Jaundice yellow staining of the skin ,mucus membranes and body tissues by bile pigments . It can be caused by
- increased bile pigment load on liver cells
- disturbances in transport of billirubin from sinusoids to microsomes
- defect in conjugation of billirubin with in microsomes
- difficulty in excretion of billiburin in biliary canaliculus more often than one process is involved.
Causes of Jaundice :
1.Hepatic Jaundice : neffective hepatitis serum hepatitis , acute yellow atrophy , passive congestion from CCF partal pyaemic abscesses cirrhosis of liver .
Jaundice in acute fevers ; malaria typhoid fever , Weil’s disease , glandular fever , relapsing fever .
Congenital abnormalities e.g., galctosaemia , Dubin Johnson’s disease , Gilbert’s disease .
2.Jaundice due to obstruction of larger bile ducts :
- caused with in the lumen of CBD gallstones , inspissated bile , rarely round worms .
- causes affecting the wall of the duct : surgical trauma –e.g., accidental ligation of division during surgery in right upper quadrant of abdomen . stricture of CBD cancer of CBD enlarged hilar lymph nodes :-metastatic carcinoma , malignant reticulasis tuberculosis , tumor of liver , gall bladder , pancreas , duodenum , stomach , hepatic flexure and rarely right kidney or suprarenal , rarely pressure from hydatid cyst or huge retropertoneal cysts and tumors .
3.haemolytic jaundice : hereditary spherocytosis sickle cell anaemia ; thalassaemia, icterusgravis , neonatorum , hypersplenism , paroxymal , laemoglobinuria , trnsfusion with incompatible blood , snake venom poisoning glucose-6 phosphate dehydrogenase deficiency .
4.Drug induced jaundice : sulphonamides , cholecystographic media , methyl testosterone , norethandrolone , chlorpromazine hydrazines , novobiocin , PAS tetrachlorethane , chloroform , chlorpropamide (diabenase ) , halothane .
Blood Examination : Leucocytosis suggests obstructive jaundice either due to malignancy or ascending cholangitis , low leucocyte count with relative lymphocytosis suggests hepato-cellular jaundice , if haemolytic is suspected there will be increased reticulocytosis and presence of immature red blood cells , erythrocytes fragility tests and coomb’s test are useful for diagnosis of haemolytic jaundice .
Biochemical Tests :- serum bilirubin level shows the severity and progress of jaundice , cephalin cholesterol , thymol turbidity and other flocculation tests will be affected in hepato-cellular jaundice
Estimation of serum albumin , globulin and electrophoretic pattern of serum proteins are very useful . A normal serum albumin with elevated a2 and B globulin shows obstructive jaundice while there is depression of albumin with elevation of r globulin in hepatocellular jaundice . Increased serum alkaline phosphatase if over 35 KA units ad gradually increasing suggests obstructive jaundice , serum iron , serum B 12 and SGPT increase in hepatitis and is normal in obstructive jaundice .
In problem cases decrease in serum bilirubin by 40% after 30 mg of predinisolone for 5 days will suggest hepatocellular jaundice , very rarely it may be essential to wait for 3 weeks and repeat all the tests .
Urine Examination : – Urine is examined for presence of bile salts and pigments and urobi-linogen , bilirubinuria with absence of urobilinogen suggests obstructive jaundice . if this persists for weeks or months , the obstruction will be due to malignancy , exception being cholestatic jaundice . billiubinuria associated with presence of urobilinogen suggest virus hepatitis while excess of urobilinogen with a negative bilirubin test would suggest the haemolytic jaundice .
General Examination :-
Age is very important , as the cause of jaundice of birth and in infancy is quite different from the causes in later life
The causes of neonatal jaundice are physiological and pre maturity jaundice ,a transient jaundice appearing around 3 days after birth and disappearing around second week . haemolytic disease of new born ; characteristically the first born escapes the disease , infant may be deeply jaundiced with in 12 hours ; rarely anaemia may be severe and jaundice may be mild . drugs which give rise to jaundice in adult are in fact more icterogenic in fact as conjugation is more deficient at and after birth . Giant cell hepatitis , viral hepatitis , congenital syphilis and pyogenic infections all rarely can cause jaundice in new born . The incidence of ineffective hepatitis decreases as the age advances , being commonest in 2nd and 3rd decades . Fertile fatty female of 40 is more likely to have stones but no age is exempt , the higher the age more the chances of malignant obstruction .
A old aged 76 years resident of Chikmagalur town came to my clinic with his wife with blood report as under :
Blood examination: he was in an advanced stage of jaundice
Serum billirubin level was : 8.2mg%
Direct billirubin 6.5%
Urine examination : Bile salt –positive
Bile pigment –positive
As a last effort he decided take homoeopathic medicines . jaundice was the only sign and he did not describe any other symptom . the only thing which I could observe from his face was an expression , probably the patient was aware of the seriousness of his illness . I got a good history from the patient who was unwell since a month . The past history how ever revealed that he was under a lot of mental stress . He developed loss of appetite ,weakness , malaise and nausea , he also noticed that urine was turning dark yellow color , stool is white color , eyes are dark yellow color . He was reduced causing weight loss and nutritional deficiency . He was dull and timid , he received some treatment from a local doctor but in vain finding no relief . the patient was of a dark complexion , he had poor appetite , sleepiness , mild pain in fore head , excessive debility and conjunctive ,his tongue and especially his palate was strikingly yellow , suffering from pains and vomiting also ,constipation ,fever
Homoeopathic Treatment :
2.carduus marinus Q
3.natrum phos 6X
Chelidonium30 was given for one week
Nat phos 6X daily 4 doses
With in a few days the stool turned yellow , the skin and eyes and tongue ,palate resumed their natural color and after a week , the urine was devoid of bile salts and pigments . not once after the first dose of the remedy did he suffer from pain or vomiting .
I prescribed chelidonium 30 daily 3 doses reduced to 2 doses with in a week , no more nausea vomiting . the yellowness of skin disappeared gradually with urine test free from bile pigments and salts . The patient regained his lost weight and energy at the end of 3 weeks
Natrum phos 6X daily 4 doses with in a few days the stool turned yellow
After 3 weeks later the patient then recovered remarkably , good appetite and weight increase by 3 kgs , motion normal , no head ache , no giddiness .
The Australia antigen test was negative after one month . all liver function tests , also came normal and negative .
Blood examination :
Total bilirubin ………2.2mg%
Direct bilirubin ……..1.41mg%
S.G.O.T …………….28 IU/L
Uric acid …………….3.9mg%
Urine examination :
Bile salt …………….negative
Bile pigment ……….negative