Jaundice

Jaundice is yellowing of the skin (and eyes and every other organ in the body) as a result of an excess of the pigment bilirubin in the circulation. Bilirubin is produced by the liver as a product of the break down of haemoglobin from red blood cells which have reached the end of their life. It is usually present in the circulation at a level up to 17 micromoles per litre. It becomes evident in the skin and eyes at levels above 30 to 35 micromoles per litre.

There are three broad types of jaundice: obstructive jaundice occurs when the drainage of bile from the liver is blocked by for example a gall stone - the level of bilirubin in the blood rises, causing yellowness and itching. Since the bilirubin has been processed by the liver and conjugated the resulting urobilinogen is water-soluble, so the urine becomes very dark. Since there is no secretion of bile into the gut the stool becomes very pale.

Cholestatic jaundice (chole- was the Greek for bile, so cholestatic means the bile stands still) occurs when the liver cells are inflamed and fail to function, such as happens in hepatitis, while so-called acholuric jaundice results from the presence of unconjugated bilirubin (since this is not water-soluble it does not appear in the urine. This is why this jaundice is called acholuric - there is no bile in the urine). It is caused by haemolysis or conditions such as Gilbert's syndrome. While slight elevations in the level of bilirubin in the blood, as occurs in Gilbert’s syndrome, may be of no consequence, more severe levels of jaundice are associated with symptoms of malaise, abdominal pain, diarrhoea, vomiting and itching, which may be intense.

The treatment of the jaundice is the treatment of the underlying cause: obstruction must be relieved via the attentions of a surgeon, if the liver is inflamed as a result of exposure to a toxic agent such as alcohol then exposure should be stopped, while if it's the result of viral infection treatment is supportive, with agents to help to nausea and vomiting and itch, and avoidance of fats and alcohol. Vitamin and mineral intake should be maintained.
 
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