What is jaundice?

Jaundice is a condition of excessive build up of a substance calledbilirubin in the blood. Bilirubin is a product of break down of red blood cells and is normally processed by the liver and excreted from the body in bile. When the liver malfunctions, bilirubin is not excreted and it gets deposited near the skin surface giving a yellow tinge to the skin, mucous membranes, and eyes.

Jaundice occurs when excess amounts of bilirubin circulating in the blood stream causes a yellowish appearance of the skin and the whites of the eyes. With the exception of physiologic jaundice in the newborn (normal newborn jaundice in the first week of life), all other jaundice indicates overload or damage to the liver, or inability to move bilirubin from the liver through the biliary tract to the gut.

Newborn jaundice is common and unless associated with an abnormal condition will clear without treatment. Another condition called Gilbert”s syndrome is a hereditary condition in which mild jaundice develops during times of stress. This condition, once recognised, requires no further treatment or evaluation. There are also other more rare hereditary causes of elevated bilirubin levels. All other jaundice is the result of an underlying disease, condition, or toxicity.

A yellow-to-orange colour may be imparted to the skin by excessive intake of beta carotene, the orange pigment seen in carrots. People who consume large quantities of carrots or carrot juice or take beta carotene tablets may develop a distinctly yellow-orange cast to their skin.
This condition is called hypercarotenemia or just carotenemia. Hypercarotenemia is easily distinguished from jaundice in that the whites of the eye (sclera) remain white, while people with true jaundice have a yellow sclera.

What are the causes?

In children:

• newborn jaundice (physiologic jaundice)
  
• breast feeding jaundice
  
• viral hepatitis (hepatitis A, hepatitis B, hepatitis C, hepatitis D, and hepatitis E)
  
• haemolytic anaemia
  
• congenital disorders of bilirubin metabolism (Gilbert”s
  syndrome) autoimmune hepatitis

• malaria

In adults:

• obstruction of the bile ducts (by infection, tumour or gallstones)
  
• viral hepatitis (hepatitis A, hepatitis B, hepatitis C, hepatitis D, and hepatitis E)
  
• drug-induced cholestasis (bile pools in the gallbladder because of the effects of drugs)
  
• drug-induced hepatitis (hepatitis triggered by medications, including erythromycin, sulpha drugs, antidepressants, anti-cancer drugs, rifampicin, steroids, chlorpropamide, tolbutamide, oral contraceptives, testosteronel)

• bile duct stricture
  
• alcoholic liver disease (alcoholic cirrhosis)
  
• primary biliary cirrhosis
  
• ischaemic hepatocellular jaundice (jaundice caused by inadequate oxygen or inadequate blood flow to the liver)
  
• intrahepatic cholestasis of pregnancy (bile pools in the gallbladder because
  of the pressure in the abdomen with pregnancy)
  
• haemolytic anaemia
  
• congenital disorders of bilirubin metabolism
  
• chronic active hepatitis
  
• autoimmune hepatitis
  
• malaria
  

What are the symptoms?

• yellow pigmentation of the skin
  
• inside of the mouth (mucous membranes) turn yellow
  
• eyes turn yellow
  
• dark urine
  
• pale stools
  
• abdominal pain, systemic symptoms (eg, anorexia, vomiting,
  fever)
  

How is it diagnosed?

The medical history is obtained and a physical examination performed.

Medical history questions may include:

Is the skin colour yellow (jaundice)?

Is the inside of the mouth (mucous membranes) yellow?

Are the eyes yellow?

When did the jaundice start?

Has the jaundice occurred repeatedly (recurrent)?

What other symptoms are also present?

During a physical examination, the doctor studies one's body to
determine the presence or absence of physical problems.


A typical physical examination includes:

• inspection (looking at the body)
  
• palpation (feeling the body with hands)
  
• auscultation (listening to sounds)
  
• percussion (producing sounds)
  

Diagnostic tests that may be performed include:

• serum bilirubin
  
• hepatic (liver) enzymes (see liver function tests) and cholesterol
  
• prothrombin time
  
• complete blood count
  
• ultrasound of the abdomen
  
• liver biopsy
  
• urine and faecal urobilinogen

What is the treatment?

The cause of jaundice must be determined before treatment can be given. Prescribed therapy is to be followed to treat the underlying cause. Treatment of jaundice depends upon an individual case. In most cases, it is treated with antibiotics, a mild case usually resolves on its own. The disease leaves a lot of weakness in its wake and thus recuperation may take a long time. Generally, the best way to treat jaundice is to correct the underlying cause; the exact remedy depends on the nature and severity of the case.

- drink 6-8 glasses of water a day

- eat lots of raw fruits and vegetables (especially green leafy vegetables)

- juice is good (make your own with a juice machine)

- do not drink coffee, alcohol, soda pop, other junk food drinks

- do not eat processed foods white sugar, white flour, etc.

-
use stress relief like going for walks in the park

- brown rice and millet are good

- avoid red meat and animal fats

- reduce dairy products cheese, milk, and others

- fast a few days a month

- a colon intestinal cleansing is helpful

- get sleep

- exercise light to moderate amounts eg. yoga and stretching are good

- do not smoke and avoid second hand smoke

What diet should I eat while suffering from jaundice?

Q. I heard that sugracane juice is helpful in the treatment of Jaundice.How far is this true? Is it effective for pre-hepatic jaundice(haemolytic jaundice) only or even the hepatic and post hepatic(obstructive) forms of the disease? A. Jaundiceis indicative of the malfunctioning of the liver. It may be caused byan obstruction of the bile ducts which discharge bile salts and pigmentinto the intestine. The simple form of jaundice, the pre hepaticjaundice can be treated well with a good diet. Recovery may however, beslow in serious cases caused by obstruction or pressure in the bileducts, the hepatic and post hepatic jaundice cases. Thepatient should rest in bed till the acute symptoms subside. He shouldnot be given any solid foods for the first few days of the treatment. He may be given plenty of fresh fruits and vegetable juices. The idea is to provide a high carbohydrate based diet as the liver is infected,and minimize the strain on the liver. Suji or dhalia porridge, softcustards, curd rice are other soft easy digestable foods. Fruits and vegetables are highly recommended, and can be used to prepare juices. Those like lemon, grapes, pear, tomato, carrot, beet and yes,sugarcane are preferable. Sugarcane juice, mixed with lime juice, being high carbohydrate can hasten recovery from jaundice. Half a glass ofthis juice, mixed with half a lime, may be given to the patient twice daily. It is, however, very essential that the juice must be pure and preferably prepared at home in a hygienic manner. Resistance is low in jaundice and any infected beverage could only make matters worse. It is also important to prepare this juice fresh each time and avoid storing it. After the severity of the decease has passed, the patient may be given a simple and well-balanced diet. The emphasis should be on fresh juicy fruits such as orange, apple, pineapple, grapes, papaya and mango, and vegetables such as spinach, fenugreek and carrots. The patient should avoid all fats like ghee, butter, cream and oils for at last two weeks and thereafter their consumption should be kept down to the minimum. Digestive disturbances must be avoided. No food with a tendency to ferment or putrefy in the lower intestines like pulses and legumes should be included in the diet. Other effective home remedy is the use of green leaves or radish (muli). The leaves should be pounded and their juice extracted. It should be strained through a clean piece of muslin before use. About 60 to 80 ml. of this juice, depending on the age, should be given to the patient three times daily. It induces healthy appetite and proper evacuation of bowels. But remember, these are all home remedy, they do help but do not substitute the need for rest and medication as prescribed by the doctor. Also remember to avoid alcohol until recovery. Alcohol may be poorly tolerated for some months and cause minor relapses - it should be totally avoided for at least 3 months or longer until the liver has fully recovered. Follow the mentioned tips to lead a healthy and a happy life. ALWAYS LISTEN TO YOUR FAMILY DOCTO