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Hyperbilirubinaemia, otherwise known as jaundice, is caused by excessive levels of bilirubin that build up in the skin (Cohen, 2006). Take a closer look in to the workings of this skin disease. What is it, what happens, and what are the treatments? Jaundice is most common in infants and occasionally occurs in adults. Jaundice develops from three major things: liver immaturity, obstruction of the bile ducts, and excessive hemolysis (Cohen, 2006).
Bilirubin is a yellow-orange pigment that is produced by breaking down hemoglobin in old red blood cells (McClean, 2008). Red blood cells only live for seventy to ninety days in a newborn. The bilirubin is attached to albumin and gets carried in to the liver. In most newborns the bilirubin levels peak in the first two to four days (Cohen, 2006). Bilirubin is mainly secreted through the bowel. It is a liver substance that accumulates in the skin. Bilirubin is a potentially toxic compound (Sargent, Clayton, 2011). A newborn has an immature system which makes it harder to break down bilirubin. When the bilirubin is not water soluble it will not go through the bowels (McClean, 2008).
Jaundice at any age can be classified as unconjugated or conjugated. The difference between conjugated and unconjugated is that the color of the urine is yellow if it is conjugated whereas the unconjugated is colorless. Unconjugated can be physiological or pathological, conjugated is always pathological and indicates a liver disease (McClean, 2008). Conjugation can be inhibited by drugs such as phenobarbitone.
The classification of jaundice can be pre-hepatic, hepatic, and post hepatic. Pre-hepatic occurs when unconjugated bilirubin is produced faster that the liver can conjugate it. The causes of pre-hepatic jaundice include; reabsorption of a hematoma and massive blood transfusion, homozygous sickle cell disease, and erythropoiesis (Sargent, Clayton, 2011). Hepatic jaundice occurs when hepatocytes are not effectively getting rid of conjugated bilirubin. Some of the most common causes of hepatic jaundice are; alcohol related liver disease, viral hepatitis, drug induced jaundice, and alcoholic hepatitis (Sargent, Clayton, 2011). Post hepatic jaundice occurs when there is a biliary obstruction and the amounts of bile do not reach the duodenum. The common causes of obstruction are gallstones or choldocholithiasis, along with trauma, strictures, and compression like carcinoma of the pancreas. A blood incompatibility can also cause jaundice.
The liver is an essential organ. Without a liver a person can only survive a few days. When cancer spreads to the liver a person can only survive a few weeks or a few months. Livers are in short supply. One fact about the liver is that a person only needs about fifteen percent of their liver to survive, but in order to donate part of a personâ€™s liver the donor need to be a close match so the body does not reject it.
The first steps in diagnosing jaundice are to collect information such as a detailed patient history, conduct a physical exam and preform hematological tests. The more information that is provided, the easier it is to find the problem and assess the situation. Recognizing jaundice early can prevent serious complications. An infant may look well apart from the jaundice but still have a life threatening liver disease (McClean, 2008). Jaundice has effects that are both psychological and physical.
Some of the risk factors for jaundice include having a sibling with jaundice when he or she was born, and gestational diabetes while pregnant. Men tend to have a higher risk of getting jaundice (Cohen, 2006). If a baby has a significant loss of weight after birth, a baby that was discharged early and did not have a follow up or proper feeding, and premature babies are likely to get jaundice. Patients with jaundice may exhibit oblivious skin discoloration. Other factors to take in consideration are the color of the urine and stool; if the urine is dark and the stool is light then there is a problem. Other indicators of liver disease are white nails and dilated veins. Pronounced anorexia along with muscle wasting away is common in patients with chronic liver disease. Severe weight loss might indicate carcinoma. A change in attitude is also a sign, so it is important to make sure that the patient is mentally stable (Sargent, Clayton, 2011).
There are several different types Jaundice. Obstructive jaundice occurs when the bile ducts are blocked, usually with gallstones or tumors. In hepatocellular jaundice the liver is diseased; this includes hepatitis and cirrhosis. Neonatal jaundice, which is in infants, tends to be the excess of bilirubin or in some cases a liver disease. Hemolytic jaundice occurs when red blood cells are destroyed too fast. This can occur when a person has a blood infection such as malaria (Shier, Butler, Lewis, 2010).
The easiest way to test for jaundice is through blood tests; they are also the cheapest. The blood test gives a baseline for further investigation. Liver function tests combine markers for liver function and liver damage. Serum bilirubin levels will indicate the severity and depth of the jaundice and is used to follow the progression of the disease. Serum ALP is an enzyme that can be useful to indicate biliary tract involvement (Sargent, Clayton, 2011). Another way to test is radiological and endoscopic investigation. An ultrasonography is one of the tools used for evaluation of the patient. The abdominal ultrasonography shows if the intrahepatic ducts are dilated. The more information and investigations that are gathered, the more easily the doctor can assess the severity and cause of the jaundice (Sargent, Clayton, 2011).
Drugs are great for pain management, but can also cause cholestatic liver disease. About ten percent of hospitalized jaundice patients represent one of the three major forms of drug induced liver injury. Many drugs and chemical agents, including prescribed drugs and non-prescribed medications like herbal remedies and illegal drugs, have been involved in causing liver damage. Some symptoms of liver damage are anorexia, fatigue and pruritus over a number of months (Sargent, Clayton, 2011).
Fatigue and pruritus are common symptoms of chronic cholestatic liver disease. These symptoms have a large impact on the patientâ€™s quality of life. Pruritus is basically itching. In most cases it is moderate, but in five to ten percent of cases it has led to depression and suicidal thoughts. The cause of fatigue is unclear, and there really is not any treatment for fatigue (Sargent, Clayton, 2011).
One of the most common treatments for infants is phototherapy. In the early nineteen- fifties phototherapy came about when a nurse noticed how the babies near the sun had less of a problem with jaundice than those further from the sun, which encouraged two biochemists to do further research (Ball, 1981). If an infant with jaundice is not treated there is a possibility of complications, or in the past, some cases have caused neonatal death (Ball, 1981). According to researchers, sun light helps break down bilirubin. Treatments for jaundice should never be delayed. At the first sign infants should be getting phototherapy (Cohen, 2006). Phototherapy is when an infant is placed under lights known as bili lights.
Jaundice can also lead to kernicterus, which is yellow deposits of cells and brain cell death from high levels of bilirubin (Cohen, 2006). This can result in permanent neurological damage. Treatment involves exchange transfusions and phototherapy; in some cases children need phototherapy for around fifteen hours a night to keep the levels of bilirubin below potentially dangerous levels. The only way a patient can get out of this life style is through a liver transplant (McClean, 2008).
Some of the short term side effects of early phototherapy include temperature instability, fluid loss, fluid stools, and rashes. Thrombocytopenia is the effect on platelets studies showed that the life spans of platelets were shortened. (Abnormal distention was noticed) In the study conducted, the infants shielded by screens were more content than the infants shielded with gauze. The majority of this is due to the irritation the gauze causes (Ball, 1981). Some of the long term complications that researchers worried about using phototherapy were skin cancer, irreversible eye damage, potential risks of mutations, and carcinoma.
Jaundice is a very complex disease of the body. There are many factors involved with infant and adults. The early signs of jaundice in infants can warn of a future liver disease or just be the infant not getting what they need. Jaundice can also lead to yellow deposits of cells and brain cell death called kernicterus. Certain factors contribute to whether or not the patient is at a higher risk of getting a liver disease, such as changes in behavior that can lead to depression. The research has gotten better in the years from transfusions and sun light to phototherapy and drugs. The current methods of blood test searching for specific chemicals associated with jaundice is high-tech. Liver function tests search for liver function and liver damage. Researchers have found new discoveries because of experiments and lab results contributing to what is known today. Jaundice has classifications and degrees of how infected a person is or could become with a disease. Professionals can predict how long a person can live, and in some cases, they can possibly treat the patient and get them back to health through the power of medicine.