What is Jaundice?
The structures that give blood its color and carry oxygen are called hemoglobin. Hemoglobin is the substance that forms the main structure of red blood cells (erythrocytes).
The lifespan of red blood cells in the body is approximately 120 days. After 120 days, the red blood cells in the blood are destroyed and renewed.
When this hemoglobin substance in the red blood cells is destroyed, it is converted into bilirubin.
Bilirubin is a yellow substance. The liver is responsible for removing bilirubin from the body. However, if bilirubin cannot be removed from the body sufficiently for any reason, it enters the bloodstream. And it causes the skin, mucous membranes and the whites of the eyes to appear yellow.
What Causes Jaundice?
The causes of jaundice are usually related to the liver, gallbladder or pancreas, and the accumulation of bilirubin in the body, its amount increasing and mixing with the blood, which the liver cannot process.
If the liver cannot convert bilirubin during the process of breaking down red blood cells, this causes a yellow color in the skin and eyes, jaundice.
The conditions that cause jaundice are generally:
- Gallstones
- Hepatitis
- Excessive alcohol consumption
- Side effects of certain medications
- Autoimmune disorders
- Gallbladder inflammation
- Gallbladder cancer
- Pancreatic tumor
- Cirrhosis
- Hemolytic anemia
- Diabetes
What are The Symptoms of Jaundice?
The symptoms of jaundice develop due to increased bilirubin levels in the blood. It usually manifests itself in the skin, eyes and body functions. Symptoms may vary depending on the underlying cause. However, there are some common symptoms.
The Most Common Symptoms of Jaundice
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Yellowing of the Skin and Eyes:
- It is the most obvious symptom.
- It is first noticed in the whites of the eyes, then spreads to the skin.
- Yellowing of the skin is more noticeable in people with fair skin.
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Darkening of the Urine:
- The color of the urine turns tea.
- This occurs because direct bilirubin is excreted in the urine (especially in the posthepatic type).
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Light-Colored Stool:
- Bile pigments give the stool its color.
- When the bile ducts are blocked, the stool becomes white or clay-colored.
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Itching (Pruritus):
- Especially in cases of bile duct obstruction, bile acids accumulate in the skin.
- It is an intense itching that increases at night.
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Fatigue and Weakness:
- It is common in liver diseases.
- It may be accompanied by loss of appetite, weight loss and sleep problems.
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Abdominal Pain:
- Especially in the right upper quadrant (the area where the liver is located)
- It may be seen in gallstones, hepatitis or liver enlargement.
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Nausea and Vomiting:
- The digestive system is affected.
- It is common in hepatitis or liver inflammation.
What is Jaundice in Babies?
Jaundice observed in babies is called neonatal jaundice. It is possible to encounter jaundice in many newborns.
Jaundice can be observed in 80% of premature babies and 80% of babies born after the 37th week. Jaundice in babies can have many causes.
One of the most common causes is physiological jaundice. The liver of babies has just taken over the task of breaking down bilirubin from the placenta after birth.
The developing liver cannot remove bilirubin effectively at first. Over time, the liver removes bilirubin effectively. And the symptoms disappear on their own.
What are The Causes of Neonatal Jaundice?
Neonatal jaundice is a physiological process that is usually harmless.
However, in some cases, there may be other underlying causes:
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Physiological Jaundice:
It occurs in most babies within 2-4 days after birth and usually goes away on its own within 1-2 weeks.
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Breast Milk Jaundice:
It can be seen in babies fed with breast milk and usually occurs after 1-2 weeks. Substances in the composition of breast milk can affect bilirubin metabolism.
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Premature Infant Jaundice:
Since liver maturation takes longer in premature babies, jaundice can be more widespread and more severe.
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Hemolytic Disease:
If the mother and baby’s blood types are incompatible (for example, Rh incompatibility), the baby’s red blood cells can break down rapidly, which increases bilirubin levels.
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Inadequate Nutrition:
If the baby does not receive enough breast milk or formula, bilirubin can be reabsorbed in the intestines and jaundice can worsen.
What are The Symptoms of Neonatal Jaundice?
Neonatal jaundice causes the baby’s skin and the whites of the eyes to take on a yellow color. Jaundice usually begins on the face and head. If the bilirubin level increases, the color spreads to the body. Jaundice can be difficult to see, especially in dark-skinned babies. To distinguish it, it is necessary to gently press the skin on the newborn’s nose or forehead. If jaundice is present, the skin will appear yellow when the finger is lifted.
Symptoms of neonatal jaundice are generally as follows;
Early Symptoms:
- A yellowish tint to the skin and whites of the eyes
- Skin that appears yellow when light pressure is applied
Signs of severe jaundice that may indicate an underlying medical condition include:
- Signs of spreading or worsening jaundice
- Deepening of the yellow color
- Fever over 38 degrees Celsius
- Loss of appetite
- Weakness and lethargy
- Loud crying
How Is Neonatal Jaundice Diagnosed?
Doctors can tell if a baby has jaundice based on yellowing of the skin and whites of the eyes.
All newborns are checked for jaundice before they leave the hospital or birthing center. Measuring the level of bilirubin in your baby’s blood is very important because it will determine the course of treatment.
Methods used to diagnose neonatal jaundice and measure bilirubin include:
- Physical exam
- Laboratory testing of a sample of your baby’s blood
- Skin testing with a device called a transcutaneous bilirubinometer, which measures the reflection of a special light passing through the skin
- Ultrasound scan, liver biopsy, or exploratory surgery (rarely)
If the baby’s jaundice is thought to be caused by an underlying disorder, your doctor may order additional blood or urine tests.
How Is Neonatal Jaundice Treated? How Does Neonatal Jaundice Go Away?
There is usually no treatment for jaundice in newborn babies. This jaundice goes away on its own as the baby’s liver develops. The recovery period may last for one or two weeks. During this period, breastfeeding the baby frequently will trigger defecation, which will allow the bilirubin to be removed from the body more quickly.
However, in cases where it does not go away on its own and the baby’s bilirubin level is high or continues to rise, the following treatment methods are used:
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Light Therapy (Phototherapy):
The aim is to lower the bilirubin levels by placing the baby under a special lamp that emits light in the blue-green spectrum. The light changes the shape and structure of the bilirubin molecules so that they can be released both in the urine and in the stool. Protective eye patches are used during treatment.
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Intravenous Immunoglobulin:
In some cases, certain drug applications may be preferred to reduce high bilirubin levels. The pharmacological agents used in treatment help to accelerate the excretion of bilirubin in the body and reduce bilirubin production.
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Transfusion:
Rarely, when severe jaundice does not respond to other treatments, a blood transfusion may be required. This involves repeatedly withdrawing small amounts of blood and replacing it with donor blood, intended to dilute the bilirubin and maternal antibodies, a procedure performed in the neonatal intensive care unit.
What are The Types of Jaundice?
Jaundice is a medical condition that can occur due to different causes, so it is classified into three broad categories based on causative factors. This classification is made according to which part of the liver is malfunctioning and how the removal of bilirubin from the bloodstream is affected.
The types of jaundice are called hepatocellular, hemolytic and obstructive jaundice:
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Hepatocellular Jaundice:
It is a type that occurs due to damage to the liver.
When the liver parenchymal cells are damaged by infection or other causes, a decrease in liver metabolism occurs.
This decrease prevents the removal of bilirubin from the body. And leads to its accumulation.
Factors such as hepatitis A, B or C viruses, liver cancer or excessive alcohol consumption can cause hepatocellular jaundice.
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Hemolytic Jaundice:
It occurs as a result of red blood cells breaking down faster than normal.
In this case, the liver cannot cope with high bilirubin.
This can be fatal and can be observed in diseases such as malaria. Because malaria parasites attack red blood cells quickly and cause them to break down.
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Obstructive Jaundice:
It is caused by blockages that occur between the bile ducts. This blockage prevents the liver from removing bilirubin and leads to bilirubin accumulation in the liver. Conditions that can cause blockages in the bile ducts may include gallstones or swollen lymph nodes.
How is Jaundice Diagnosed?
Since jaundice can develop due to different causes, the diagnostic process requires a careful evaluation and a series of tests.
The first step in the diagnostic process is a detailed evaluation of the patient’s medical history. The doctor questions the patient’s symptoms, how long these symptoms have continued, any other accompanying symptoms, and the patient’s general health status.
In addition, information is collected about the patient’s medications, alcohol consumption, previous illnesses, and whether there are similar conditions in the family. A physical examination is an important step in diagnosing jaundice.
The doctor checks the skin, eyes, and mucous membranes for yellowing. He or she also touches the abdomen to assess the size and tenderness of the liver. Symptoms such as bloating, abdominal pain, and itching are also examined.
Various laboratory tests are performed to confirm the diagnosis of jaundice and determine the underlying cause:
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Bilirubin Test:
Total bilirubin, direct bilirubin, and indirect bilirubin levels in the blood are measured. This test helps identify disorders in bilirubin metabolism.
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Liver Function Tests (LFT):
Liver function is assessed by measuring enzyme levels such as ALT, AST, ALP, and GGT. High enzyme levels may indicate liver damage.
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Complete Blood Count (CBC):
It is performed to detect signs of anemia or infection.
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Blood Incompatibility Tests:
If the blood types of the mother and the baby are incompatible, hemolytic disease is investigated in babies.
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Viral Hepatitis Tests:
It is done to check for the presence of viral infections such as Hepatitis A, B, C.
Various imaging methods are used to determine the cause of jaundice and evaluate possible blockages in the bile ducts:
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Ultrasonography:
It is used to view the liver, gallbladder and bile ducts. Gallstones, tumors or duct obstructions can be detected.
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CT Scan (Computed Tomography):
It is used to obtain more detailed images. It is suitable for evaluating anomalies in the liver, pancreas and bile ducts.
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MRCP (Magnetic Resonance Cholangiopancreatography):
It is used to image the bile and pancreatic ducts. It helps to identify blockages and other structural problems.
Liver biopsy plays an important role in the diagnosis of liver diseases. In this procedure, which is performed under local anesthesia, a small tissue sample is taken from the liver and examined under a microscope. The biopsy helps to evaluate the structure of the liver and the degree of damage. In some cases, additional tests may be needed to learn more about the cause of jaundice:
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Endoscopic Retrograde Cholangiopancreatography (ERCP):
Used to examine the bile and pancreatic ducts and treat if necessary.
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Serologic Tests:
Used to diagnose autoimmune hepatitis or other autoimmune diseases.
How is Jaundice Treated?
It is very important to lower the high bilirubin levels that cause jaundice with appropriate treatment and to remove the bilirubin from the body. Elevated bilirubin levels can cause permanent brain damage. Treatment for jaundice varies depending on the type of underlying disease. Almost all treatments for jaundice are based on treating the underlying cause rather than the jaundice itself.
Some of the common treatment methods used for jaundice can be listed as follows:
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Hemolytic Jaundice Treatment:
Treatment for hemolytic jaundice is to correct the anemia or other condition that impedes the production of healthy red blood cells.
In cases where jaundice occurs due to systemic anemia, supplementing with iron through the diet may help. Other cases, such as cases of inherited disorders that affect red blood cells, such as sickle cell anemia, should be treated with other treatments such as intravenous fluids and blood transfusions.
Folic acid supplementation and surgical removal of the spleen are other hemolytic treatments for jaundice caused by conditions such as thalassemia and spherocytosis. In severe cases, healthy blood production is severely limited and surgical interventions such as bone marrow replacement are required.
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Hepatocellular Jaundice Treatment:
Since hepatocellular jaundice is caused by liver damage, the primary focus is on the root cause of this damage. And treatment is applied accordingly.
In liver damage caused by infections, antiviral drugs are preferred to stop the spread of the infection.
However, the healing process is usually slower. Especially in cases such as hepatitis, steroids can be used in addition to antiviral drugs.
In liver damage caused by cirrhosis, doctors usually recommend a low-protein diet and strongly recommend that patients stay away from alcohol completely. In addition, beta-blockers and intravenous antibiotics are also used in the treatment of cirrhosis.
On the other hand, liver cancer is one of the most important causes of jaundice. In this case, standard cancer treatment methods such as chemotherapy and radiotherapy are commonly used. These treatments are shaped depending on the course and severity of the disease. However, in advanced cases, liver transplantation may be necessary for the health of the patient.
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Obstructive Jaundice Treatment:
Jaundice cases caused by obstruction are treated using surgical methods. In cases of jaundice caused by gallstones, doctors recommend a dietary change that can prevent the production of gallstones. Medicines aimed at dissolving gallstones are also used to make the treatment more effective. In severe cases, surgery is performed to completely replace the gallstones or the gallbladder.
