Internal Medicine

Jaundice

Synonyms

Jaundice

Definition of jaundice

Jaundice is an unnatural yellow coloration of the skin or the conjunctiva of the eyes and mucous membranes, which is triggered by an increase in the metabolic product bilirubin. If the blood bilirubin in the body rises to values above 2 mg / dl, a yellow coloration is triggered.

What is jaundice?

Jaundice is the medical term for jaundice. A characteristic of jaundice is a visible discoloration of the skin and eyes or the “white of the eyes”, the so-called sclera.

The cause of the occurrence of jaundice is an increased amount of bilirubin, which is the breakdown product of the red blood pigment, so-called hemoglobin. The bilirubin can be divided into a direct form and an indirect form, depending on how far the metabolic process has progressed. There are many reasons for the occurrence of jaundice and should always be clarified by a doctor.

Forms and causes of jaundice

The metabolic product bilirubin is the breakdown product of the red blood pigment. If there is a disruption of transport or an increased attack, bilirubin is released to the surrounding tissue and then turns the skin, mucous membrane and dermis or conjunctiva of the eyes yellowish.

In principle, one differentiates between three main forms of jaundice (jaundice), which are derived from the place of origin.

Optic disc cancer can also lead to the development of jaundice. Jaundice (posthepatic jaundice) can develop due to the narrowing of the biliary tract caused by the tumor. Read more about this under: Optic disc carcinoma

Prehepatic jaundice

Prehepatic jaundice usually has its cause outside the liver, namely in the metabolic area that precedes the liver. These include hemolytic anemias, i.e. diseases in which blood components are dissolved. The product that is created is i.a. Bilirubin, which then turns the skin yellow. However, ineffective blood production can also lead to an increased attack of bilirubin and is therefore also counted as prehepatic jaundice.
The so-called Morbus Haemolyticus Neonatorum (neonatal icterus) is a special form. A blood intolerance in newborns. If a mother gives birth to a child with a different Rh group, she will form antibodies. When a second child is born, the antibodies are directed against the second child and attack its blood components. The child will i.a. conspicuous by jaundice.
Today this type of jaundice (jaundice) has become relatively rare, because precise checks on the mother and previous pregnancies are standard examinations.

Hepatic jaundice

Hepatic jaundice is caused by the liver. This includes all inflammations of the liver tissue, such as infectious hepatitis caused by viruses, bacteria and chronic hepatitis and liver cirrhosis, which are caused either by infections or by excessive alcohol consumption.

Diseases that result in increased bilirubin production (familial hyperbilirubinemia), poison-induced hepatitis caused by alcohol, carbon tetrachloride, and tuber poisoning are also among the intrahepatic causes of jaundice.
Since most drugs are metabolized in the liver after ingestion, it is also possible in the event of an overdose to damage the liver so severely that jaundice results (drugs hepatitis, drugs hepatitis).

Excessive alcohol consumption and cirrhosis of the liver can ultimately lead to congestive liver with what is known as portal hypertension, which hinders the flow of bile acids through the liver. One of the first symptoms of this congested liver (portal hypertension) is usually jaundice.

Numerous other diseases can also cause intrahepatic jaundice.
These are rare metabolic diseases, such as Wilson's disease, in which iron is stored abnormally in the liver, the liver can no longer work properly and the blood pigment bilirubin can no longer be disposed of.

Cicatricial sticking of the bile ducts, the so-called PSC (primary sclerosing cholangitis) and PBC (primary biliary cirrhosis) are further rare causes of intrahepatic jaundice. Inflammatory changes in the bile ducts after infusion of a chemotherapeutic agent or a thrombosis in the liver veins (Budd Chiari syndrome) are at times also causes of jaundice.

Idiopathic pregnancy icterus is a special form of intrahepatic jaundice. It is harmless for the mother, but if left untreated, around 10% of children die during childbirth and 20% of children are born prematurely. If there is a family history, there may be a disturbance of the bile acid outflow during pregnancy with an accompanying rise in bilirubin. In addition to yellowing, a concomitant symptom is usually an unpleasant itchy skin.

Posthepatic jaundice

Posthepatic jaundice is a drainage disorder from the outflow pathway of the liver and the bile duct system.
On the one hand, this can happen through a gallstone or adhesions formed after operations, but also through tumor formation in the bile duct or pancreas area. The jaundice (jaundice) is often the first symptom of this malignant disease, unfortunately the tumor is already well advanced at this point.

Newborn jaundice

In newborns, jaundice between the ages of 3 and 8 days is usually considered natural. This usually disappears again within 1-2 weeks.

As long as they are in the mother's womb, children still have red blood cells, which differ slightly from those of adults and also occur in much higher numbers. After birth, these blood cells are increasingly broken down and replaced by new ones, namely the same ones that adults also have. The strong accumulation of breakdown products of the red blood pigment or bilirubin is then responsible for the jaundice and generally to be regarded as harmless.

Caution is advised, however, in neonates with jaundice that develops in the first 24 hours of life or lasts longer than 10 days. It is also considered problematic if the concentration of bilirubin exceeds a certain value. In these cases, an immediate medical examination of the child is necessary.

Important information on this topic:

Newborn jaundice
Neonatal icterus

Cholestatic jaundice

Cholestatic jaundice is jaundice that is caused by impaired bile formation or secretion or a problem with the drainage of bile. The bile outflow disorder can be localized both in the liver and in the biliary tract, which is located outside the liver.

The bile naturally transports the blood breakdown product bilirubin into the intestine, which can then be excreted in the stool. If there is an obstruction of the drainage or the secretion of bile, the bilirubin cannot be properly excreted. The typical symptoms of jaundice then occur. Furthermore, cholestatic jaundice can become noticeable through the appearance of discolored stool, as the bilirubin, which normally gives the stool its typical brown color, is missing. Alternatively, the body tries to excrete the existing bilirubin through the urine, which then turns brown, as the stool normally does. Another symptom of jaundice can therefore be brown urine.

The cause of the disturbance of the bile production or secretion, as well as its outflow, can be a multitude of things. These include causes that are localized in the liver itself, such as inflammation of the liver or cirrhosis of the liver, i.e. cell death of the liver cells, which can have different causes. A tumor of the liver or the biliary tract running there can also lead to jaundice by blocking the flow of bile due to the growing tumor tissue.

Furthermore, drainage disorders outside the liver can occur due to mechanical obstacles, such as gallstones or inflammatory processes in the biliary tract. In addition, malformations of the biliary tract can obstruct drainage. Tumors of the pancreas or an inflammation of the same can also lead to jaundice. The reason for this is the anatomical proximity of the pancreas to the bile duct, which flows from the liver and gall bladder into the intestine.

Symptoms of jaundice

The jaundice is characterized by a coloring of the skin. Often the skin tone is described as yellowish, which is also reflected in the name of jaundice. If the total bilirubin rises above 2 mg / dl in the serum, not only the skin but also the eyes can be affected by the color. This is where the sclera show up, meaning the naturally “whitish part of the eye”, also in a yellowish tone.

Severe itching of the skin is also one of the symptoms of jaundice, but the exact cause has not yet been adequately clarified.

A dark color of the urine can also present in the context of jaundice. A discolored stool may also pass (more about this under: Yellow bowel movements - what do I have?). The stool then lacks its characteristic brown color, it appears much lighter than usual. The appearance of the symptoms depends on the cause of the jaundice. A change in the color of urine and stool, for example, occurs primarily in the case of blocked biliary tracts or in the case of drainage disorders in the biliary tract.

Also read: Colors of bowel movements

Accompanying the jaundice can also show fever, fatigue and an enlarged liver. This mainly occurs with inflammation or infection of the liver itself. Other accompanying symptoms then depend on the underlying cause of the jaundice.

Symptoms around the eyes

A coloring of the sclera or the white part of the eye occurs with increased bilirubin levels in the blood. The otherwise whitish sclera are then discolored yellow.

The jaundice of the eyes usually occurs before the skin turns yellow, as a lower concentration of bilirubin is sufficient for the coloration. The yellowing of the eyes alone should also be diagnosed in order to prevent the jaundice from progressing or to identify the cause and to initiate adequate therapy as a result.

itching

One of the core symptoms of jaundice is itching of the skin. Those affected often perceive this as very painful.

The exact cause of the itching has not yet been clearly clarified; it is suspected that the nerve endings are irritated by the accumulation of bilirubin in the skin. There are also other hypotheses whose proof is still pending and should be neglected at this point.
Far more important is what can be done against the itching in the context of jaundice. Special medication can be given to those affected to relieve itching. These include, for example, the remedy colestyramine as well as the drugs rifampicin or naltrexone. The prescription of these drugs, some of which are rich in side effects, is always made by the attending physician.

Therapy for jaundice

Treatment for jaundice always depends on the underlying cause. Jaundice is “just” the symptom of a disorder or illness.

Gallstones are one of the possible causes of jaundice. These can usually be treated with surgical removal of the stone.

In the case of inflammation of the liver due to so-called hepatitis, drug therapy may have to be initiated. Here again a subdivision of the inflammation-triggering causes is crucial for the therapy planning.

If, on the other hand, drugs or heavy alcohol consumption are responsible for the jaundice, these should be discontinued.

Tumors in the liver itself, in the pancreas or in the bile ducts can also lead to jaundice. These are mostly recognized in imaging diagnostic measures such as ultrasound, CT, MRT and then treated depending on the existing treatment options. These include surgical removal, chemotherapy, and radiation. Depending on the tumor, the chances of success or healing are very individual and cannot be predicted across the board.

Special blood diseases can also lead to jaundice. For example, in spherical cell anemia, in which the red blood cells are noticeable due to their round cell shape and, due to their deviating shape, lead to an increased breakdown in the spleen - which leads to increased bilirubin. If necessary, the spleen is removed here to counteract the cause of the jaundice.
The mostly naturally occurring jaundice in newborns can be treated with phototherapy (treatment with light). This is usually done in the hospital and the child is irradiated with certain light frequencies for several hours a day.
To treat the excruciating itching, a symptom that often shows up in jaundice sufferers, it can be countered by the administration of certain medications, especially in adults.

You will find more information on this topic here:

Therapy for jaundice (jaundice)

Frequency of jaundice

The frequency of jaundice depends on the disease causing it. In hepatitis A e.g. icteric disease occurs in less than 10% of children younger than 6 years of age, 45% of children over 6 years of age, and 75% of adults.
Haemolyticus Neonatorum disease as the cause of jaundice (jaundice) is relatively rare today. Likewise the multitude of familial hyperbilirubinemia syndromes. Tumor diseases such as pancreatic carcinoma mainly occur in patients in the sixth or seventh decade of life. In 25% there is jaundice in the early stages. In the late stages, 90% of patients have jaundice.

diagnosis

The Jaundice is not an independent clinical picture, but rather a symptom that is triggered by various factors (see above).
Jaundice is mostly a visual diagnosis. The doctor can then determine the bilirubin level by taking a blood sample. This is usually increased in jaundice, the value is at least over 2 mg / dl. Now it has to be found out what is the cause of the increased bilirubin level.

Determining a complete blood count can provide information about whether one of the numerous blood formation disorders is present. The Ultrasound examination from liver and Biliary system gives indications of diseases of these organs. To investigate whether e.g. A mass of the bile duct or the pancreas causing the bile acid drainage can be a so-called ERCP (endoscopic retrograde C.holangiopancreaticography). A tube with a camera attached to the tip is pushed into the stomach and from there into the duodenum. At the entrance to the pancreatic duct, a contrast agent is injected into it.
An x-ray will be taken shortly thereafter. In the picture you can now see whether the bile duct and pancreatic duct are open or whether something closes or constricts them. This instrument can also be used to retrieve bile duct stones or to take samples of the constriction. The ERCP represents an important examination method for finding the cause of jaundice and for diagnosing one Pancreatic tumor represent.

Course of disease

Jaundice is a symptom of an illness or, in the context of newborns, mostly a naturally occurring phenomenon.

The course of the "jaundice-causing" illness is fundamentally decisive. Depending on the cause and therapeutic measure, the course of the jaundice is also determined.

Increased levels of bilirubin in the blood are decisive for the existence of jaundice. In most cases, the eyes are first colored and then turned into a yellowish skin tone.If these are treated appropriately, the jaundice also disappears, although the underlying disease may persist for longer and must continue to be treated.

In newborns, particularly high levels of bilirubin or indirect bilirubin can also lead to so-called bilirubin encephalopathy. In medical terminology, this means pathological changes in the brain. The children can show different symptoms: These include drowsiness, high-pitched screaming, poor drinking and seizures. Phototherapy and, if necessary, a blood exchange transfusion are used for treatment.

The increased amount of bilirubin, especially if left untreated, can lead to so-called kernicterus in the worst case. This involves severe nerve damage to the child's brain, which is triggered by the abnormally high concentration of bilirubin or the so-called indirect bilirubin that is not yet metabolized in the liver.

Duration and forecast

The duration of jaundice depends on its cause. A general statement can therefore not be made. The same also applies to the prognosis for jaundice.

In the case of a gallstone disease, for example, which is more "harmless", surgery usually helps to alleviate the symptoms. The jaundice is then eliminated by removing the stone and those affected usually have a good prognosis.

For other causes, such as a tumor, the symptoms of jaundice may be eliminated by removing the tumor. However, the further course and the associated prognosis cannot generally be predicted.

Is jaundice contagious?

Jaundice or jaundice is generally not contagious as it is simply a symptom of an underlying disorder or disease. The cause of the jaundice can in turn harbor a risk of infection.

An example would be the hepatitis B disease. This can be spread to another person through unprotected sex or through a needle injury with a hepatitis B infected needle. A vaccination against the hepatitis B virus is one of the possible preventive measures for jaundice.

What is kernic terus?

The kerinkerus is a serious damage to the child's brain, which is due to an abnormally high concentration of bilirubin or indirect bilirubin.

The indirect bilirubin has not yet been processed in the liver and, due to its special property, can cross the so-called blood-brain barrier. Various diseases can lead to an unusually high increase in bilirubin in newborns.

As a rule, the children are then treated with phototherapy. In severe cases, a blood exchange transfusion is also done. If the jaundice remains untreated or if extremely high indirect bilirubin values are found, kernicterus can also develop. The possible serious sequelae of kernicterus then include a possible visual and hearing impairment, a reduced intelligence as well as a motor, i.e. movement disorder affecting the muscles in the newborn.

What is jaundice prolongatus?

This is understood to mean an increased bilirubin level in the blood with associated jaundice in newborns, which persists even after the 10th day of life. Usually jaundice shows up naturally between the ages of 3 and 8 days of life. Beyond this point in time, increased bilirubin levels in the newborns can indicate the presence of a disorder or illness.

As with adults, there are many causes and a medical examination is essential to uncover any existing diseases.

Can you drink alcohol if you have jaundice?

It is generally not advisable to consume alcohol during existing jaundice.

The liver is part of the metabolic process for breaking down alcohol and can be heavily stressed in jaundice. Especially if the cause of the occurrence lies in the liver itself, e.g. due to hepatitis, alcohol consumption should be avoided. After finding the cause and successful therapy, those affected can again consume alcohol to a healthy extent. This is best done in consultation with the doctor, since the liver in particular has to be in perfect condition for alcohol utilization.