KOCHI: Jaundice is a condition that causes yellowish discolouration of the white part of the eyes, skin, and mucous membrane due to the accumulation of bile in the blood. Severe cases may be associated with itchiness of the skin.Our blood contains a lot of red blood cells that carry oxygen from the lungs to all parts of the body. Oxygen is bound to hemoglobin which in turn has two parts - heme (iron-containing protoporphyrin) and globin (protein).
The normal life span of red corpuscles is about 120 days, after which worn out cells are broken down in the reticuloendothelial cells of the spleen. The iron is restored to the iron pool for the re-synthesis of hemoglobin. Globin goes to the protein pool. The protoporphyrin molecules go to the liver, where they are converted into non-soluble (indirect) and soluble (direct) bilirubin by hepatocytes or liver cells. Bile is essential for fat digestion and upon entering the hepatic ducts gets stored in the gall bladder and is periodically emptied into the intestine.
In the intestine, bile gets converted to urobilinogen and stercobilinogen and is excreted. This normal mechanism of various intercellular processes involving oxidation and reduction is done by various enzymes. Deficiency of these enzymes is what causes congenital jaundice.Causes of deficiency can be multifold. If hepatocytes are sick, they may not be able to break protoporphyrin molecules into bile. Similarly, if the path of drainage of bile is blocked it may get accumulated in the circulation.
These various causes can be classified into three categories - pre-hepatic, hepatic post-hepatic. Pre-hepatic causes may be due to increased hemolysis (destruction of red blood cells) in conditions of spherocytosis (abnormal sphere-shaped red blood cells), malaria, septicemia (blood poisoning), mismatched blood transfusion, etc. Hepatic causes can be genetic abnormality off liver cells, deficiency of various enzymes and inherited hyperbilirubinemia (excessive bilirubin in the blood).
Viral hepatitis is another common cause of jaundice which includes hepatitis A, B, C, D, and E. Other autoimmune liver diseases like graft rejections (liver, kidney, heart, etc) also lead to jaundice. This is very important in the era of transplant surgery. Vascular injury to liver vessels, accidental ligation of hepatic vessels result in massive liver necrosis and manifest as jaundice. Post-hepatic bile duct occlusion by parasites, stones, malignancy in the path of the bile are other major factors. Alcoholic cirrhosis is also a leading cause.
In the newborn babies, mild jaundice may clear within days, this is called physiological jaundice. If jaundice persists and deepens congenital abnormalities like delivery atresia (no passage for bile into the intestine) are tested for. In such cases, surgical correction is mandatory. Various diagnostic tools are now available to test for jaudince. A blood test scans both direct and indirect bilirubin levels. Liver function test, enzyme studies, ultrasonogram, CT scan are additional methods. Serological study for hepatitis B and C is important for long time prognosis. The last option is a liver biopsy.
What I aim is to give a glimpse of the umpteen number of causes of jaundice. My advice for you is to avoid self-medication and advertisements in media claiming liver protection therapy using herbs. Medical intervention may be futile after you lose crucial days of proper treatment. Dr C K Pareed Pillai is a laparoscopic surgeon and a retired captain with the Armed Forces Medical Service. (Views expressed are his own)