Jaundice

Definition

Jaundice is recognised as a yellow staining of the skin and the whites of the eyes (sclera). It occurs due to an increase in the level of an enzyme produced by the liver called bilirubin in the blood. 

What are the Risk factors?

Jaundice can occurs due to:

1) Increase in breakdown of blood in conditions such as haemolytic anaemia
2) Damage to the liver caused by conditions which lead to cirrhosis such as viral hepatitis, excessive alcohol consumption, haemochromotosis, certain drugs and genetic disorders
3) Obstruction of the flow of bile from the liver due to secondary causes:
a. Bile duct stones
b. Pancreatic cancer
c. Bile duct cancer
d. Chronic pancreatitis
e. Duodenal cancer

The secondary causes of Jaundice are described as obstructive jaundice and are managed by surgeons specialising in this field. 

What are the Symptoms?

Primary Jaundice presents mainly with yellow discolouration of the skin, nausea and occasional weight loss. Patients with Jaundice are admitted to hospital for further investigations.

Secondary Jaundice due to blockage of the bile ducts is associated with itching, nausea, occasional vomiting, some weight loss, pale stools and dark urine.

How is Jaundice investigated?

Primary Jaundice management is guided by investigating causes of liver damage such as viral hepatitis with the mainstay of management directed at controlling the symptoms and treating the cause if possible.

Secondary Jaundice is predominantly managed by the surgical team and requires specialised blood tests (liver enzymes, bone profile, clotting screen), an ultrasound examination followed by a CAT (computer tomography) scan or Magnetic scan (MRI) and in some cases both. A further specialised investigation called an endoscopic ultrasound (EUS) in some cases is required for more accurate examination of the bottom end of the bile duct and pancreas.

What are the Treatment options for Jaundice?

The treatment is aimed at the cause. A primary cause of Jaundice is managed by Hepatologists (specialist liver physicians), with the mainstay of treatment being either supportive care or antiviral treatment for hepatitis.
 
Secondary Jaundice requires treatment by a specialised team of surgeons and gastroenterologists aimed at relieving the obstruction/ blockage of the bile duct.
Bile duct stones can be removed by a special camera test called an ERCP (endoscopic retrograde pancreatography), which has a side-viewing camera and is able to view the ampulla (bottom end of the bile duct) in the duodenum (first part of the small bowel) and remove the stones. ERCP can also be used to relieve any blockage of the bile duct as a result of a suspected malignancy by placement of a plastic stent (tube) across the narrowing.

Gallstones require keyhole surgery (laparoscopic cholecystectomy) at which time the bile duct can be explored with removal of bile duct stones. This procedure if successful avoids the need for an ERCP.

The other causes such as pancreas cancer are treated by surgery if possible after careful investigation.