Jaundice

By Dr. Loretta Lanphier, ND, CN, HHP, CH

To the laymen, jaundice is often associated with such conditions as hepatitis and other liver diseases. While it is true that jaundice is a symptom, either directly or indirectly, of improper liver function, the variety of conditions that can result in jaundice are surprisingly numerous. Jaundice is a symptom, not a disease of its own accord, and the reasons why it may occur are quite complex.

What is Jaundice?

Jaundice is a symptom of abnormally high levels of bile pigments in the blood that results in a yellowish color of the skin and the whites of the eyes. There are many different causes for jaundice, but they are all related in one way or another to liver dysfunction.

A bit of basic information about how the liver produces and processes bile will be helpful in understanding jaundice. The liver performs many crucial functions, but it is primarily a chemical factory/filter that takes in raw materials, such as nutrients, toxins, and drugs, and separates the useful products from the waste products, and then sends them on their way to the proper destination. One key job that is accomplished via this process is the transformation of waste products such as cholesterol into a substance called bile that is delivered back to the intestinal tract as a needed ingredient for digestion. The liver also filters the blood and collects substances, good and bad, which it then processes and passes many of them off to the bile. One waste product of a protein in the blood called hemoglobin is known as bilirubin. This substance is yellow, and if it is not properly excreted from the body, it will cause other tissues of the body to take on a yellow tint, such as the whites of the eyes and the skin.

Bile is manufactured in the liver, and travels to the gall bladder through a series of hepatic bile ducts, where it becomes concentrated, and is stored for later use. When food enters the stomach, a signal is given to the gall bladder to release bile. As the bile travels to the intestinal tract, it is joined by secretions from the pancreas. Together these substances form the digestive juices that break down our food. With this background information, we can better grasp the different types of jaundice.

What Causes Jaundice?

Many different conditions can exhibit jaundice as a symptom, but it might be best if we break down these conditions into three main categories based on where they occur: Pre-hepatic (before the liver), hepatic (in the liver), and post-hepatic (after the liver).

Pre-Hepatic Jaundice

Red Blood Cells (RBCs) are formed primarily in the bone marrow. If anything causes the death of RBCs faster than the hemoglobin can be used, excess hemoglobin accumulates, causing in turn an abnormal amount of bilirubin. The abnormal death of RBCs also contributes to excessive levels of bilirubin, which leads to jaundice.

Many pre-hepatic causes of jaundice are the result of conditions that cause abnormally high rates of RBC destruction. RBC death is called hemolysis, and conditions that cause it are known as hemolytic disorders. Common hemolytic disorders that are pre-hepatic causes for jaundice include:

  1. Malaria:  This disease that was once very common in tropical climates is caused by a parasite that is passed to people mainly through mosquito bites. The parasite attacks the RBCs, where it matures until the cell bursts and the parasite enters the blood stream. Malaria is a serious and sometimes fatal disease that has many negative effects on the body, but one of them is the accelerated death of RBCs that releases high levels of bilirubin and causes jaundice.
  2. Poisons:  Certain toxins directly attack RBCs and result in jaundice. These include some spider and snake venom, copper poisoning, many organic industrial toxins, as well as some bacterial agents.
  3. Drugs:  Some drugs have the potential to kill RBCs as a possible side effect. One of the more well known ones is Levodopa, commonly prescribed to treat Parkinson’s disease. Others include drugs that regulate the heartbeat, and some medicines given to treat tuberculosis.
  4. Enzyme deficiency:  A genetic disorder that leaves folks with insufficient amounts of an enzyme called G6PD can make them more susceptible to hemolysis in combination with the drugs listed above, as well as with quinine, a common drug used to treat malaria. In folks with G6PD deficiency Vitamins C and K can also lead to hemolysis and jaundice.
  5. Inherited RBC disorders:  The most famous disorder of this type is sickle cell anemia. Some of these disorders, such as sickle cell, compromise the physical structure of the RBC. Others affect the RBCs chemically. Either way the result is the same: hemolysis that leads to jaundice.
  6. Artificial heart valves: These inflexible parts tend to damage RBCs and cause abnormally high numbers of them to die prematurely. This is why parts made of organic material such as pig heart valves are preferred.
  7. Immune system dysfunction:  Occasionally, the immune system will turn on RBCs and destroy them. This can also occur in conjunction with certain types of cancer, but about 75% of the time it is strictly an abnormally aggressive immune system response.
  8. Spleen enlargement:  Certain diseases, such as malaria and some types of leukemia and other cancers, can cause the spleen to swell to the point where it filters out healthy RBCs as well as worn out ones, as it is designed to do. Jaundice can result.
  9. Kidney failure:  When the kidneys fail, one consequence is often improper coagulation of the blood. This can kill large numbers of RBCs.
  10. Improper blood transfusions:  If you are given a blood type that does not match your own, hemolysis may occur and lead to jaundice.

Hepatic Jaundice

This type of jaundice is a symptom of conditions that occur within the liver. Just about any type of liver disease can result in jaundice. When the liver is not functioning properly, it cannot keep up with processing bilirubin, so jaundice can easily result.  Some of the most common include:

  1. Hepatitis (inflammation of the liver)
  2. Cirrhosis of the liver (often associated with alcoholism)
  3. Drug abuse
  4. Liver infections
  5. Malnutrition and/or starvation
  6. Bad reactions to certain medications
  7. Gilbert’ syndrome and Crigler-Najjar syndrome:  These are both genetic, inherited disorders that adversely affect the chemistry of the liver.

Post-Hepatic Jaundice

This type of jaundice is often called obstructive jaundice because it occurs when bilirubin that has left the liver is not able to reach the intestines. The most typical causes are:

  1. Gallstones
  2. Physical trauma
  3. Bile duct infections
  4. Certain cancers
  5. Drug reactions that cease the flow of bile

Jaundice in and of itself is not usually dangerous or bothersome, but there are a few exceptions to that statement. Some people with jaundice will experience itching of the skin that can be quite severe in some cases. Long-term jaundice may also cause bile stones to form in the bile ducts, resulting in further complications and infections. Other than these, yellow skin and yellowish whites of the eyes are the main symptoms of jaundice.

Infant Jaundice

There is one form of jaundice that deserves special mention, that being infant jaundice. This common form of jaundice is found in about 50% of all full-term babies, and up to 80% of all preemies. It often appears as the characteristic yellow skin and yellowish whites of the eyes 2 or 3 days after birth. It usually results because a newborn’s liver has not matured yet to the point where it can handle bilirubin.

Parents can do an easy check if they suspect jaundice. Simple push your finger gently onto your baby’s forehead. If the skin appears yellow, they probably have jaundice. This test works for any race or skin color.

Besides an immature liver, there are other reasons your baby can have jaundice:

  1. Premature birth:  Even full-term kids can have livers that are not fully developed, but the chance is much greater for that to happen if a child is born prematurely. It can also be a factor of preemies feeding less the first few days of life. This can lead to fewer bowel movements, which is one way bilirubin is eliminated from the body.
  2. Difficult birth:  If there was any trauma involved for the baby during birth, bruising may have occurred, which can damage abnormal numbers of RBCs and result in excess bilirubin.
  3. Blood type differences:  If mom and baby have different blood types, the newborn may have received certain antibodies through the placenta that can result in the destruction of more RBCs than normal. This can be a more troublesome issue if the mother is Rh-negative, and is carrying an Rh-positive baby. In this case, the mother may be given an immune globulin Rho (D) that will prevent the production and transfer of the unwanted antibodies.
  4. Breast Feeding can also contribute to some cases of infant jaundice. If the child has a slow start at breast-feeding, dehydration and poor appetite can contribute temporarily to higher levels of bilirubin. Let me stress, however, that the benefits of breast-feeding far outweigh any potential risks associated with jaundice or any thing else. By all means, breast-feeding is best!

Most cases of infant jaundice are nothing to worry about, and will usually clear up on their own without any intervention. However, if your baby’s jaundice is severe, or she seems listless or unable to stay awake, it could indicate a greater underlying problem that should be addressed immediately.

What Treatments Are Available for Jaundice?

There are no remedies that directly deal with jaundice. The only way to help jaundice is to deal with the disease that is causing the jaundice. The most important thing is to identify why you are experiencing jaundice. Jaundice is a warning sign that something in the body is not right, a red flag if you will.

Jaundice can be very upsetting to a patient or especially to the parent of a newborn with jaundice. But it is not time to panic. Jaundice in newborns is common and usually not harmful. In adults, it can actually be a blessing because it can help you to find the cause of your jaundice before the underlying condition gets any worse. If you have jaundice, your body is talking to you, and I suggest you listen.

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