When 13-year-old Meera (name changed) with Wilson’s disease, a rare genetic disorder, developed jaundice and her eyes turned yellow, her family tried to manage the condition with home remedies — exposing her to sunlight and also trying herbal products. However, as her condition did not improve, she was taken to the hospital, but by then it was too late. Meera failed to recover and she died during treatment. “Jaundice is a symptom of many medical conditions. If the underlying condition is not treated, it can turn fatal,” said Dr S N Pravindhira, consultant, surgical gastroenterology and hepato-pancreato-biliary surgery, SRM Global Hospital, Chennai.
Wilson’s disease is a rare genetic condition that prevents the body from clearing extra copper, leading to toxic buildup of copper, primarily in the liver, and it damages the liver cells even before the symptom develops. “If it had been detected early, it could have been treated. There are medicines to treat copper accumulation in the liver. It is better to get treated if jaundice develops, as many causes of jaundice are treatable,” Dr Pravindhira added. Jaundice occurs when there is an increase of bilirubin, a yellow pigment created when red blood cells break down, in blood. The liver processes the bilirubin and sends it to the small intestine via bile duct. The bilirubin is absorbed into the blood from the small intestine and again reaches the liver, say doctors.
But where there is too much destruction of RBCs, beyond the capacity of the liver to process the bilirubin, jaundice occurs. Another reason the liver cannot process it is because of injury to the liver. Obstruction of the bile duct also makes the bilirubin escape into the blood producing jaundice.
“Jaundice or hyperbilirubinemia is a symptom and not a disease. Whenever there is a yellow discolouration of eyes (sclera) or urine that particular symptom is called Jaundice,” said Dr Vaibhav Patil, consultant, hepatology and medical gastroenterology, liver disease and transplantation, Rela Hospital, Chennai.
There are three types of jaundice: prehepatic, hepatic and post hepatic. Prehepatic jaundice is when there is too much destruction of RBCs and the liver cannot process it. “Diseases like autoimmune hemolytic anemia, some infections like malaria and also dissolutions of blood clots from trauma can cause prehepatic jaundice,” said Dr A Murali, director and head of medical gastroenterology department, MIOT Hospital, Chennai.
Hepatic jaundice type is a common type of jaundice and happens when the liver cells are damaged. The damage is caused commonly due to viral infections. Hepatitis A and E spread through contaminated food and water. Whereas B, C and D spread through contaminated blood and blood products. Another cause is alcohol consumption, which will cause injury to the liver. “Hepatitis B and C infections and alcohol consumption will lead to chronic liver disease,” he added.
Another condition which causes damage to the liver is metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease. Also overuse of medications, and some herbal medications also can cause injury to the liver. “It should be noted that congenital conditions like Gilbert’s syndrome may also be the cause for jaundice. Autoimmune disease also can damage the liver and affect processing of bilirubin,” Dr Murali said. Dr Murali further added that post hepatic jaundice is when the bilirubin processed in the liver cannot travel via bile duct into the intestine due to obstruction by gallstones, inflammatory strictures of bile ducts, and cancers of the bile duct, gallbladder, duodenum, and the head of the pancreas. “Discolouration of eye (sclera), and urine, reduced appetite, nausea, and sometimes low grade fever. These are some common symptoms of jaundice. These make patients go to the hospital,” said Dr Vaibhav Patil. Due to viral infection, some of the common symptoms in jaundice are fatigue, body pain and vomiting. In malignant obstructive jaundice, weight loss, and prolonged loss of appetite are some of the symptoms. When a tumour blocks the normal flow of bile out of the liver, it causes malignant obstructive jaundice, which often develops slowly and without pain. In benign obstruction, because of gallstones, the patient experiences severe pain in the right side of the abdomen, fever and vomiting, said Dr Murali.
The treatment depends on the cause of the jaundice. In case of bile duct obstructions due to tumours and cancer, and gallstones, it should be removed with surgical procedures. Viral infections can be treated with antiviral drugs and fluids. In case of liver injury, it should be treated accordingly.
“If the jaundice is not treated early, the patient will develop chronic liver disease. Fluids will start accumulating in the legs and the stomach. They will also vomit blood and pass blood in stools,” added Dr Pravindhira.
Vaccine is available for hepatitis B, while a vaccine for hepatitis E has just been introduced. An infection by hep A virus will give lifetime immunity.
Dr Murali said hand hygiene is a must to prevent infections due to hepatitis A and E. The hepatitis A virus infection will cause lifetime immunity. Infected blood transfusions, sharing of needles (among drug addicts) and unsterilised medical equipment are the causes for hepatitis B and C. To prevent damage to the liver, people should avoid taking over the counter medicines.
“Eat food rich in fibre and proteins, and low in carbohydrates and fat. Exercise is important. Obesity is another risk factor. People should avoid taking alcohol too often. Physical exercise is important as a sedentary lifestyle will lead to obesity, non-alcoholic fatty liver disease, and other complications. For adults, annual screening is a must,” said Dr Vaibhav Patil “For adults, annual screening is a must. Non alcoholic people develop fatty liver due to sedentary lifestyle, eventually they develop irreparable damage to the liver leading to chronic liver disease,” said Dr Vaibhav Patil.