 to 0.35 mg / dL. Medical studies have also calibrated a normal or safe range for total bilirubin – the normal range stands at 0.1 to 1.0 mg / dL. When the quantum of total bilirubin breaches 1.5-times this usual / standard upper limit, it is often diagnosed as a condition of liver damage or injury. When this range reaches beyond 2-times the upper limit, it is labelled as a spell of jaundice.
Apart from tests done to check the levels of bilirubin, your treating doctor may recommend a complete blood count (CBC) – also known as full blood count. The CBC helps count the number of white cells, red cells as well as platelets in your blood. CBC checks for differentials in these cell counts. As pregnant women are more likely to develop anemia, they run added risks of developing jaundice. In such instances, it may adversely affect the health of both babies and mothers. Your doctor may advise periodic measurements of the count of blood cells to assess any likely drop in these cells.
Hepatitis A, B or C tests – These tests focus on detecting the levels of proteins such as albumin, globulin, etc. as well as enzymes such as alanine aminotransferase (ALT), alkaline phosphatase (ALP) and aspartate aminotransferase (AST).
Albumin is a kind of protein that is made in your liver. This protein takes a lion’s share in the total amount of proteins produced by your liver. A safe range of this protein is between 3.5 to 5.3 g / dL. But if a test reveals abnormal amounts of albumin, it denotes a likely injury to your liver – especially, cirrhosis.
Alanine aminotransferase (ALT) –
This enzyme is seen in sizable levels in your liver. Always remember that it is also present in your kidneys and muscles, though in very limited quantities. Damage to the liver can enhance its levels.
A safer range of its presence is between 7 to 56 units per liter of serum. If its level reaches 480 units or more, it is construed as a likely liver condition. Causes attributed of its increase include presence of toxins, or hepatitis (swelling of your liver).
Among the possible risks, it is more likely to be hepatitis C (which may escalate the levels of this enzyme) than other hepatic conditions such as hepatitis A or B. Your treating doctor may advise you to take liver tests on a regular basis. If this enzyme fares persistently at a higher level for several weeks, it may be due to a chronic hepatic condition.
Alkaline phosphatase (ALP) –
This is another enzyme found in the linings of the bile ducts. Its safe range is between 40 to 133 units per liter. Increase in these levels is attributed to an episode of hepatitis. However, a milder rise can be due to conditions such as an injury, damage or cirrhosis of the liver. Pregnant women are likely to have it in increased levels in their placenta; it can be in the order of 190 units or even more. Pregnant women may report such high levels at fairly advanced stages of their pregnancy.
Aspartate aminotransferase (AST) –
This is an enzyme your liver uses a lot. Its safe range is between 5 to 35 units per liter of serum. If your blood carries a higher level of this enzyme, it may indicate a possible liver problem. As this is also made in your muscles, the treating doctor may want to rule out likely muscular conditions.
Other approaches to diagnose jaundice
As a very direct measure, your doctor may recommend a biopsy of the liver. A panel of tests done of hepatic tissues can help detect fat accumulation in the liver, cancers, swelling or cirrhosis of the liver. This approach involves extracting a tissue-sample from your liver (often through a needle). The tissue is then seen under a powerful microscope to check its present condition.
Your doctor may also use radiology and imaging examination. The most common tools used under this domain include ultrasound, CT or an MRI scan. These scans help your doctor detect a possible incidence of an internal blockage. In some cases, your doctor may also do an endoscopic retrograde cholangiopancreatography (widely known as ERCP); this employs the use of x-rays along with an endoscopic procedure.
Ultrasound-scan – This is a painless approach to assess the condition of your liver. It is primary done to detect problems in your duct carrying bile or your gallbladder. It is also a proven approach to locate gallstones – if any, in your bladder. Not stopping with these, the scan is also used to assess the condition of your pancreas as well as liver.
CT scan – Though it can help detect problems in your abdomen, pancreas and liver, it has limitations in revealing presence of stones in your gallbladder.
MRI scan – It is often used to assess the medical condition of the duct that carry bile.
ERCP – A tube fitted with a camera is inserted to reach your intestine. It is mainly used to assess if your biliary duct has constricted or if there are stones present in your gallbladder. A dye to serve as a contrast medium is used to enable x-ray radiations to detect anomalies, if any.
In general, treatment for jaundice includes administration of IV fluids (primarily to arrest spells of dehydration), transfusion of blood and prescription of antibiotics as well as antiviral drugs. The leading cause for jaundice needs to be identified prior to developing or starting a treatment plan. Without understanding its root cause, treating the signs of jaundice is of no avail.
If hepatitis is the cause for jaundice, your treating doctor will prescribe steroids or antiviral drugs. Drugs like lamivudine, ribavirin or adefovir dipivoxil are commonly prescribed as part of treatment. Of these drugs, ribavirin works well to fight hepatitis C. This drug inhibits the synthesis of the DNA of hepatitis C virus and thus stops further spread of its infections. Adefovir dipivoxil is used for the removal of traces of hepatitis B virus from your blood. These drugs can also limit conditions such as cirrhosis and cancers in the liver. Lamivudine is used for treating hepatitis B; as it is a powerful antiviral drug, it is also used to treat severe viral attacks such as HIV AIDS, etc.
Ribavirin 200mg – For hepatitis-triggered conditions
This drug belongs to a genre called antivirals. It is used as part of treatments offered to chronic spells of hepatitis C. Its main function is to stop the spread of viral infections by working on cell structures of germs. The drug can stop the virus from reproducing or multiplying further. This action leads to reducing the intensity of hepatitis C. It may also be taken along with fellow-antiviral medications like interferon. Likely side effects of this drug include nausea, headache, feeling drowsy, blurring of eyesight, sleeplessness, etc. If you are having prior medical conditions such as pancreatic dysfunction; if you are diabetic or currently having an episode of anemia, you need to keep your doctor informed about such conditions. This drug may interact with acid reflux meds as well as HIV AIDS drugs. It may also react with drugs such as didanosine or zidovudine.
Adefovir dipivoxil – For hepatitis-triggered medical conditions
Hepatitis B can be triggered when you have sex with a person already affected by this virus, if you use infected needles, through needle stick injuries, etc. Babies are at risk as they may get it from their mothers – especially while being born. Antiviral medications such as Adefovir Dipivoxil are widely administered for treatment. This medication works by removing viral strands from your blood. It thus inhibits the spread of hepatitis B virus and arrests the extent of its infections. Adefovir Dipivoxil may cause a few side effects; most common among them are headache, weariness, nausea, vomiting, etc. If these side effects are persisting for long, it is highly recommended to talk to your treating doctor on an emergency basis. This drug may interact with non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, etc. If you have a clinical history of strokes, renal disorders, cardiac problems, etc. you need to tell about such conditions to your treating doctor.
Iron supplements for jaundice triggered by anemia
If jaundice is triggered by blood disorders such as anemia, your condition may be treated with iron supplementing drugs. Your dietician may also advise you to consume foods that are rich in iron.
Integra 100mg is an iron supplement aimed to correct the imbalance of iron in your body. This drug is widely administered to set right iron deficiencies during pregnancy. Your doctor may prescribe it when the need for iron in your body exceeds its supply. Whenever your body is suffering from a poor supply of this essential mineral, inflammation is a common thing to occur. Upon confirming the need for iron, this drug is administered until iron is found in normal levels in your body. You may need to remember that it may take some time – upto say, 2 months or even more – for positive results to show up.
Likely side effects of taking this supplement are darkening of stool, diarrhea, problems with digestion, etc. If your medical history has prior occurrences of metabolic problems or internal ulcers, you need to inform your doctor about such conditions. Stay aware about the drug’s ability to interact with calcium channel blocking drugs, alpha blocking medications, nitrates, etc.
At times, an internal blockage an also trigger jaundice. These internal blocks can be removed through surgical interventions. In some instances, jaundice may be an outcome of taking a drug. In such spells, your doctor may stop your existing course of drugs and may administer safer, alternative medications.
Jaundice among babies
More than 55% of newly born babies may develop jaundice within 3 days of their birth. If the baby is prematurely born, the risks only become higher. As livers of babies are not fully developed, they may be ineffective in their filtering function. As a result, babies may have a high level of bilirubin; however, this will go away in less than a fortnight after their birth. But, if the baby has persistently high levels of bilirubin for a fairly longer span of time, it needs to be resolved either through phototherapy or by transfusion of blood.
How to manage jaundice at your home?
The cause of jaundice will decide what kind of care you may require. For some people, visits to your doctor’s clinic may be needed only over a very short-term period. However, for a few patients – a long term observation or follow-up is needed.
At home, you are advised to adhere to the advice of your doctor as well as your dietician. You are advised not to take alcohol; even a small quantity of alcohol may cause serious effects in patients with liver problems. It is also very important to drink a lot of fluids; this is one sure way to always stay hydrated. Along with hydration, you will also need to take a lot of rest at home. It becomes essential to consume all the drugs prescribed to you. It is a good practice to take drugs at the same times each day; your drugs’ efficacy levels as well as your body’s ability to absorb the drugs may increase if same timings are adhered. Last but not least, the medicines prescribed to you may interact with other drugs or herbal medicines. So, before taking any supplements or drugs, you are advised to talk to your treating doctor and take needful consent.
Newly born infants may need to be nursed near windows with proper supply of natural light. Infants kept near windows in naturally lit ambience have shown decreased levels of bilirubin. In most cases, the child specialist may discharge your baby with a home-variant of a phototherapy kit. It is also vital to provide sufficient quantities of milk for your infant.
How to prevent a likely onset of jaundice?
A few of the popular approaches to prevent jaundice are – taking shots of vaccines for hepatitis, stay away from drinking alcohol (those who drink large quantities may need to control its intake), keep off from having sex with unknown people (who may be infected) and refrain from taking foods or fluids from possibly contaminated sources. Some drugs are known to cause hemolysis. Check with your doctor about drugs which can trigger these risks and avoid taking such drugs after taking needful consent from your treating doctor.
In sum, jaundice can be managed at home if it is not a chronic condition. Once your doctor zeros-in the cause, non-chronic jaundice can be treated with proper medications and needful care to support the patient. If the causes have led to a chronic condition, it may require a fairly long term medical support to manage it well. You may need to stay aware that in some instances jaundice can lead to near-fatal or fatal outcomes. So, it is essential to talk to your treating doctor and adhere to the treatment plan without any possible lapses.