Jaundice

Jaundice is mainly of two types:

• Medical jaundice: Caused by liver dysfunction or systemic illnesses.
• Surgical/obstructive jaundice: Caused by physical blockages in the bile ducts.
   

The signs of jaundice may vary depending on the underlying cause, but common symptoms include:

• Yellowing of the skin and eyes
• Dark urine and pale stools
• Itching due to bile salts in the skin
• Abdominal pain, nausea, or vomiting (depending on the cause)
• Unexplained weight loss or loss of appetite (especially in cancer-related cases)

There are various factors leading to jaundice:

• Medical causes
  • Infections: Viral hepatitis (hepatitis A, B, C, non A–non B, and E)
  • Liver damage from medications, chemicals, and drugs
  • Chronic liver diseases: Conditions like cirrhosis, primary biliary cholangitis, primary sclerosing cholangitis, or autoimmune hepatitis
  • Non-alcoholic fatty liver disease (NAFLD): Common in obese individuals or those with diabetes, leading to cirrhosis.
• Surgical/obstructive causes
  • Gallstones: Stones that migrate to the bile ducts, causing blockage.
  • Tumours: Cancers of the liver, gallbladder, bile duct (cholangiocarcinoma), pancreas, or periampullary region.
  • Biliary strictures: Narrowing of bile ducts due to scarring or inflammation.
     

Doctors use a stepwise approach to identify the cause:

• Blood Tests
  • Liver function tests (LFTs): Assess bilirubin levels and liver enzymes.
  • Additional blood tests: To check for infections, blood counts, or tumour markers.
• Imaging Studies
  • Ultrasound: Often the first test to identify obstructions or stones.
  • CT scan/MRI/magnetic resonance cholangiopancreatography (MRCP): Provides detailed images of the liver, bile ducts, and surrounding structures.
• Endoscopy
  • Endoscopic retrograde cholangiopancreatography (ERCP): Helps in visualising and treating blockages, obtaining tissue samples, and placing stents to treat jaundice.
  • Endoscopic ultrasound (EUS): Helps in evaluating tumours or stones.
    
     

Treatment depends on the cause of jaundice and includes:

• For medical causes
  • Infections: Treated with antiviral or antibacterial medications.
  • Cirrhosis or NAFLD: Managed through lifestyle changes, medications, or, in severe cases, liver transplantation.
• For surgical/obstructive causes
  • Gallstones
    • Cholecystectomy: Removal of the gallbladder, often performed laparoscopically.
  • Cancer or tumours
    • Liver resection: Removal of part of the liver for liver cancer or metastases.
    • Hilar resection: Surgery to remove tumours blocking the main bile duct (hilar cholangiocarcinoma).
    • Whipple procedure: Extensive surgery for cancers of the pancreas, bile ducts, or periampullary region.
  • Minimally invasive procedures
    • Endoscopic retrograde cholangiopancreatographywith stenting: Temporary relief of jaundice by placing plastic or metal stents in the bile ducts.
    • Stone removal: Endoscopic extraction of stones blocking bile flow.
• For advanced cancer: If curative treatment is not possible, palliative care focuses on symptom relief, including biliary drainage to improve quality of life in advanced cancer.

Seek medical attention if you experience yellowing of the skin or eyes, persistent itching, dark urine, pale stools, unexplained weight loss, or sudden worsening of known liver disease.

While not all causes of jaundice can be prevented, you can lower your risk by:

• Getting vaccinated against hepatitis A and B.
• Avoiding excessive alcohol and unnecessary medications.
• Maintaining a healthy weight and controlling diabetes to reduce fatty liver risk.
• Eating a balanced diet rich in fruits, vegetables, and whole grains.

For diagnosis and treatment of jaundice, patients may need to consult:

• Gastroenterologist/hepatologist for medical causes like hepatitis, cirrhosis, or fatty liver.
• Surgical gastroenterologist/hepatobiliary surgeon for gallstones, bile duct obstruction, or cancers requiring surgery.