Jaundice: Causes, Pathogenesis, Symptoms, Prevention, Treatment and MCQs for NEET, GPAT, Pharmacist, Staff Nurse

INTRODUCTION :-

1. Jaundice or icterus means yellow pigmentation of the skin.
2. Jaundice is basically the result of elevated level of bilirubin in the blood termed as hyperbilirubinemia.
3. Normal serum bilirubin concentration ranges from 0.3 – 1.3 % mg/dl.
4. Jaundice became clinically evident when the total serum bilirubin exceed 2 mg/dl.
5. A rise of serum bilirubin between the normal and 2 mg/dl is generally not accompanied by visible jaundice and is called latent jaundice.

CAUSES OF JAUNDICE :-

Bilirubin is a yellow-colored waste material that remains in the bloodstream after iron is removed from the blood.

The liver filters waste out from the blood. When bilirubin reaches the liver, other chemicals attach to it. A substance called conjugated bilirubin results.

The liver produces bile, a digestive juice. Conjugated bilirubin enters the bile, then it leaves the body. It is this type of bilirubin that gives feces its brown color.

If there is too much bilirubin, it can leak into the surrounding tissues. This is known as hyperbilirubinemia, and it causes the yellow color in the skin and eyes.

PATHOGENESIS FOR JAUNDICE :-

1. Bilirubin pigment has high affinity for elastic tissue and hence jaundice is partially noticeable in tissue rich in elastic content.
2. Cholestasis refers to the bile secretory failure per se, which is accompanied by the accumulation in blood of substances normally excreted in bile ( bilirubin, bile salt and cholesterol).
3. Excessive production of bilirubin, reduced hepatic uptake, and impaired hepatic conjugation (reversibly combined with another) produces unconjugated hyperbilirubinemia.
4. Decreased hepatic excretion of bilirubin conjugates and impaired extrahepatic bile flow produce conjugated hyperbilirubinemia.
5. With prolonged conjugation hyperbilirubinemia, a portion of circulating pigment also may become covalently bound to albumin ( the delta fraction).
6. Alternatively, pruitis is a common presenting symptom, presumably related to the elevation in plasma level of bile acid.
7. Skin xanthomas sometimes appears, the result of hyperlipidemia and impaired excretion of cholesterol.
8. Also, bilirubin is a waste product released during the breakdown of red blood cell or erythrocyte.
9. Common to both obstructive and hepetocelluar cholestasis is the accumulation of bile pigment within the hepatic parenchyma.
10. Droplets of bile pigment are accumulate within hepatocyte, causing the cells to take on a wispy appearance (feathery or foamy degeneration).
11. In the absence of bile duct disease, hepatocellular cholestasis per se does not lead to permanent liver damage.
12. The resultant looping and reduplication of duct is termed ” bile duct proliferation ” and is one of the most helpful features indicative of the obstructive cholestasis.
13. Jaundice can be diagnosed by blood test.
14. Cholestasis and jaundice are common to many hepatic diseases and a non – specific clinical finding.

SYMPTOMS FOR JAUNDICE :-

Common symptoms of jaundice includes :

• a yellow tinge to the skin and the whites of the eyes, normally starting at the head and spreading down the body
• pale stools
• dark urine
• itchiness

Accompanying symptoms of jaundice resulting from low bilirubin levels include:

• fatigue
• abdominal pain
• weight loss
• vomiting
• fever
• pale stools
• dark urine

PREVENTION FOR  JAUNDICE :-

Jaundice is related to liver function. It is essential that people maintain the health of this vital organ by eating a balanced diet, exercising regularly, and not consuming more than the recommended amounts of alcohol.

TREATMENT :-

The following treatments are used:

• Anemia-induced jaundice may be treated by boosting the amount of iron in the blood by either taking iron supplements or eating more iron-rich foods.
• Hepatitis-induced jaundice requires antiviral or steroid medications.
• Doctors can treat obstruction-induced jaundice by surgically removing the obstruction.
• If the jaundice has been caused by use of a medication, treatment for involves changing to an alternative medication.

MULTIPLE CHOICE QUESTIONS :-

1.] Jaundice is caused due to ?

a. excess of uric acid in blood

b. excess of hemoglobin in blood

c. excess of bilirubin in blood

d. excess of potassium in the blood

2.] Bilirubin is a waste product released during the breakdown of ?

a. mast cell

b. RBC

c. WBC

d. platelets

3.] Jaundice is also known as ?

a. icterus

b. hemophilia

c. anemia

d. hypercholestormia

4.] Hemolytic jaundice occur due to ?

a. liver disease

b. rapid destruction of erythrocyte

c. intestinal disease

5.] Obstruction of bile duct causes jaundice ?

a. true

b. false

6.] Jaundice caused due to obstruction of bile duct is also called ?

a. hemolytic jaundice

b. hepatocellular jaundice

c. cholestasis

d. none of the above

7.] Some of the most common symptoms of jaundice are ?

a. breathlessness

b. yellowing of skin, sclera (white of eye) and darkening of skin

c. palpitation

d. all of the above

8.] Jaundice can be diagnosed by ?

a. blood test

b. ECG

c. EEG

d. ELISA

9.] Which of the following is most closely associated with bilirubin ?

a. RBC

b. T – cells

c. lymphocytes

d. B – cells

10.] Blood incompatibility between the mother and baby can cause jaundice in new born ?

a. true

b. false

SOLUTIONS :-

1.] (c) excess of bilirubin in blood

2.] (b) RBC

3.] (a) icterus

4.] (b) rapid destruction of erythrocyte

5.] (a)

6.] (c) cholestasis

7.] (b) yellowing of skin, sclera ( white of eye ) and darkening of urine

8.] (a) blood test

9.] (a) RBC

10.] (a)

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REFERENCE :-

1.) Textbook of pathology by Harsh Mohan; 7th edition; Page no. 581 – 584.

2.) Robbin’s Basic Pathology; 5th edition; Page no. 838 – 840.