turning yellow

Jaundice

““Kamale” say the elders friends and relatives. After making this unsubstantiated diagnosis of jaundice, based on perhaps the patient’s yellow eyes, home remedies are tried. Food without oil, salt or protein is force fed along with goats milk and ground leaves of the keengasnellai plant.

“Don’t go to the doctor” advice well wishers , “they have no treatment for jaundice in English medicine”

The word jaundice is a corrupted form of “Jaune, ” a word coined by French physicians in the 19th century. Even at that time physicians noticed that all jaundice was not the same. The progress of the disease varied in different individuals. Many recovered completely, others bloated, some wasted away and a few died.

This difference in outcome is not based on fate. It occurs because all jaundice is not the same. jaundice is not a diagnosis in itself but a symptom seen in many disease processes .Today jaundice is evaluated with laboratory tests on the blood and urine and ultrasound and other scans. This way the diagnosis is accurate.

Not all people who appear yellow are jaundiced. Sometimes the normal skin colour appears yellow under fluorescent lighting. There may be an excess of yellow carotene pigment deposited in the skin as a result of consumption of orange-yellow fruits and vegetables like papayas and carrots. Fat deposits under the sclera of the eye or excessive exposure to dust can give dark skinned individuals a “muddy sclera” and a false “jaundiced” look.

The yellow colour in real jaundice is actually due to staining of the eyes and skin by the deposition of a pigment called bilirubin. If bilirubin is also excreted in excess, there is an obvious colour change in the urine and sweat as well.

Bilirubin is a pigment produced naturally when old red blood cells are broken down in the spleen and liver .It is then metabolized in the liver and excreted. The human eye can discern the yellow colour imparted by bilirubin when the level is three times normal or
> 3mg/dl in the blood.

If the number of red blood cells destroyed is greater than normal, the liver is unable to cope with the overload of pigment and the person becomes jaundiced.. This occurs in some hereditary blood disorders like thalassaemia, sickle cell disease. It may be due to an infection like malaria, or a drug reaction.

Even eating mouldy raw peanuts can cause jaundice because they contain aflotoxin which is toxic to liver cells.

Sometimes, the liver cells themselves are defective and unable to cope with the normal amount of bilirubin produced in the body. This occurs in certain hereditary conditions. Several members of a family are affected, the jaundice is mild and fluctuating, and it is not fatal.

Immaturity of the liver cells in a newborn, or a mother- baby blood group incompatibility (Rh or ABO) can cause a self limited treatable jaundice in the new born.

Some viral infections like that caused by the hepatitis viruses A,B C D, E, herpes virus, leptospirosis or cytomegalovirus can cause a temporary dysfunction of the liver cell enzymes and jaundice.

Alcohol is poisonous to the liver cells. Drinking regularly for many years can damage the liver can resulting in jaundice.

The drainage of the bilirubin from the liver may be prevented if the liver ducts are blocked by stones, strictures and cancer deposits. Even if the bilitrubin is formed and excreted at the normal rate by the liver, it cannot drain out.

All jaundice is not the same and cannot be treated alike. Before embarking on a course of treatment, it is advisable to obtain a precise documented diagnosis after proper evaluation with blood and urine tests from a qualified medical person.

80 % of the jaundice in young adults is due to hepatitis A. It is self limited and recovers spontaneously without treatment in a few weeks. Quackery and miracle cures are therefore widely publicized. Any treatment logical or illogical, or for a pure profit motive, with IV fluids, glucose drips and herbs, is sure to succeed.

Hepatitis A and B are preventable diseases. Vaccination against hepatitis B is offered in a 3 dose schedule before the age of 1 year. Hepatitis A vaccines are a given after the age of 2 years in a 2 dose schedule. If Injections are missed in childhood, they can be taken later at any age.

Newer curative treatments with antiviral medications, interferon and liver transplants are available for Hepatitis B and C infections. Specific medicines are available for herpes infections, leptospirosis and cytomegalovirus infections.

Recovery will be complete in secondary jaundice once the causative factor is removed. Abstaining from alcohol and discontinuing offending drugs may reverse jaundice. If a correctable obstruction is seen on scanning or laparoscopy, surgical treatment provides relief.

Jaundice requires appropriate treatment depending on the diagnosis. If this is delayed through ignorance or fear, the severity of the illness may increase or even be fatal.

Unfortunately many people still self diagnose jaundice and opt for naturopathy from unqualified practitioners. A “hit or miss” approach is alright for sports and games, not for medical conditions affecting human lives.

Dr. Gita Mathai
The writer is a paediatrician with a family practice at Vellore.
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