Jaundice is characterized by the yellowish color of the skin, mucous membranes and the white part of the eyes, called sclerae, due to the increase in bilirubin in the bloodstream, a yellow pigment that results from the destruction of red blood cells in the blood.
Jaundice in adults is usually caused by diseases that affect the liver, such as hepatitis, by obstruction of the bile ducts, such as a stone, or by diseases that cause destruction of red blood cells, such as sickle cell anemia or spherocytosis, for example. In newborns, the most common cause is physiological jaundice, caused by the immaturity of the liver. Check out what causes and how to treat neonatal jaundice.
Treatment is done according to the cause, and may include treating infections with antibiotics, removing gallstones by surgery or measures to combat hepatitis, for example.
What are the causes
Bilirubin is a yellowish pigment that appears as a result of the breakdown of red blood cells, being metabolized and eliminated by the liver, together with bile, through the intestine. Jaundice can arise when there are changes at any stage of this production process until elimination.
Thus, excess bilirubin in the blood can happen for 4 main reasons:
- Increased destruction of red blood cells, which is due to blood disorders such as sickle cell anemia, spherocytosis or other hemolytic anemias, or infections such as malaria; Changes in the liver that impair the ability to capture bilirubin from the blood or to metabolize this pigment due to hepatitis, side effects of certain medications, such as Rifampicin, prolonged fasting, alcoholism, intense exercise or genetic diseases such as Gilbert's syndrome or Crigler's syndrome -Najjar; Changes in bile ducts inside or outside the liver, called cholestatic or obstructive jaundice, which prevent the elimination of bilirubin along with bile, due to stones, narrowing or tumors in the bile ducts, autoimmune diseases such as primary biliary cholangitis, or hereditary syndrome like Dubin-Johnson syndrome; Other conditions that interfere in more than one phase of bilirubin metabolism, such as a generalized infection, liver cirrhosis, hepatitis or neonatal jaundice.
The increased bilirubin can be of 2 types, called indirect bilirubin, which is free hemoglobin, or direct bilirubin, when it has already undergone a change in the liver, called conjugation, in order to be eliminated along with bile through the intestine.
How to identify
The yellowish color of the skin and mucous membranes in jaundice usually appears when the levels of bilirubin in the blood exceed 2 mg / dL. Understand how to identify high bilirubin in the blood test.
It can be accompanied by other signs and symptoms, such as dark urine, called choluria, or whitish stools, called fecal acolia, which arise especially when there is an increase in direct bilirubin. High values of this pigment in the blood can be irritating to the skin, which causes severe itching.
In addition, symptoms that indicate the cause of the jaundice may also be present, such as abdominal pain and vomiting in hepatitis, pallor and tiredness in diseases that cause destruction of red blood cells or fever and chills in case of infections, for example.
How the treatment is done
To treat jaundice, it is necessary to treat the disease that led to its onset. Generally, treatment is guided by a gastroenterologist, hepatologist or hematologist, and may include measures to unblock the bile ducts, use of medications to fight infections, interruption of toxic drugs to the liver or immunosuppressants to control diseases that cause hemolysis, for example.
The doctor can also guide protective measures, such as drinking plenty of water and reducing the consumption of fatty foods to avoid abdominal discomfort. To control the itching caused by excess bilirubin, medications such as antihistamines or cholestyramine may be indicated.
