Signs and Symptoms of Jaundice
Overview I Types I VAN DEN BERG TEST I Causes I Signs and Symptoms I Treatment
Jaundice is defined as yellowish discoloration of the skin, sclera and mucous membrane. This yellowish appearance is due to the deposition of bilirubin. The signs and symptoms of jaundice are enlisted below. Bilirubin is the end product of the hemoglobin catabolism. These catabolic reactions take place in spleen, liver, lymph nodes and bone marrow. Jaundice first appears in the sclera because bilirubin has a
The normal serum bilirubin level is between 0.2 to 1mg% in an adult. Bilirubin levels between 1 and 2mg% are called latent jaundice. Jaundice manifests when the plasma bilirubin level exceeds 2mg%.
Jaundice can be classified in to two categories
- Physiological jaundice
- Pathological jaundice.
PHYSIOLOGICAL JAUNDICE
Physiological jaundice occurs in case of newborn babies which are often referred to as neonatal jaundice. It is jaundice that occurs in newborn babies on the second or third day of birth. It disappears within 10 to 14 day of birth.
The cause for this physiological neonatal jaundice is due to rapid hemolysis that is the destruction of RBCs leading to increased bilirubin production and reduced conjugation due to the deficiency of enzyme glucuronyltransferase. This condition is self-limiting and requires no treatment.
PATHOLOGICAL JAUNDICE
Pathologically, causes of jaundice can be broadly divided into two categories
- Increased production of bilirubin
Production of bilirubin is increased in this case due to hemolysis. Therefore this type of jaundice is called hemolytic jaundice.
- Decreased production of bilirubin
The excretion of bilirubin is inhibited as the liver cannot efficiently conjugate bilirubin or when conjugated bilirubin cannot be excreted out in bile.
Hemolytic jaundice
In hemolytic jaundice, excessive production of bilirubin occurs as a result of hemolysis. This excessive amount of bilirubin allows the liver to conjugate more than the normal quantity of bilirubin. Thus more amount of bilirubin glucuronide is delivered to the small intestine. This increases the amount of stercobilinogen in the small intestine. Bilirubin forms a complex in the plasma with albumin hence cannot be excreted in the urine.
Hepatic jaundice
Hepatic jaundice is caused due to infection or toxic damage to the liver. There is an increase in both conjugated and unconjugated bilirubin in the blood. The stercobilinogen and urobilinogen are reduced. Conjugated bilirubin gets excreted in urine giving a deep yellow color to urine.
Obstructive jaundice
Obstructive jaundice is caused due to the obstruction in bile which inhibits the bilirubin from entering the intestine. This occurs due to gallstones or tumors. In the case of cancer of the head of the pancreas, this type of jaundice can occur.
VAN DEN BERG TEST
Van den Berg test helps us to identify the type of jaundice. Serum of the patient is combined with the
In an indirect positive test, the patient ‘serum is first treated with alcohol and later mixed with the diazo reagent. This causes the development of red color. It is seen if unconjugated bilirubin is present. If both conjugated and unconjugated bilirubin is present, the reaction is termed biphasic reaction. In hemolytic jaundice, the unconjugated bilirubin is increased. The Van Den Bergh reaction is indirectly positive. Urobilinogen levels are increased. In obstructive jaundice, conjugated bilirubin is present and serum ALT levels are increased. Bile salts are also increased.
Tests
| Specimen | Test | Hemolytic jaundice | Hepatocellular jaundice | Obstructive jaundice |
| Blood | Unconjugated bilirubin | present | present | normal |
| Conjugated bilirubin | normal | limiting | present | |
| ALT | normal | 2-3 times increased | 10-20 times increased | |
| Urine | Bile salts | absent | Absent | present |
| Conjugated bilirubin | absent | present | present | |
| Unconjugated bilirubin | present | Increased in early phase | absent | |
| Feces | urobilins | present | Normal or decreased | Clay colored |
CAUSES
EXTRA HEPATIC
- Cholelithiasis
- Carcinoma head of pancreases
- Chronic pancreases
- Biliary S
tricture
INTRA HEPATIC
- Alcoholic cirrhosis
- Biliary cirrhosis
- Viral hepatitis
- Protoporphyria
- DRUGS
Androgens
- Chlorpropamide
- Nitrofurantoin
- Cyclosporine
Signs and symptoms of jaundice
some of the important signs and symptoms of jaundice are enlisted below:
- the yellow color of the eyes and sclera
- Fatigue
- weight loss
- fever
- vomiting
- Presence of dark urine
- pale stools are common.
Treatment
Hepatocellular jaundice is treated with steroids and antiviral medication.
Hemolytic jaundice is treated with iron supplements.
Obstructive jaundice is treated by removing the obstruction
Summary
Jaundice in adult patients can be caused by a wide variety of benign and life-threatening conditions. The word jaundice has come from the French word ‘jaune’ which means yellow color. As jaundice is yellow discolorization of skin, sclera and mucous membrane. For the treatment, you must know the sign and symptoms of jaundice. One of the main important symptoms of jaundice is yellow discolorization of the skin, sclera and mucous membrane. This article discusses the sign and symptoms of jaundice, types, causes and the treatment of jaundice.
