Jaundice Disease Essay Example

spleen.

It should be thoroughly investigated so that the underlying cause can be identified and treated.The red blood cells in our circulation carry oxygen to all parts of the body and have a life span of about 120 days. At the end of their life they are broken down and removed from the circulation by special cells called phagocytes, which are found within the bone marrow, spleen and liver. New red cells are of course continually manufactured and this also takes place within the bone marrow. Following breakdown of the red cells some of their component parts such as amino acids and iron can be re-used by the body.Other components such as bilirubin need to be removed.

Knowing how this removal pathway works is the key to understanding how jaundice occurs. Most waste products of the body are excreted in the urine via the kidneys but the liver and bile system is the other main physical route out of the body for these substances. By 'waste products' we mean the many compounds that arise in the course of the body's metabolism but almost all forms of drugs must also be eliminated either via the urine or bile routes.In the case of bilirubin released from old red cells, it passes through the bloodstream to the liver, where the liver cells process it.

These cells carry out many complex chemical functions and also produce the liquid bile, which is the 'vehicle' by which the cells discharge their output to the bile duct system. This is a branching network of tiny tubes throughout the liver, which merge in the same way as the branches of a tree. Ultimately

a single main bile duct comes out of the liver and joins the first part of the small intestine (duodenum).Bile (and therefore bilirubin) then passes out through the small and large intestines and is excreted in the stool (feces).

Bile is green in colour, but bacteria in the large bowel act to change the bilirubin to substances that are brown, which gives stool its characteristic colour. Some of the bilirubin is reabsorbed back into the body through the bowel wall, eventually appearing in the urine as a substance called urobilinogen (although the typical yellow/orange colour of urine is in fact due a different pigment called urochrome).Therefore, any failure of the bilirubin removal pathway will lead to a build-up of bilirubin in the blood. When this happens the individual's skin turns yellow, causing jaundice. There are many conditions that could be associated with jaundice, such as: An excessive breakdown of red blood cells The balance between manufacture and breakdown of red cells is normally precisely balanced and equal but there are several conditions in which the rate of breakdown increases. If the amount of bilirubin thus released exceeds the liver's capacity to remove it, then jaundice will develop.

The medical term for excessive red cell breakdown is 'haemolysis', and within the developed world it is a fairly rare condition. Malaria is however a major cause in tropical climates as the malaria parasites live within the red cells and shorten their life. Similarly the condition in which a foetus develops haemolysis due to incompatibility of its Rhesus blood group with that of its mother is now rarely seen in the UK where we routinely check for 'Rhesus antibodies'

in the mother's blood. In parts of the world where antenatal care is not as good haemolytic disease of the newborn is much more common.A temporary jaundice of newborn babies is however quite common, due to the relative immaturity of the baby's liver cells and the higher than normal rate of cell breakdown that occurs in the first few weeks of life. It improves rapidly without treatment although when too high it can be speeded up by exposing the baby to ultraviolet light.

Jaundice of the newborn is commoner in premature babies as their liver is even more immature than a baby born at term. Autoimmune haemolytic anaemia is a rare disease in which the body's immune system seems to attack the red cells.It usually affects adults. Haemolysis can also be a side effect of some drugs, eg dapsone.

Impairment of liver cell function The commonest cause is a viral infection of the liver cells (hepatitis). Many different types of infection including glandular fever (mononucleosis) can also be responsible for this. Alcohol abuse and subsequent scarring of the liver (cirrhosis) can cause significant cell damage leading to jaundice. Other less common conditions causing liver cell damage include haemochromatosis, alpha-1 antitrypsin deficiency and primary biliary cirrhosis.Tumours of the liver - either primary liver cancers (arising from the liver tissue itself) or more commonly, the secondary spread of a tumour from elsewhere in the body into the liver can lead to cell failure and jaundice.

Blockage of the bile ducts This can occur as a result of abnormality inside or outside the ducts. The commonest example of an internal blockage is a gallstone. Tumours of the bile

duct are rare but if large enough, or situated just where the bile duct meets the duodenum, then they can block the flow of bile.At this junction point, known as the ampulla of Vater, the tube from the pancreas gland also joins to the duodenum. Cancer of the pancreas tends to arise in the part of the pancreas nearest to the ampulla of Vater, so is another potential cause of 'obstructive' jaundice. Any external organ or mass lying nearby that becomes large enough to press on the bile duct could be responsible.

Examples include swollen internal lymph glands, a cyst (perhaps of the pancreas) or scar tissue following a previous infection or surgery.Symptoms of Jaundice, other than that of the jaundice itself, will relate to the underlying cause. For example someone with haemolysis might also be anaemic and tired. If a gallstone were responsible there would probably have been a preceding history of pain in the abdomen. A cancer might be accompanied by weight loss, and so on.

When jaundice is due to obstruction of the bile duct the person will often notice that their urine becomes dark and stools become pale, as the excess bilirubin 'spills over' into the urine and no longer colours the stool.Obstructive jaundice is also often accompanied by intense itching. The diagnosis is made by recognition of the patient's appearance and accompanying symptoms. A blood test will confirm the raised bilirubin level and other tests such as those for hepatitis and haemolysis are also done on the blood. Ultrasound is a good way to inspect the liver and bile ducts for signs of obstruction, and often can give useful information

on the pancreas gland. CT scanning also helps diagnose obstructive jaundice accurately.

Treatment will depend upon the diagnosis behind the symptom of jaundice.For example, if the problem is one of gallstones, then removal of the gallbladder may be required. Jaundice comes in several other types, I will elaborate briefly about some of those types as follows: Neonatal jaundice is usually harmless: this condition is often seen in infants around the second day after birth, lasting until day 8 in normal births, or to around day 14 in premature births. Serum bilirubin normally drops to a low level without any intervention required: the jaundice is presumably a consequence of metabolic and physiological adjustments after birth.

In extreme cases, a brain-damaging condition known as kernicterus can occur; there are concerns that this condition has been rising in recent years due to inadequate detection and treatment of neonatal hyperbilirubinemia. Neonatal jaundice is a risk factor for hearing loss. Jaundiced eye, It was once believed persons suffering from the medical condition jaundice saw everything as yellow. By extension, the jaundiced eye came to mean a prejudiced view, usually rather negative or critical. Alexander Pope, in 'An Essay on Criticism' (1711), wrote: "All seems infected that the infected spy, As all looks yellow to the jaundiced eye.

Similarly in the mid 19th century the English poet Lord Alfred Tennyson wrote in the poem 'Locksley Hall': "So I triumphe'd ere my passion sweeping thro' me left me dry, left me with the palsied heart, and left me with a jaundiced eye. " In conclusion, if you or one of your friends or relatives suspect that you may have jaundice, it is essential

that you arrange to see your doctor in order that the underlying cause is identified and any possible treatment initiated as soon as possible.