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What is jaundice?

Jaundice is not a disease, but rather a sign that can occur in many different diseases. Jaundice is the yellowish staining of the skin and sclerae (the whites of the eyes) that is caused by high levels in blood of a chemical bilirubin. The color of the skin and the whites of the eyes vary depending on the level of bilirubin. When the bilirubin level is mildly elevated, they are yellowish. When the bilirubin level is high, they tend to be brown.

What causes jaundice?

Bilirubin comes from red blood cells. When red blood cells get old, they are destroyed by the body. Hemoglobin, the iron-containing chemical in the red blood cells that carries oxygen, is released from the destroyed red blood cells after the iron it contains is removed. The chemical that remains in the blood after the iron is removed becomes bilirubin. The liver has many functions. One of its functions is to produce and secrete bile into the intestines to help digest dietary fat. Another function is to remove toxic chemicals or waste products from the blood, and bilirubin is a waste product. The liver removes bilirubin from the blood. After the bilirubin has entered the liver cells, the cells conjugate (attaching other chemicals, primarily glucuronic acid) to the bilirubin, and then secrete the bilirubin/glucuronic acid complex into bile. The complex that is secreted in bile is called conjugated bilirubin. The conjugated bilirubin travels in the bile to the intestine and is eliminated in the feces. (Bilirubin is what gives feces its brown color.) Conjugated bilirubin is different from the bilirubin that is released from the red blood cells and not yet removed from the blood. The latter is termed unconjugated bilirubin. Jaundice occurs when there is: 1. too much bilirubin being produced for the liver to remove from the blood (for example, patients with hemolytic anemia have an abnormally rapid rate of destruction of their red blood cells that releases large amounts of bilirubin into the blood); 2. a defect in the liver that prevents bilirubin from being removed from the blood, converted to bilirubin/glucuronic acid (conjugated) or secreted in bile; or 3. blockage of the bile ducts that decreases the flow of bile and bilirubin from the liver into the intestines. For example, the bile ducts can be blocked by cancer, gallstones, or inflammation of the bile ducts. The decreased conjugation, secretion, or flow of bile that can result in jaundice is referred to as cholestasis: however, cholestasis does not always result in jaundice.

What problems and symptoms does jaundice cause?

Jaundice or cholestasis, by themselves, causes few problems (except in the newborn, and jaundice in the newborn is different than most other types of jaundice, as discussed later.) Jaundice can turn the skin and whites of the eyes yellow. In addition, stool can become light in color, even clay-colored because of the absence of bilirubin that normally gives stool its brown color. The urine may turn dark or brownish in color. This occurs when the bilirubin that is building up in the blood begins to be excreted from the body in the urine. Just as in feces, the bilirubin turns the urine brown. Besides the cosmetic issue of looking yellow and having dark urine and light stools, the symptom that is associated most frequently with jaundice or cholestasis is itching, medically known as pruritus. The itching associated with jaundice and cholestasis can sometimes be so severe that it causes patients to scratch their skin "raw," have trouble sleeping, and, rarely, even commit suicide. It is the disease causing the jaundice rather than the jaundice itself that causes most problems associated with jaundice. Specifically, if the jaundice is due to liver disease, the patient may have symptoms or signs of liver disease or cirrhosis (cirrhosis represents advanced liver disease). The symptoms and signs of liver disease and cirrhosis include fatigue, swelling of the ankles, muscle wasting, ascites (fluid accumulation in the abdominal cavity), mental confusion, coma, and bleeding into the intestines.

If the jaundice is caused by blockage of the bile ducts, no bile enters the intestine. Bile is necessary for digesting fat in the intestine and releasing vitamins from within it so that the vitamins can be absorbed into the body. Therefore, blockage of the flow of bile can lead to deficiencies of certain vitamins. For example, there may be a deficiency of vitamin K that prevents proteins that are needed for normal clotting of blood to be made by the liver, and, as a result, uncontrolled bleeding may occur.

What diseases cause jaundice?

Comment on thisShare Your Story Increased production of bilirubin There are several uncommon conditions that give rise to over-production of bilirubin. The bilirubin in the blood in these conditions usually is only mildly elevated, and the resultant jaundice usually is mild and difficult to detect. These conditions include: 1. rapid destruction of red blood cells (referred to as hemolysis); 2. a defect in the formation of red blood cells that leads to the over-production of hemoglobin in the bone marrow (called ineffective erythropoiesis); 3. absorption of large amounts of hemoglobin when there has been much bleeding into tissues (for example, fromhematomas, collection of blood in the tissues). Acute inflammation of the liver Any condition in which the liver becomes inflamed can reduce the ability of the liver to conjugate (attach glucuronic acid to) and secrete bilirubin. Common examples include acute viral hepatitis, alcoholic hepatitis, andTylenol-induced liver toxicity. Chronic liver diseases Chronic inflammation of the liver can lead to scarring and cirrhosis, and can ultimately result in jaundice. Common examples include chronic hepatitis Band C, alcoholic liver disease with cirrhosis, and autoimmune hepatitis. Infiltrative diseases of the liver Infiltrative diseases of the liver refer to diseases in which the liver is filled with cells or substances that don't belong there. The most common example would be metastatic cancer to the liver, usually from cancers within the abdomen. Uncommon causes include a few diseases in which substances accumulate within the liver cells, for example, iron overload (hemochromatosis), alpha-one antitrypsin (alpha-one antitrypsin deficiency), and copper (Wilson's disease). Inflammation of the bile ducts

Diseases causing inflammation of the bile ducts, for example, primary biliary cirrhosis or sclerosing cholangitis, and some drugs, can reduce the flow of bile and elimination of bilirubin leading to jaundice. Blockage of the bile ducts The most common causes of blockage of the bile ducts are gallstones andpancreatic cancer. Less common causes include cancers of the liver and bile ducts. Drugs Many drugs can cause jaundice and/or cholestasis. Some drugs can cause liver inflammation (hepatitis) similar to viral hepatitis. Other drugs can cause inflammation of the bile ducts, resulting in cholestasis and/or jaundice. Drugs also may interfere directly with the chemical processes within the cells of the liver and bile ducts that are responsible for the formation and secretion of bile into the bile ducts or the intestine. As a result, the constituents of bile, including bilirubin, are retained in the body. The best example of a drug that causes this latter type of cholestasis and jaundice isestrogen. The primary treatment for jaundice caused by drugs is discontinuation of the drug. Almost always the bilirubin levels return to normal within a few weeks, though in a few cases it may take several months. Genetic disorders There are several rare genetic disorders present from birth that give rise to jaundice. Crigler-Najjar syndrome is caused by a defect in the conjugation of bilirubin in the liver due to a reduction or absence of an enzyme responsible for conjugating the glucuronic acid to bilirubin. Dubin-Johnson and Rotor's syndromes are caused by abnormal secretion of bilirubin into bile. The only common genetic disorder that may cause jaundice is Gilbert's syndrome which affects approximately 7% of the population. Gilbert's syndrome is caused by a mild reduction in the activity of the enzyme responsible for conjugating glucuronic acid with bilirubin. The increase in bilirubin in the blood usually is mild and infrequently reaches levels that cause jaundice. Gilbert's syndrome is a benign condition that does not cause health problems, although patients with Gilbert's syndrome may develop gallstones more frequently. Developmental abnormalities of bile ducts There are rare instances in which the bile ducts do not develop normally and the flow of bile is interrupted. Jaundice frequently occurs. These diseases usually are present from birth though some of them may first be recognized in childhood or even adulthood. Cysts of the bile duct (choledochal cysts) are an example of such a developmental abnormality. Another example is Caroli's disease.


Email this page to a friendShare on facebookShare on twitterBookmark & SharePrinter-friendly version Hepatomegaly is swelling of the liver beyond its normal size. If both the liver and spleen are enlarged, it is called hepatosplenomegaly. See also: Splenomegaly Considerations The lower edge of the liver normally comes just to the lower edge of the ribs on the right side. The edge of the liver is normally thin and firm. It cannot be felt with the fingertips below the edge of the ribs, except when you take a deep breath. It may be enlarged if a health care provider can feel it in this area. Causes The liver is involved in many of the body's functions. It is affected by many conditions that can cause hepatomegaly, including: Alcohol use Congestive heart failure Glycogen storage disease Hepatitis A Hepatitis B Hepatitis C Hepatocellular carcinoma Hereditary fructose intolerance Infectious mononucleosis Leukemia Niemann-Pick disease Primary biliary cirrhosis Reye syndrome Sarcoidosis Sclerosing cholangitis Steatosis (fat in the liver from metabolic problems such as diabetes, obesity, and high triglycerides, also called nonalcoholic steatohepatitis, or NASH) Tumor metastases

When to Contact a Medical Professional This condition is usually discovered by a health care provider. You may not be aware of the liver or spleen swelling.

What to Expect at Your Office Visit The doctor will examine you and ask questions such as: Did you notice a fullness or lump in the abdomen? What other symptoms do you have? Is there any abdominal pain? Is there any yellowing of the skin (jaundice)? Is there any vomiting? Is there any unusual-colored or pale-colored stools? Have you had a fever? What medications are you taking? How much alcohol do you drink?

Tests to determine the cause of hepatomegaly vary, depending on the suspected cause, but may include: Abdominal x-ray Abdominal ultrasound (may be done to confirm the condition if the doctor thinks your liver feels enlarged during a physical exam) CT scan of the abdomen Liver function tests, including blood clotting tests MRI scan of the abdomen

Hepatomegaly is the condition of having an enlarged liver. It is a nonspecific medical sign having many causes, which can broadly be broken down into infection, direct toxicity, hepatic tumours, or metabolic disorder. Often, hepatomegaly will present as an abdominal mass. Depending on the cause, it may sometimes present along with jaundice.

1 Diagnosis 2 Common causes

o o o o o o o

2.1 Infective 2.2 Neoplastic 2.3 Cirrhotic 2.4 Metabolic 2.5 Drugs and toxins 2.6 Congenital 2.7 Others

3 See also 4 External links

Diagnosis[edit source | editbeta]

A suspicion of hepatomegaly indicates a thorough medical history and physical examination, wherein the latter typically includes an increased liver span. Blood tests should be done, importantly liver-function series, which will give a good impression of the patient's broad metabolic picture. An ultrasound of the liver can reliably detect a dilated biliary-duct system, which helps distinguish parenchymal liver disease from extrahepatic bile-duct obstruction. Ultrasound can also detect the characteristic texture of a cirrhotic liver, and can guide fine-needle aspiration of cysts, abscesses and tumours. Computed tomography (CT) can help obtain more accurate anatomical information, and is unaffected by obesity or the presence of bowel gases.

Common causes[edit source | editbeta]

This article is incomplete. Please help to improve the article, or discuss the issue on the talk page. (February 2009)

Infective[edit source | editbeta]

Glandular fever (Infectious mononucleosis) This is caused by the Epstein-Barr virus (EBV). A similar condition (pseudoglandular fever) may be caused by the Cytomegalo virus (CMV). Hepatitis (Although not all hepatitis viruses cause hepatomegaly) Liver abscess (pyogenic abscess and amoebic abscess) Malaria Amoeba infections Hydatid cyst Leptospirosis Actinomycosis

Neoplastic[edit source | editbeta]

Metastatic tumours secondary to spread from cancer in other organs (most common) Hemangiomas Hepatocellular carcinoma Myeloma Leukemia Lymphoma

Cirrhotic[edit source | editbeta]

Portal Biliary Cardio Haemochromatosis

Metabolic[edit source | editbeta]

Fatty infiltration Lysosomal Acid Lipase (LAL) Deficiency, also known as Wolman disease or cholesteryl ester storage disease, (CESD Amyloidosis Gaucher's disease Niemann Pick disease Von Gierke disease (Glycogen Storage Disease type 1) Glycogen Storage Disease types III, VI and IX

Drugs and toxins[edit source | editbeta]

alcoholism poisoning

Congenital[edit source | editbeta]

Hemolytic anemia Riedel's lobe is an extended, tongue-like, right lobe of the liver. It is not pathological; it is a normal anatomical variant and may extend into the pelvis. It is often mistaken for a distended gall bladder or liver tumour. Polycystic disease Cori's disease

Others[edit source | editbeta]

BuddChiari syndrome Hunter syndrome Zellweger's syndrome Carnitine palmitoyltransferase I deficiency Right ventricular failure Granulomatous: Sarcoidosis Glycogen storage disease type II