Yellow Skin/Eyes

Jaundiced, is the yellowingof skin and other body parts, due to a build-up of a chemical in the body called as bilirubin. There are many causes of jaundice.  Its important to see a doctor if you become jaundiced. The treatment and outlook (prognosis) depends on the cause.

Bilirubin is a normally produced in the body, but abnormally high levels in various diseases, could lead to yellowing of tissues (whites of the eyes are often the first tissues that turns yellow) known as jaundice. With higher levels of bilirubin, the skin also becomes yellow.

Bilirubin is one of the chemicals produced by degradation of broken red blood cells in the body. It is then carried by blood to the liver, where they alter its structure to make it more water soluble (conjugated bilirubin). This is then passed into the bile ducts and stored in the gall bladder and this then excreted into the gut. The bilirubin in the bile gives the poo (faeces) the typical brown colour. So, getting rid of bilirubin is a normal process. It is when abnormal amounts of bilirubin build up in the blood that you become jaundiced. And this can happen for many different reasons.

The causes of jaundice are divided into the following:

  • Conditions affecting the red blood cells, causing there increased destruction, thus producing increased bilirubin. Conditions causing this would be:
  • Some genetic diseases such as sickle cell anemia, thalassemia, spherocytosis, and glucose 6-phosphate dehydrogenase deficiency.
  • Haemolytic uraemic syndrome.
  • Malaria.
  • Conditions causing destruction of liver cells can also cause jaundice; this could be due to
    • Hepatitis, which is inflammation of liver cells (due to infection, alcohol, autoimmune disease and intake of certain medicines or poisons.
    • Cirrhosis is a condition where normal liver tissue is replaced by scar tissue (fibrosis), generally caused by slow and continuous destruction of liver tissue.
    • Hereditary defects in the chemicals (enzymes) that process bilirubin in liver cells. These include Gilbert's syndrome, Dubin-Johnson syndrome, Crigler-Najjar syndrome and Rotor's syndrome.
    • Conditions affecting the tiny bile ductswithin the liver become damaged or narrowed , causing flow of bile to be  restricted. A backlog of bile (which contains bilirubin) then spills into the bloodstream.
    • Conditions affecting the common bile duct to become blocked (obstructed). This is sometimes called obstructive jaundice or post-hepatic jaundice (hepatic is another word for liver). Conditions causing this includes, that can cause this includes, gallstones, pancreatic cancer in the head of the pancreas, Inflammation of the pancreas (pancreatitis), biliary atresia and cancer of the gallbladder may grow to block the common bile duct.

If a person becomes jaundiced one should see your doctor immediately.  Since the causes are so many that it is vital to get the correct diagnosis, as the treatment and outlook (prognosis) can vary greatly, depending on the cause. Doctor is likely to ask various questions, do some examination and on the basis of these come to a conclusion.

The tests advised by doctors include:

  • Blood tests done, to find out the blood levels of bilirubin (unconjugated or conjugated). This can help to narrow down the possible causes of jaundice. Also blood levels of various liver enzymes (called liver function tests), help to show if the liver is inflamed or working well. Blood tests can also detect certain viruses or markers of other infections that can affect the liver.
  • Urine tests may help to show if the levels of various chemicals in the blood are raised. This can help to narrow down the possible causes of jaundice.
  • An ultrasound scan of the liver, common bile duct and pancreas may identify a cause. For example, a gallstone or cancer of the pancreas and be detected.
  • An MRI scan of the liver may be useful.
  • A sample of the liver (biopsy), taken to look at under the microscope), or other more complex tests may be needed if the diagnosis is still in doubt.

Physiological jaundice is common for newborn babies to develop when they are 2-3 days old. It is due to a mild increase in the breakdown of red blood cells combined with a liver that is not quite fully functioning. The liver soon matures and the jaundice begins to disappear towards the end of the first week and has gone by day 10.

The baby is well and has no other problems.Other causes of physiological jaundice may be due to serious disease of the blood, liver or other problems. As a rule, the jaundice is not likely to be physiological jaundice if the baby is unwell, and/or the jaundice is present in the first 24 hours after birth or lasts for more than 10 days. The treatment depends on the cause.

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