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What is jaundice?
Jaundice, also known as yellowing, is characterized by the yellow color of the skin and the whites of the eyes. It is primarily a symptom. It happens when there is an accumulation of bilirubin in the blood, a yellow pigment that is produced by the body when red blood cells are degraded. Bilirubin normally passes through the liver and is excreted in the stool.
Red blood cells are red blood cells, which give red color to the blood and are responsible for bringing oxygen to the cells of the body.
If something prevents bilirubin from being eliminated, it accumulates in the skin and gives the disease a yellowish tinge.
Causes
Bilirubin is a pigment created naturally by the body when old or damaged hemoglobins are broken down. The yellow pigment is sent to the liver, where it is mixed with bile, which is sent to the gallbladder and used in the digestion process.
This substance is eliminated, mostly, through the feces. A small amount can be released into the urine.
If something prevents some part of this process and bilirubin cannot be eliminated, it accumulates in the blood. Jaundice appears when the bilirubin concentration is more than 2 mg per deciliter (dL, 100 ml) of blood.
In newborns, due to the stress of childbirth, bilirubin may be higher naturally and is only considered jaundice after 5 mg / dL. At this point, the yellowish color starts to be noticeable on the patient’s skin.
Various diseases, medications and conditions can cause bilirubin to accumulate in the blood. Some examples are:
Hepatitis
Hepatitis is an inflammation of the liver. It can be caused by viruses and, in the vast majority of cases, leads to jaundice by preventing bilirubin from being transported to the gallbladder.
Alcoholic liver disease
An injury to the liver caused by excessive alcohol consumption over a long period of time – alcoholic liver disease – can block the yellow pigment pathway, causing it to concentrate in the blood and go to the skin and eyes.
Yellow fever
The Yellow Fever is transmitted by the bite of an infected mosquito by flavivirus. It has this name because, in addition to other symptoms, it causes liver failure, which leads to jaundice, leaving the patient’s skin yellow.
Bile duct obstruction
Bile duct obstructions can be caused by stones in the liver or, in rarer cases, by tumors that may be in the duct or pancreas. Without the bile duct, bilirubin cannot pass into the gallbladder and is trapped.
Cholestasis of pregnancy
Hormones that act normally during pregnancy can reduce the rate at which bile moves through the bile ducts. This reduces the ability of the liver to metabolize bilirubin. If there is excess, the pigment returns to the blood, causing jaundice.
Cholangitis
Cholangitis is a type of autoimmune disease that affects the bile ducts, causing their destruction and healing, depending on the type of disease. This destruction or obstruction by scarring prevents bilirubin from being eliminated, causing jaundice.
Hemolysis
Some conditions can cause the excessive breakdown of red blood cells in the blood, increasing the production of hemoglobin and, consequently, that of bilirubin, which if it is greater than the processing capacity of the liver, will allow the pigment to accumulate.
Wilson’s disease
This rare and hereditary disease prevents the liver from releasing copper from the body in the bile, causing buildup and damage to the organ. This can result in accumulations of other substances, such as bilirubin, which leads to jaundice.
Crigler-Najjar syndrome
Another rare inherited disease, Cringler-Najjar syndrome can cause severe jaundice and lead to bilirubin encephalopathy, a brain intoxication caused by the excess of the substance in the brain.
Medicines
Some drugs and substances are capable of causing jaundice. Are they:
- Acetaminophen (in high doses and overdose);
- Certain medicinal herbs such as green tea extract, pyrrolizidine, kava and mackerel;
- Iron ingested in large quantities.
Toxins
Similarly, some toxins can cause liver damage and cause jaundice, as is the case with the toxin from the Amanita phalloides mushroom – the green hemlock, an extremely poisonous mushroom.
Neonatal jaundice
At birth, the baby has an extra amount of red blood cells that it does not need outside the womb.
In the first days of life, the child may experience jaundice due to the breakdown of these extra blood cells, which are too many for the small liver to metabolize quickly enough.
It is normal for this to happen. Between 50 and 80% of babies have jaundice in the first week of life.
The condition is even more common when the baby’s and mother’s blood types are different, with the ABO system being incompatible. That’s because the mother and baby share blood through the umbilical cord.
Thus, the mother’s red blood cells, incompatible with those of the child, are in her body when she is born and need to decompose, producing even more bilirubin.
The yellow color usually appears on the second day of life when the baby is born after the 37th week of gestation, so it is common that he is still in the hospital when this happens. The staining should disappear in five to seven days on its own, but the pediatrician should be warned. If the color does not disappear, it is necessary to take the baby to the doctor.
Neonatal jaundice can be divided into five stages that vary according to the amount of bilirubin in the child’s blood. Yellow appears when there is more than 5 mg of bilirubin per deciliter (100 mL) of blood.
Stage 1
With 6 mg / dL of bilirubin, stage 1 jaundice is classified. In this stage, the yellow color affects only from the baby’s neck upwards.
Stage 2
9 mg / dL of the pigment are required for this stage, which shows yellow extending to the navel, without affecting the limbs.
Stage 3
At 12 mg / dL, jaundice reaches the knees, without affecting the arms. It is from this stage that there must be research into the reason for the jaundice, which may be a problem in the liver or bile ducts.
Stage 4
The limbs are affected when the bilirubin concentration reaches 15 mg / dL. Only the hands and feet maintain normal color.
Stage 5
With more than 18 mg / dL of bilirubin in the blood, the child’s whole body turns yellow.
There are risks related to neonatal jaundice when it is very intense and, although the risks are small, medical care should be taken.
The dangers decrease as the newborn’s life span extends. This means that in the child’s first 12 hours of life, stage 2 jaundice can be dangerous, but after 72 hours of life the risk only becomes high after stage 3.
However, stages 4 and 5 are always dangerous for newborns and must be examined by the doctor.
The treatment usually lasts from one to two days, but it may need to last longer and the mother may be discharged before the baby, but the child should be released soon, safely.
Groups of risk
Everyone can develop jaundice, but some groups are more susceptible to the causes of the symptom than others. Are they:
Pregnant
Pregnancy hormones can slow down the movement of bile through the bile ducts and cause jaundice.
Newborns
Often affected by jaundice after the second day of life, neonatal jaundice is usually benign and disappears within a week, but it is important to watch the condition develop.
The condition is more common in premature babies than in term babies. It is also more common for an Asian baby to have jaundice than those of other ethnicities.
Alcoholics
Alcohol is metabolized in the liver and if used too often for a long time it can damage the organ, reducing its capacity and causing jaundice.
Hepatic
People with diseases that affect the liver such as cirrhosis and viral hepatitis can suffer from jaundice as the metabolism and transport of bilirubin may be affected and reduced by the condition.
Medicines
Several drugs are metabolized by the liver and, as in the case of alcohol, continuous use for long periods of time can cause damage to the organ, leading to the accumulation of bilirubin in the blood.
People with liver damage
Liver damage, caused by previous illnesses or trauma, can incapacitate or weaken the organ, causing jaundice.
Symptoms
Jaundice itself is already a symptom. It is characterized by an accumulation of bilirubin in the blood and it is possible to visualize the symptom through the yellowing of the skin and sclera (the whites of the eyes).
There are some signs that, in addition to jaundice, can serve as a warning for serious illnesses. If you have jaundice and any of the following signs, see a doctor:
- Abdominal pain and tenderness;
- Drowsiness, agitation, confusion or any mental change;
- Blood in stools or black stools;
- Vomiting with blood;
- Fever;
- Ease of forming bruises or bleeding.
Seniors
Jaundice in the elderly, in most cases, is caused by blockage of the bile ducts. This block is often cancer .
However, it is common for other symptoms that usually accompany liver disease to go unnoticed in older people.
Viral hepatitis causes less pain in the elderly and, in this age group, mental confusion caused by hepatic encephalopathy can be confused with dementia.
Suspicions of cancer appear when a lump is found or when the patient loses too much weight too quickly and for no apparent reason.
It is not jaundice!
Some foods, such as pumpkins and carrots, are rich in beta-carotene , the pigment that makes them orange. Eating too many of these foods can turn your skin yellow, but your eyes are not.
If that happens, you don’t have to worry. Your body will eliminate beta-carotenes and the skin will return to normal color soon.
How is jaundice diagnosed?
Jaundice is usually a symptom of a disease affecting the liver and can be identified by the yellow color of the skin and sclera, the white of the eye. After that, exams are done to look for the cause of this accumulation of pigmentation in the patient’s body. The exams are:
Physical exam
The doctor can place a finger on the patient’s forehead, apply pressure and remove the finger. The skin should be whitish. If it turns yellow, there is excess bilirubin in the patient’s body.
Liver function tests
These tests are carried out on blood samples and seek to identify the functioning of the liver based on the amount of liver enzymes found in the samples. Through this, it is possible to find out if the problem is in the functioning of the liver or if it is a blockage of the bile duct.
Imaging exams
Ultrasonography, computed tomography and magnetic resonance imaging can be used to identify obstruction in the bile duct if liver function tests point to this.
It is important to know the size of the obstruction and whether it is a cyst , a tumor or a liver stone so that treatment can be done properly.
Magnetic resonance cholangiopancreatography (CPRM)
This imaging exam is done for the accurate analysis of bile duct and pancreatic blockages. This examination uses a contrast liquid that appears bright from the MRI, clearly showing the ducts that you want to observe.
It is a highly accurate test for the identification of blockages in the bile ducts and pancreatics.
Bloodtests
Other blood tests, such as a complete blood count and blood cultures, may be done to identify other diseases that may be suspected of causing jaundice based on clinical tests.
Liver biopsy
Biopsy can be used if previous tests have not been able to reveal the cause of the jaundice. Suspected viral hepatitis, use of drugs or toxins may require a liver biopsy.
Laparoscopy
If the other tests have not explained the blocking of the flow of bile, a laparoscopy can be performed. It consists of a small incision into which a viewing tube is inserted. The doctor can directly observe the liver and bile ducts.
Cutaneous bilirubinometer
In newborn babies, the cutaneous bilirubinometer is used. It is a non-invasive device that is placed on the child’s forehead and, through lights, can identify the amount of bilirubin in the blood. Although not as accurate as blood tests, it is practical and quick.
Is jaundice curable?
Yes, jaundice is curable. Depending on the cause, it can be more difficult to achieve and, in cases where the causative disease has no cure, the symptoms can be treated. In general it is possible to avoid and treat jaundice.
What is the treatment?
Treatment depends on the cause. In the case of neonatal jaundice, the condition should go away in a few days, but when it is a case in adults or a child exception, it is possible that there are causes that need treatment, which varies from case to case.
However, there are specific ways to reduce the level of bilirubin in the person’s body regardless of the cause.
Phototherapy
Phototherapy is a technique used to reduce the amount of bilirubin in the blood. The baby is lying in a light cradle, with the skin exposed and the eyes covered by a protective mask .
Strong, blue, high-frequency light is capable of transforming bilirubin into lumirubin, a non-toxic and water-soluble substance that can be processed by the kidneys and eliminated in the urine and feces, without having to pass through the liver.
Hemodialysis
Severe cases of jaundice, called hyperbilirubinemia, have more than 18 mg of bilirubin per liter of blood. In these cases, due to the toxicity of the substance, phototherapy may not be efficient enough and hemodialysis can be used to filter the blood and remove the pigment from it.
Hemodialysis is a procedure for filtering blood through a machine. It usually does the work that the kidney cannot do in cases of kidney failure, but it can be used in the case of hyperbilirubinemia since the filtering process is necessary and the kidney, even healthy, would not do this without the bilirubin being converted into lumirubin.
Jaundice medications
There are no drugs to eliminate excess bilirubin from the blood and, although some may temporarily relieve some causes, it is not recommended to take medication without specific medical advice for your situation.
Some medications that can be indicated to deal with a cause of jaundice can make the situation worse if the cause is otherwise. For example, Epocler is a medicine capable of eliminating toxins from the liver, but it is not indicated for people who have cirrhosis, which also causes jaundice.
Attention!
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
Prognosis
The prognosis depends on the cause. Chronic diseases like cirrhosis send the organ to complete bankruptcy and require a transplant. A simple liver infection can be cured in a short time, eliminating the infection and jaundice without leaving any sequelae.
Neonatal jaundice, in most cases, disappears alone in a short time, without treatment and without consequences. Even if you need treatment with phototherapy, you can expect complete recovery.
Complications
Most of the problems related to jaundice are not a direct consequence of it, but of the disease that is causing it. Liver problems are serious and should be investigated.
However, excess bilirubin can have consequences, especially in newborns, who can be more easily affected by the substance.
Quernictero
Bilirubin is a substance that the body produces, but it is also a toxic substance. In low amounts, the body is able to metabolize, but when it accumulates in large quantities in the blood of newborns, who are the only ones susceptible to this disease, it can, on rare occasions, affect the central nervous system.
The concentration of bilirubin in the blood for this condition to appear is 20 mg / dL, an extremely high amount.
Because it affects the brain, the disease can cause serious problems, including hypotonia (loss of muscle elasticity), apnea crises (inability to breathe) and spasticity during the disease, and sequels such as abnormalities in muscle tone, balance problems, motor disorders , intellectual deficit, personality and sensory changes.
Although uncommon, this disease is the reason why there is a need for close observation and treatment of babies born with jaundice.
How to prevent jaundice?
It is not possible to prevent jaundice in newborns, but adults can prevent the disease with appropriate health care.
Take care of the food
Healthy eating avoids disease and keeps organs healthy. Avoiding high cholesterol can prevent the accumulation of bilirubin.
Consume alcoholic beverages in moderation
Keeping the liver functioning properly is important to prevent jaundice and liver problems. Drinking too much causes liver damage that can cause serious problems.
Hepatitis vaccination
Viral hepatitis is one of the most common causes of jaundice. Getting vaccinated prevents this disease.
Jaundice is a clear symptom that leaves the skin and eyes yellow and can represent serious liver problems, but it is also common and often harmless in newborns, but it must be observed closely in these cases to avoid more serious conditions.
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