Pathological Jaundice

Pathological jaundice is a condition where the skin and the whites of the eyes turn yellow due to excess bilirubin in the bloodstream. This can happen when there’s a problem with the liver, gallbladder, or bile ducts. In newborns, it can be a sign of underlying health issues. Let’s break down the different aspects of pathological jaundice in simple terms.

Pathological jaundice is when the skin and eyes turn yellow due to high levels of bilirubin in the blood, often indicating a problem with the liver or bile ducts.

Types:

1. Physiological Jaundice: Common in newborns due to the immature liver.
2. Hemolytic Jaundice: Caused by rapid breakdown of red blood cells.
3. Hepatocellular Jaundice: Due to liver damage or disease.
4. Obstructive Jaundice: Caused by blockage of the bile ducts.
5. Prehepatic Jaundice: Caused by excessive breakdown of red blood cells.
6. Hepatic Jaundice: Arises from liver diseases affecting bilirubin processing.
7. Posthepatic Jaundice: Occurs due to bile duct obstruction, hindering bilirubin excretion.

Causes:

1. Liver Disease: Such as hepatitis or cirrhosis.
2. Gallstones: Blockage of bile ducts.
3. Pancreatitis: Inflammation of the pancreas.
4. Hemolytic Anemia: Rapid breakdown of red blood cells.
5. Genetic Disorders: Like Gilbert’s syndrome.
6. Alcohol Abuse: Damages the liver.
7. Medications: Certain drugs can affect liver function.
8. Infections: Such as malaria or sepsis.
9. Autoimmune Diseases: Like autoimmune hepatitis.
10. Liver Cancer: Tumors affecting liver function.
11. Bile Duct Disorders: Such as primary biliary cholangitis.
12. Inborn Errors of Metabolism: Genetic conditions affecting bilirubin processing.
13. Obesity: Can lead to non-alcoholic fatty liver disease.
14. Hemochromatosis: Excess iron in the liver.
15. Wilson’s Disease: Copper accumulation in the liver.
16. Drugs and Toxins: Harmful substances can damage the liver.
17. Sepsis: Severe infection affecting liver function.
18. Pregnancy: Can cause temporary jaundice.
19. Trauma: Liver injury due to accidents.
20. Malnutrition: Lack of essential nutrients affecting liver health.

Symptoms:

1. Yellowing of the skin and eyes (jaundice)
2. Dark urine
3. Pale stools
4. Abdominal pain
5. Nausea and vomiting
6. Fatigue
7. Itchy skin
8. Loss of appetite
9. Swelling in the abdomen
10. Weight loss
11. Fever
12. Confusion or difficulty concentrating
13. Bruising easily
14. Joint pain
15. Swollen legs and ankles
16. Enlarged liver or spleen
17. Spider-like blood vessels on the skin
18. Weakness
19. Jaundice appearing within 24 hours of birth in newborns
20. Poor weight gain in infants

Diagnostic Tests:

1. Blood Tests: Measure bilirubin levels.
2. Liver Function Tests: Assess liver enzymes and function.
3. Ultrasound: Imaging of the liver and bile ducts.
4. CT Scan: Detailed imaging of the liver and surrounding organs.
5. MRI: Provides detailed images of liver and bile ducts.
6. Endoscopic Retrograde Cholangiopancreatography (ERCP): Examines the bile ducts.
7. Liver Biopsy: Collects a sample of liver tissue for analysis.
8. Abdominal X-ray: Checks for blockages or abnormalities.
9. Stool Tests: Checks for bilirubin in stool.
10. Genetic Testing: Identifies underlying genetic conditions.
11. Viral Hepatitis Panel: Tests for hepatitis viruses.
12. Autoimmune Markers: Checks for autoimmune liver diseases.
13. Serum Iron Studies: Assess iron levels in the blood.
14. Copper Tests: Measure copper levels in the blood.
15. Ferritin Test: Assesses iron stores in the body.
16. Immunoglobulin Levels: Tests for autoimmune diseases.
17. Liver Enzyme Tests: Measures specific enzymes in the blood.
18. Coagulation Studies: Checks blood clotting function.
19. Alpha-1 Antitrypsin Test: Detects a deficiency associated with liver disease.
20. Lactate Dehydrogenase (LDH) Test: Measures enzyme levels in the blood.

Treatments:

Non-Pharmacological Treatments for Pathological Jaundice:

1. Phototherapy: Exposure to special lights to help break down excess bilirubin.
2. Fluid replacement: Ensures hydration and supports liver function.
3. Nutritional support: Balanced diet to aid liver health.
4. Avoidance of alcohol and certain medications: Prevents further liver damage.
5. Liver transplantation: For severe cases of liver failure.
6. Dietary modifications: Low-fat, low-sodium diet to ease liver strain.
7. Regular exercise: Supports overall health and may aid liver function.
8. Hepatic artery embolization: Minimally invasive procedure to treat liver tumors.
9. Endoscopic retrograde cholangiopancreatography (ERCP) stenting: Opens blocked bile ducts.
10. Biliary drainage: Removes excess bile from the liver.
11. Bile acid therapy: Helps manage bile duct obstruction.
12. Nasogastric tube insertion: Delivers nutrients directly to the stomach if eating is difficult.
13. Portosystemic shunt surgery: Redirects blood flow in the liver to relieve pressure.
14. External biliary drainage: Removes bile from the body externally.
15. TIPS procedure (transjugular intrahepatic portosystemic shunt): Creates a channel to reduce portal vein pressure.
16. Paracentesis: Drains fluid buildup in the abdomen (ascites).
17. Splenectomy: Removes the spleen in certain cases of liver disease.
18. Percutaneous transhepatic biliary drainage (PTBD): Relieves bile duct obstruction.
19. Cholecystectomy: Surgical removal of the gallbladder for gallstone-related jaundice.
20. Liver resection: Removes part of the liver affected by tumors or disease.
21. Nutritional counseling: Helps maintain a balanced diet despite liver-related dietary restrictions.
22. Liver support devices: Assist liver function in critical cases.
23. Esophageal variceal ligation: Treats esophageal varices associated with liver disease.
24. Lactulose therapy: Manages hepatic encephalopathy by reducing ammonia levels.
25. Total parenteral nutrition (TPN): Provides nutrients intravenously if oral intake is insufficient.
26. Liver-directed therapy for tumors: Targets liver tumors with chemotherapy or radiation.
27. Intraoperative cholangiography: Imaging during surgery to assess bile ducts.
28. Biliary stenting: Keeps bile ducts open to prevent obstruction.
29. Liver transplant evaluation: Determines candidacy for liver transplantation.
30. Ascitic fluid analysis: Tests fluid removed from the abdomen for signs of infection or cancer.

20 Drugs Used in the Treatment of Pathological Jaundice:

1. Ursodeoxycholic acid (UDCA): Dissolves cholesterol gallstones and treats certain liver conditions.
2. Phenobarbital: Stimulates liver enzyme activity to enhance bilirubin breakdown.
3. Rifampicin: Antibiotic used off-label to reduce bilirubin levels.
4. Lactulose: Manages hepatic encephalopathy by lowering ammonia levels.
5. N-acetylcysteine (NAC): Antioxidant used in acetaminophen overdose and certain liver diseases.
6. Corticosteroids: Anti-inflammatory medications for autoimmune liver diseases.
7. Octreotide: Reduces portal pressure in liver disease.
8. Cholestyramine: Binds bile acids to treat pruritus associated with liver disease.
9. Entecavir: Antiviral medication for hepatitis B.
10. Sorafenib: Chemotherapy drug for advanced liver cancer.
11. Imatinib: Targeted therapy for certain liver tumors.
12. Interferon alfa: Antiviral medication for hepatitis C.
13. Lenvatinib: Targeted therapy for liver cancer.
14. Obeticholic acid: Farnesoid X receptor agonist for primary biliary cholangitis.
15. Ribavirin: Antiviral medication used in combination therapy for hepatitis C.
16. Vedolizumab: Biologic medication for autoimmune liver diseases.
17. Tenofovir: Antiviral medication for hepatitis B.
18. Regorafenib: Targeted therapy for advanced liver cancer.
19. Dasatinib: Targeted therapy for certain liver cancers.
20. Simeprevir: Antiviral medication for hepatitis C.

10 Surgeries for Pathological Jaundice:

1. Liver transplant: Replaces a diseased liver with a healthy one from a donor.
2. Cholecystectomy: Removes the gallbladder to treat gallstone-related jaundice.
3. Biliary bypass surgery: Creates a new pathway for bile flow around obstructed ducts.
4. Hepatectomy: Surgical removal of part of the liver affected by tumors.
5. Kasai procedure: Corrective surgery for biliary atresia in infants.
6. Whipple procedure: Removes part of the pancreas, bile duct, and small intestine for pancreatic cancer.
7. Portosystemic shunt surgery: Redirects blood flow in the liver to relieve pressure.
8. TIPS procedure: Creates a shunt to reduce portal vein pressure in portal hypertension.
9. Liver resection: Removes tumors or damaged parts of the liver.
10. Pancreaticoduodenectomy (Whipple procedure): Removes part of the pancreas, bile duct, and small intestine for pancreatic cancer.
11. Cholecystectomy: Removal of the gallbladder.
12. Liver Transplantation: Replacement of a diseased liver with a healthy one.
13. Sphincterotomy: Cutting the muscle to widen the bile ducts.
14. Liver Resection: Surgical removal of part of the liver.
15. Biliary Bypass: Creating a new route for bile to flow.
16. Pancreaticoduodenectomy (Whipple Procedure): Removal of part of the pancreas and bile ducts.
17. Biliary Stent Placement: Insertion of a stent to keep bile ducts open.
18. Liver Abscess Drainage: Removing pus from an infected area of the liver.
19. Liver Cyst Drainage: Draining fluid from cysts in the liver.
20. Liver Biopsy: Surgical removal of liver tissue for examination.

Preventions:

1. Vaccination: Against hepatitis viruses.
2. Safe Sex Practices: To prevent transmission of hepatitis B and C.
3. Avoiding Alcohol Abuse: Protects the liver from damage.
4. Healthy Diet: Low in fat, sugar, and processed foods.
5. Regular Exercise: Promotes overall health, including liver function.
6. Maintaining a Healthy Weight: Reduces the risk of fatty liver disease.
7. Safe Handling of Chemicals: Minimizes exposure to liver-damaging substances.
8. Proper Medication Use: Follow doctor’s instructions and avoid overuse.
9. Screening for Liver Diseases: Early detection can lead to better outcomes.
10. Regular Health Check-ups: Monitoring liver health as part of routine care.

When to See a Doctor:

1. Yellowing of the skin or eyes
2. Dark urine
3. Pale stools
4. Abdominal pain
5. Nausea and vomiting
6. Fatigue
7. Itchy skin
8. Loss of appetite
9. Unexplained weight loss
10. Swelling in the abdomen
11. Fever
12. Confusion or difficulty concentrating
13. Bruising easily
14. Joint pain
15. Swollen legs and ankles
16. Enlarged liver or spleen
17. Spider-like blood vessels on the skin
18. Weakness
19. Jaundice appearing within 24 hours of birth in newborns
20. Poor weight gain in infants

Pathological jaundice can be a sign of serious health issues, especially in newborns, so it’s important to seek medical attention if you notice any of these symptoms. Early detection and proper treatment can help prevent complications and improve outcomes.