Jaundice

Jaundice is yellowish discoloration of eyes, skin and  high color (Yellow) urine. Bilirubin or liver enzymes may be raised in jaundice either due to medical cause (Hepatitis) or due to blockage of the bile-duct (Surgical or Obstructive jaundice; see later) both requires urgent medical attention.

Many diseases can cause elevated bilirubin and liver enzymes. Your doctor determines the specific cause by reviewing your medications, your signs and symptoms and, in some cases, other tests and procedures.

• Certain medications, including statin drugs used to control cholesterol
• Drinking alcohol
• Heart failure
• Hepatitis A
• Hepatitis B
• Hepatitis C
• Nonalcoholic fatty liver
• Cirrhosis
• Obesity
• Obstructive jaundice:

Obstructive jaundice is a particular type of jaundice and occurs when the  flow of bile from the liver to the intestine is blocked and remains in the bloodstream. This might be due to blocked common bile duct, (common bile duct is a duct connecting liver to the intestine) this blockage may be due to stones, or tumours of the bile duct, these may be cancerous.

• Pancreatic cancer and periampullary cancers can also be a cause of common bile duct blockage and presents with jaundice
• Other conditions that can cause obstructive jaundice include those that cause pressure on the bile duct such as swelling of lymph glands or pancreatitis, scar tissue (from previous surgery like gallbladder removal or  infections ), or a cyst, present from birth (choledochal cyst) or of the pancreas.

• Symptoms of obstructive jaundice include yellowing of the skin and whites of the eyes; paler stools and darker urine; and intense itching. Other symptoms vary, depending on the underlying cause of the obstruction although you may also feel tired.

• As obstructive jaundice is a serious condition linked to high mortality rates and early diagnosis is important. If it is caught early enough a curative operation to remove the blockage is possible, otherwise only palliative treatments that ease the symptoms and which may prolong life are available.
• Obstructive jaundice can be diagnosed through various tests including blood tests to examine the level of bilirubin( Liver function test), as well as ultrasound of the liver and bile ducts to find out the exact cause of the obstruction is. If stone is suspected to be the culprit, MRCP is done to diagnose, whereas if a cancer is suspected Triple phase CECT scans or MRI are used to help examine what is causing the blockage and stage the disease. Biopsy or FNAC can be tried for tissue diagnosis, but it is not mandatory as negative result does not exclude cancer.

• Treatment depends on what is causing the obstruction; your doctor will advise you about your treatment options. Usually bile duct stones are removed by a non operative procedure called ERCP. If this fails surgical removal of the stones with or without a bilary bypass may be indicated. Gallbladder needs to be removed surgically in any case as stones usually come to bile duct from gallbladder. Tumour of the bile duct s are treated with surgical resection if found at an early stage. Similarly pancreatic cancer or periampullary cancers are best treated with a hope of cure with surgical removal of the tumour. After surgery chemotherapy may be required depending on the biopsy report of the operation.
• When cancers present at an advanced stage only symptomatic relief can be provided with ERCP stenting or PTC, where a tube is placed inside the bile duct to beyond the blockage to reduce the jaundice . chemotherapy may be considered in advanced cases to prolong the life to some extent.