Jaundice Definition, Causes & Symptoms, Diagnosis, Treatment, Complications, Prevention
Jaundice is a condition when the skin and the whites of the eyes (sclera) turn yellow. Jaundice or what in medical terms is called icterus is a symptom of a disease.
In newborns, jaundice is a normal condition. This condition can be experienced by babies aged 2-4 days and will disappear in 1-2 weeks. However, jaundice that occurs in the first 24 hours after the baby is born or does not disappear after the baby is more than 14 days old should be checked by a doctor.
While jaundice in adults indicates the presence of a disease. Therefore, a doctor’s examination should be done to ascertain the underlying cause.
Causes of Jaundice
Jaundice is a symptom of certain conditions. Jaundice is caused by a disruption in the process of forming and removing bilirubin, the substance that gives stool and urine a yellow pigment.
Normally, the bilirubin that is formed from the destruction of red blood cells will flow in the blood and be carried to the liver, to be processed and then excreted with urine and feces.
In people with jaundice, this process does not run normally, causing bilirubin to accumulate in the blood and body tissues. As a result, the skin becomes yellow.
Based on the location of the disturbance in the above process, jaundice can be divided into three types, namely:
Pre-hepatic Jaundice
Pre-hepatic jaundice occurs when red blood cells are destroyed too quickly or too much so that the level of the substance bilirubin in the blood rises. This condition makes the liver unable to process all the bilirubin. As a result, bilirubin enters the body’s tissues and causes jaundice.
Pre-hepatic jaundice can be caused by a number of the following conditions:
- Sickle cell anemia
- Malaria
- Thalassemia
- Autoimmune disease
- Spherocytosis
- G6PD ( glucose-6-phosphate dehydrogenase ) enzyme deficiency
- Hemolytic anemia
Intra-hepatic Jaundice
Intra-hepatic jaundice occurs when the liver is damaged or does not function normally. This condition makes bilirubin can not be processed to be removed from the body.
A number of conditions that can cause intra-hepatic jaundice are:
- Hepatitis A
- Hepatitis B
- Hepatitis C
- Hepatitis D
- Hepatitis E
- Excessive consumption of alcoholic beverages
- Cirrhosis
- Heart cancer
- Gilbert syndrome
- Crigler-Najjar Sindrom syndrome
- Dubin-Johnson syndrome
- Glandular fever
- Leptospirosis
- Paracetamol drug overdose
- Drug abuse
- Exposure to harmful chemicals
- Wilson’s disease
Post-hepatic Jaundice
Bilirubin that has been processed by the liver will pass through the bile ducts and the pancreas. Post-hepatic jaundice occurs when the bile ducts and pancreas become inflamed, blocked, or damaged so that the flow of bilirubin is not smooth.
There are a number of diseases that can cause post-hepatic jaundice, namely:
- Gallstone disease
- Inflammation or infection of the bile ducts, such as primary sclerosing cholangitis
- Bile duct cancer ( cholangiocarcinoma )
- Blockage of the bile ducts in newborns ( biliary atresia )
- Parasitic infections in the liver, such as liver flukes
- Inflammation of the pancreas (pancreatitis)
- Pancreatic cancer
Jaundice Risk Factors
Different from adults, jaundice or jaundice in newborns is generally a normal and harmless condition. This is because the baby has more red blood cells and his liver has not been able to function perfectly.
However, jaundice in newborns should be watched out for if it occurs at the age of 1-3 days or when it is more than 2 weeks old.
There are a number of factors that can trigger jaundice in newborns, namely:
- Premature birth
- Differences in blood type between baby and mother
- Disturbances in breastfeeding
- Glucose-6-phosphate dehydrogenase (G6PD) deficiency
- History of jaundice in siblings
While in adults, jaundice is more prone to be experienced by someone with the following conditions:
- Abusing drugs
- Make a tattoo on the body
- Have not received hepatitis vaccination
- Work as a health worker
- Having unsafe sexual habits
Symptoms of Jaundice
Jaundice can be recognized from the following signs:
- Yellow skin and eyes
- Yellowing of the lining of the mouth or nose
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Depending on the cause, the signs above can also be accompanied by other complaints, such as:
- Dark colored urine
- Pale stool color
- Fever
- Shivering
- Bewildered
- Loss of appetite
- Muscle and joint pain
- Headache
- Stomachache
- Diarrhea
- Nausea and vomiting
- Weight loss
- Itchy skin
- Swelling in the abdomen and legs
- Melena
When should you go to the doctor?
Do a self-examination to a doctor as soon as possible if you experience symptoms of jaundice. The condition can indicate disease in the liver, gallbladder, or blood.
Immediately seek medical help if your child is suspected of suffering from jaundice, especially if the following symptoms appear:
- Fever
- Vomiting, especially when vomiting blood
- Difficulty eating
- Dizziness and loss of consciousness
- Coma
Jaundice in babies needs to be dealt with immediately because it can indicate a serious condition in babies. Quick handling should be done especially if the baby:
- Newborn to 3 days old
- 2 weeks old or older
- Continuous crying
- Don’t want to breastfeed
- Looks weak and difficult to develop
- Looks more yellow
Jaundice Diagnosis
The diagnosis of jaundice begins with a detailed examination of the patient’s symptoms and medical history, followed by a physical examination.
To confirm the diagnosis, the doctor will check bilirubin levels through a blood test. A higher-than-normal level of bilirubin can signal jaundice.
In adults, normal bilirubin levels are below 1.2 mg/dL. Meanwhile, in children (under 18 years), normal bilirubin levels are less than 1 mg/dL. Especially in newborns, normal bilirubin levels depend on the baby’s age. Here’s the full explanation:
- Age less than 1 day: under 10 mg/dL
- 1 to 2 days old: under 15 mg/dL
- 2 to 3 days old: under 18 mg/dL
- Age more than 3 days: under 20 mg/dL
To find out the underlying cause, the doctor can run some of the tests below:
- Blood
tests Blood tests aim to measure bilirubin levels and check liver function. Through blood tests, doctors can also detect autoimmune or infectious diseases, such as malaria or hepatitis C. - Urine test Urine
test or urinalysis aims to measure levels of bilirubin that has been processed (urobilinogen). This test can also help doctors to determine the type of jaundice suffered by the patient. - Scanning
Scanning aims to determine the condition of the liver, gallbladder, and bile ducts. Types of scans that may be performed include ultrasound, CT scan, MRI, cholescintigraphy, or ECRP. - Liver biopsy A liver
biopsy is performed by taking a sample of liver tissue for examination under a microscope. A biopsy is usually necessary if the doctor suspects cancer.
Jaundice Treatment
Jaundice treatment depends on the type of jaundice experienced and the cause. The following are the treatment methods that can be done based on the type:
Treatment of Pre-hepatic Jaundice
Treatment of pre-hepatic jaundice aims to prevent red blood cells from breaking down too quickly or too much. For example, if pre-hepatic jaundice is caused by malaria, the doctor will prescribe antimalarial drugs, such as doxycycline or chloroquine.
Treatment of Intra-hepatic Jaundice
The treatment of intra-hepatic jaundice aims to prevent extensive damage to the liver and repair the damage. For example, if liver damage is caused by the habit of consuming excessive alcoholic beverages, then the doctor will advise the patient to stop the habit.
When liver damage is triggered by an infection, such as hepatitis B or C, the doctor will give antiviral drugs. Meanwhile, if the liver damage is at the final stage and cannot be repaired (cirrhosis), the doctor will recommend a liver transplant procedure.
Treatment of Post-hepatic Jaundice
Treatment of post-hepatic jaundice aims to remove blockages in the bile ducts and pancreas. In post-hepatic jaundice caused by gallstones, the doctor will remove the stone through surgery.
Meanwhile, if the cause is cancer of the pancreas or bile duct, then the doctor may perform an operation to remove the pancreatic organ.
Treatment of Jaundice in Newborn Babies
Jaundice in babies should improve on its own in 2 or 3 weeks. However, in severe cases, the baby needs to receive the following treatment in the hospital:
-
Providing additional nutrition Additional
nutrition should be given to the baby to prevent weight loss. This nutritional supplement can be given through an interval.
-
Phototherapy
In the phototherapy procedure, the baby will be irradiated with blue light ( blue light therapy ). This blue light will help remove bilirubin from the baby’s body.
-
Immunoglobulin
injection Immunoglobulin injection aims to lower the level of antibodies that trigger the destruction of red blood cells, due to the difference in blood type between the baby and the mother.
-
Exchange
transfusion Exchange transfusion is done if the baby does not improve with other therapies. In this procedure, the baby’s blood will be replaced with blood from a donor.
Complications of Jaundice
If left untreated or the bilirubin level reaches 25 mg/dL, jaundice in infants can lead to serious complications, such as:
- Hearing loss
- Cerebral palsy
- Brain damage
- Kernicterus
Whereas in adults, jaundice can cause complications with varying degrees of severity, depending on the cause. These complications can include:
- Electrolyte disturbance
- Anemia
- Bleeding
- Infections, eg sepsis
- Chronic hepatitis
- encephalopathy
- heart failure
- Kidney failure
- Cancer
In severe cases, jaundice can also cause death.
Jaundice Prevention
Prevention of jaundice is done by preventing the cause. Some preventive measures that can be taken are:
- Get vaccinated for hepatitis A and B.
- Consumption of malaria prevention drugs before visiting areas prone to the disease.
- Limit consumption of alcoholic beverages, to prevent liver damage.
- Stop smoking, to prevent cancer.
- Avoid drug abuse, especially those using syringes.
- Avoid unprotected sex and multiple partners.
- Consumption of clean food and drink, to avoid hepatitis A.
- Use personal protective equipment in the work environment, to avoid exposure to chemicals that can trigger liver damage.
- Consult with your doctor about the dosage, benefits, and risks of the drugs used.