Jaundice is a symptom complex which is characterized by yellow coloration of tissues and body fluids due to increase in bile pigments.
It may arise due to –
- Increase bile pigment load to the liver
- Defective conjugation
- Defective excretion
Yellow discoloration of tissues can occur due to carotenemia and mepacrine therapy.
Normal values –
- Serum bilirubin – Total 1 mg%, Direct 0.25 mg%. Urinary bilirubin is present if direct bilirubin is greater than 0.4 mg% in serum.
- Urine urobilinogen – 100-200 mg/day
- Fecal stercobilinogen – 300 mg/day
Differential Diagnosis of Jaundice
|Abdominal Pain||Absent||Present||Present in crisis|
|Tender Liver||May be present||Absent||Absent|
|Spleen||May be present||Absent||Present|
|Gall bladder||Not palpable||Palpable if due to neoplasm||Not palpable|
|Peripheral Smear||Leucopenia in infective hepatitis||Normal||Reticulocytosis Spherocytosis|
|Alkaline phosphate||Raised||Markedly raised||Normal|
|Barium meal and choliangiography||Normal||May reveal pancreatic growth||Normal|
Hepatocellular (Medical Jaundice – Hepatic)
- Viral Hepatitis
- Weil’s disease (Leptospirosis)
- Anesthetic agents (Halothane, chloroform)
- Anti-coagulants (Phenindione)
- Anti-tuberculous drugs (Rifampicin, Thiacetazone)
- Metals (Arsenic, mercury, gold, bismuth)
- Chemicals (D.D.T.)
- X-ray radiations
Obstructive (Surgical jaundice – post hepatic)
Extra Hepatic causes –
- Inflammatory : stone, parasites, stricture, acute cholecystitis
- Neoplastic :Carcinoma of head of the pancreas, neoplasm of bile ducts, gall bladder and ampulla of vater
- Congenital : Biliary atresia
Intra Hepatic causes –
- Cholestatic phase of infective hepatitis
- Drugs : Steroids, chlorpromazine, Pas, sulfonamides, methyl testosterone, erythromycin
- Pregnancy with cholestasis
Hemolytic (Pre-hepatic) –
Intra-corpuscular defects –
- Hereditary spherocytosis
- Hemoglobinopathies : sickle cell anemia, sickle cell thalassemia, HbE thalassemia, homozygous beta thalassemia
- Enzyme deficiency (pyruvate kinase)
- Paroxysmal nocturnal hemoglobinuria (PNH)
Extra-corpuscular defects –
- Infections : Malaria, Clostridium welchii
- Drugs : quinine, sulfonamides
- Physical agents : burns, Irradiation
- Poisons : snake venom
- Immunological : mismatched blood transfusion, lymphoma etc
- Miscellaneous : uremia, cirrhosis
Congenital Hyperbilirubenia –
- Disturbance of bilirubin transport : Gilbert’s syndrome
- Disturbance of bilirubin conjugation : Crigler Najjar syndrome
- Disturbance in excretion of bilirubin : Dubin Johnson syndrome and Rotor’s syndrome
Diet plays very major role in jaundice. Your liver helps your body take in nutrients from food and turn them into energy. Your liver also moves toxins and old, damaged blood cells out of the body. When this process is disrupted, it can cause the waste product bilirubin to build up which results in Jaundice. Our digestive system requires some rest during jaundice, therefore, avoiding complex foods can be beneficial.
- Drink at least 8 glasses of water
- Lemon water too helps but drink in moderation
- Coconut water is very helpful as it contains potassium and plenty of nutrients that are beneficial for liver. It is a good source of antioxidants which help in fighting the free radicals that can damage your system. It not only boosts your immunity but also prevents recurrence of jaundice. It provides hydration and helps in maintaining a proper fluid balance
- Eat small frequent meals
- Sugar cane – It is viewed as valuable for the liver and is suggested that jaundice patients take in a lot of sugarcane juice for prompt alleviation.
- Walnuts, almonds are beneficial to liver function.
- Fresh fruits – It contains powerful antioxidants and fiber that can help ease digestion. Cranberries, blueberries, grapes,papaya, melon, avocados, citrus fruits, especially lemons, limes, tomatoes, pumpkin and grapefruits
- Vegetables – carrots, beets, turnips, spinach, kale, broccoli, cauliflower, sweet potatoes
- Carbohydrates are a powerhouse of energy. Try not to exaggerate the utilization of carbs as they contain a high-glycemic index which sets aside effort for assimilation. Stay away from complex carb. Including a modest quantity of rice, potatoes, oats in eating routine can help your digestion.
- Proteins – Include plenty of dals, pulses, legumes. During any disease protein-rich diet is highly recommended, as it not only helps in repairing body cells but also aids in producing new ones. They provide energy to the body and thus, help in healing the damaged organs.
- Coffee and tea – coffee, when devoured in little amounts, is known to decrease liver cirrhosis and help an individual recover. The dimension of compounds that are unfavorable to the liver can likewise be controlled through the utilization of tea/coffee. Herbal teas are likewise known to diminish aggravation of the liver through their cancer prevention properties.
Diet restrictions for Jaundice –
- Avoid spicy, oily, hot and heavy foods; eat a vegetarian diet.
- Alcohol can cause additional damage to your liver, so it’s best to avoid it completely.
- Avoid complex foods such as heavy cream milk, red meat.
- Avoid canned and preserved foods, cakes, pastries, chocolates
- Avoid excessive use of salt, as, it leads to water retention and liver damage
- Refined sugars like white bread, pasta etc. should be avoided