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What is Jaundice

Jaundice

In India, every 2.76 per 1000 people are stated and confirmed cases of jaundice. Children under 5 years of age are at a greater risk of jaundice. Almost 60% of jaundice cases occur during the monsoon and summer months. About 3 in 5 new-borns suffer from jaundice a few days after birth. Severe neonatal jaundice is 100-fold more frequent in Nigeria than in industrialized countries.

In jaundice, excessive levels of bilirubin in the blood cause the whites of the eyes, skin, and mucous membranes to appear yellow. Bilirubin is released into the bloodstream when red blood cells break down and can no longer carry oxygen. The orange-yellow hue of bilirubin makes the jaundiced patient appear pale and tired.

Jaundice occurs in all 3 phases and as each phase begins the prognosis becomes more serious:

Pre hepatic (Phase-1):

During this phase the excessive breakdown of red blood cells exceeds the liver's ability to produce bilirubin. This causes unconjugated hyperbilirubinemia. At this stage, bilirubin is transported from the liver to plasma for conjugation.

Intrahepatic (Phase-2):

Hepatocellular or intrahepatic jaundice occurs when there is dysfunction in the liver cells. Due to this misconjugation, abnormal bilirubin secretions and impaired cellular uptake of lead to disruption of liver cell function.

Post hepatic(Phase-3):

Post hepatic jaundice refers to a blockage in the flow of bile. This in turn causes bilirubin to build up in the liver and can only be corrected by surgery.

 

Who is affected by jaundice?

Jaundice in Children

Jaundice is the most common condition requiring medical attention in new-borns. About 50% of term babies and 80% of premature babies develop jaundice in the first week after birth. Jaundice is also a common cause of readmission to the hospital after early discharge of infants. Jaundice usually occurs two to four days after birth and eventually resolves with effective treatment.

Jaundice in Adults

The prevalence of jaundice in adults is rare compared to children. Therefore, it is often an indicator of an underlying problem related to haematopoiesis, liver dysfunction, and biliary obstruction. White men, and particularly smokers, are more likely to have high-risk serum bilirubin levels than women.

People who have hepatitis and drink excessive alcohol are also at a greater risk. Non-Hispanic white population and Mexican American population also have higher bilirubin levels, unlike the non-Hispanic black population.

 

What are the symptoms of jaundice?

Symptoms appear earlier in infants than in adults. However, early detection is key to speed recovery processes for all ages. Before the bilirubin secretions starts the discoloration of the skin, one should be aware of these symptoms and seek medical attention as soon as possible:

  • Fever
  • Chills
  • Abdominal pain
  • Flu-like symptoms
  • Change in skin color
  • Dark-colored urine or clay colored stools
  • Weight loss
  • Itchy skin

 

What causes jaundice?

Jaundice can be caused by a problem in any of the three phases of bilirubin production.

Prehepatic

(Phase - 1)

Intrahepatic

(Phase - 2)

Posthepatic

(Phase - 3)

  • Hemolytic anaemias
  • CrigglerNajjar syndrome
  • Gilbert's syndrome
  • Alcoholic liver disease
  • Latrogenic
  • Viral hepatitis
  • Hereditary haemochromatosis
  • Autoimmune hepatitis
  • Primary biliary cirrhosis or primary sclerosing cholangitis
  • Hepatocellular carcinoma
  • Alcohol
  • Rare genetic metabolic defects
  • Intraluminal causes, (gallstones)
  • Wall-related causes, (cholangiocarcinoma, strictures, or drug-induced cholestasis)
  • Extramural causes, (pancreatic cancer or abdominal masses e.g., lymphoma)

 

 Prehepatic jaundice

Prehepatic jaundice occurs when the rate of hemolysis of the blood increases. Malaria is one of the most common causes of prehepatic jaundice. Other causes include sickle cell anemia and spherocytosis, genetic conditions responsible for red blood cells becoming crescent and spherical in shape, as opposed to the usual disc shape. Another underlying cause of increased hemolysis could be thalassemia, a deadly blood disorder that makes it harder for the body to produce healthy red blood cells. Patients suffering from hepatitis A, chronic hepatitis B and C, and Epstein-Barr virus infections are also at increased risk of being diagnosed with prehepatic jaundice

Intrahepatic jaundice 

Intrahepatic jaundice occurs when scar tissue in the liver interferes with the process of filtering bilirubin from the blood. One of the main causes of liver cirrhosis in adults is alcohol abuse. Long drinking damages the functions of the liver and slows down the filtration process. This is followed by viral hepatitis, which causes inflammation in the liver and reduced function due to viral bombardment. Liver cancer is one of the worst causes of jaundice because the rapid spread of cancer cells drastically impairs the liver's functions

Posthepatic jaundice 

Posthepatic jaundice is caused by blockages in the bile duct. This occurs mainly due to gallstones (hard calcium deposits in the ducts) and cancers of the gallbladder and pancreas. Pancreatitis, a condition in which inflammation of the pancreas causes complications, is also a major cause of blockages in the bile ducts. However, biliary atresia is one of the direct causes of this type of jaundice as it is genetic due to narrow and absent bile ducts.

Neonatal Jaundice

New-born jaundice is very common in new-borns with high levels of bilirubin. This is mainly due to the fact that the liver is not yet fully formed. Therefore, premature babies are at high risk for neonatal jaundice. Incorrect breastfeeding and different blood types of mother and child can also lead to this condition.

 

How is jaundice diagnosed?

Symptoms may not be very noticeable initially, so it is recommended that patients with mild symptoms see their doctor as soon as possible. Diagnosis is a lengthy process and consists of:

Physical Examination: The physical examination focuses on detecting signs of liver complications such as bruising, spider veins, testicular atrophy, gynecomastia and palmar erythema. An abdominal exam is also done to check the size and tenderness of the liver. The presence of ascites (accumulation of fluid in the liver) is also helpful in diagnosing jaundice.

Imaging: ultrasonography and computed tomographic tests are useful in distinguishing an obstructing lesion from a hepatocellular disease like jaundice. Ultrasonography is usually the first recommended test as it’s inexpensive, widely available and doesn’t have radiation exposure which may be harmful to pregnant women. Biliary stones can be detected using ultrasonography but CT scans can provide more information in comparison.

Serum testing: The level of bilirubin in the liquid part of the blood is called serum. Testing this bilirubin concentration in one’s blood and urine is an effective way of diagnosing jaundice. In new-born cases, if the blood is too high during birth, an infant's blood is tested several times over the first few days of their lives to monitor liver function.

Liver Biopsy: If imaging and serum testing are insufficient, biopsy is the next best thing.Liver biopsies provide information about the architecture of the liver and help doctors make a prognosis. It is also useful in diagnosing autoimmune hepatitis or biliary tract disease. A liver biopsy removes a small amount of tissue from a patient's liver so it can be examined under a microscope for damage and disease.

 

How is jaundice treated?

Treating Jaundice in Adults

In adults, doctors focus on the cause of the jaundice rather than treating the jaundice directly.Here's how the different causes are addressed:

Malaria: In malaria, drugs are given to kill the parasites. These medicines help your liver build immunity to prevent it from coming back. Sickle Cell Anemia, Spherocytosis, and Thalassemia: Blood transfusions from a healthy donor are the best choice for blood-related causes of jaundice. Intravenous rehydration and folic acid supplementation are also recommended. A bone marrow transplant is the last alternative if transfusions do not bring the desired result.If there is obstruction or irreparable damage to the gallbladder or spleen, removal surgery is performed.

Hepatitis: For viral hepatitis, antiviral drugs and many other vaccines are given. Patients with alcoholic hepatitis are advised to stop drinking. A low-protein diet is also prescribed. In severe cases, liver transplantation is the last resort.

Cirrhosis: With cirrhosis of the liver and bile, beta-blockers, IV fluids, antibiotics, bile-lowering drugs, antihistamines (anti-itching), etc. are prescribed.

Liver Cancer: Chemotherapy and radiation therapy for liver cancer are the most commonly prescribed therapies to control the spread of cancer. If the cancer continues to spread, a liver transplant is recommended.

Gallstones: Medicines for gallstones and diet changes are highly recommended for patients with gallstones. Stone removal is also a common line of treatment, depending on the severity.

Pancreatic Cancer: Radiation and chemotherapy are the most commonly used therapies to stop the spread of cancer cells. Patients may also need to undergo surgery to remove cancerous tissue if spread becomes too deadly.

Bile Duct Cancer: When radiation and chemotherapy are ineffective, the patient should have surgery to remove the bile ducts and parts of the pancreas and liver. Even in this condition, a liver transplant is the last resort if removal surgery does not bring the desired result.

Biliary Atresia: The Kasai procedure of removing and replacing conduits is most effective in controlling biliary atresia. Liver transplantation is the last line of treatment if there is no improvement.

 

Treatment for Neonatal Jaundice:

Neonatal jaundice, if left untreated, can affect the brain and spinal cord and lead to life-threatening conditions. Therefore, proper nutrition and timely treatment play a key role in speedy recovery. This includes the general line of treatment:

Improved Nutrition: To prevent weight loss and gain strength, doctors will recommend frequent feedings and supplements to the sick baby.

Phototherapy: Phototherapy or light therapy The baby is placed under a lamp that emits blue-green light. The baby wears only a diaper and a protective eye patch. In this therapy, the light changes the shape of the bilirubin molecules so that it is excreted in the form of urine and faeces.

Intravenous immunoglobulin: Due to the different blood types of the baby and the mother, the amount of antibodies that the baby has in his body can cause rapid breakdown of red blood cells. For this reason, immunoglobulin transfusions can help reduce antibodies and relieve the baby of red blood cell loss.

Exchange transfusion: When all else fails, babies are given blood exchange transfusions. Blood is repeatedly drawn and replaced with donor blood to dilute the bilirubin and antibodies in the baby's blood.

 

Complications of jaundice during treatment

  • Constipation
  • Stomach pain
  • Bloating
  • Gas
  • Upset stomach
  • Vomiting
  • Diarrhoea

 

How to prevent jaundice?

Because there are multiple causes of jaundice, there are not many specific precautions that can be taken to prevent it. However, the following measures can be considered:

  • Stop drinking and smoking
  • Maintain a healthy weight
  • Control cholesterol levels
  • Drink at least 8 glasses of water a day
  • Opt for fruits and vegetables that are rich of digestive enzymes
  • Eat high-fiber foods

 

How can Livocumin help with jaundice?

Livocumin consists of excellent Ayurveda herb Curcumin, a powerful hepato-protective agent that helps in decreasing the bilirubin content in the gall bladder and thus prevent its further escalation to Jaundice. 

Livocumin is a hepato-protective stimulant that detoxes, repairs and strengthens the liver. The all-natural formulation of Livocumin makes it a reliable anti-oxidant and anti-inflammatory medicine to aid the detoxification processes of the liver. 

The medicinal values of turmeric help fix indigestion and manage the damage caused by metabolic fatty liver disease. Jaundice, loss of appetite, viral & infective hepatitis, and gall stones can also be prevented with Livocumin.

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