Jaundice (cont.)
What diseases cause jaundice?
Increased production of bilirubin
There are several uncommon conditions that give rise to over-production of
bilirubin. The bilirubin in the blood in these conditions usually is only mildly
elevated, and the resultant jaundice usually is mild and difficult to detect.
These conditions include: 1) rapid destruction of red blood cells (referred to
as hemolysis), 2) a defect in the formation of red blood cells that leads to the
over-production of hemoglobin in the bone marrow (called ineffective
erythropoiesis), or 3) absorption of large amounts of hemoglobin when there has
been much bleeding into tissues (e.g., from hematomas, collections of blood in
the tissues).
Acute inflammation of the liver
Any condition in which the liver becomes inflamed can reduce the ability of the
liver to conjugate (attach glucuronic acid to) and secrete bilirubin. Common
examples include acute viral hepatitis, alcoholic hepatitis, and Tylenol-induced
liver toxicity.
Chronic liver diseases
Chronic inflammation of the liver can lead to scarring and cirrhosis, and can
ultimately result in jaundice. Common examples include chronic hepatitis B and
C, alcoholic liver disease with cirrhosis, and autoimmune hepatitis.
Infiltrative diseases of the liver
Infiltrative diseases of the liver refer to diseases in which the liver is
filled with cells or substances that don't belong there. The most common example
would be metastatic cancer to the liver, usually from cancers within the
abdomen. Uncommon causes include a few diseases in which substances accumulate
within the liver cells, for example, iron (hemochromatosis), alpha-one
antitrypsin (alpha-one antitrypsin deficiency), and copper (Wilson's disease).
Inflammation of the bile ducts
Diseases causing inflammation of the bile ducts, for example, primary biliary
cirrhosis or sclerosing cholangitis and some drugs, can stop the flow of bile
and elimination of bilirubin and lead to jaundice.
Blockage of the bile ducts
The most common causes of blockage of the bile ducts are gallstones and
pancreatic cancer. Less common causes include cancers of the liver and bile
ducts.
Drugs
Many drugs can cause jaundice and/or cholestasis. Some drugs can cause liver
inflammation (hepatitis) similar to viral hepatitis. Other drugs can cause
inflammation of the bile ducts, resulting in cholestasis and/or jaundice. Drugs
also may interfere directly with the chemical processes within the cells of the
liver and bile ducts that are responsible for the formation and secretion of
bile to the intestine. As a result, the constituents of bile, including
bilirubin, are retained in the body. The best example of a drug that causes this
latter type of cholestasis and jaundice is estrogen. The primary treatment for
jaundice caused by drugs is discontinuation of the drug. Almost always the
bilirubin levels will return to normal within a few weeks, though in a few cases
it may take several months.
Genetic disorders
There are several rare genetic disorders present from birth that give rise to
jaundice. Crigler-Najjar syndrome is caused by a defect in the conjugation of
bilirubin in the liver due to a reduction or absence of the enzyme responsible
for conjugating the glucuronic acid to bilirubin. Dubin-Johnson and Rotor's
syndromes are caused by abnormal secretion of bilirubin into bile.
The only common genetic disorder that may cause jaundice is Gilbert's syndrome
which affects approximately 7% of the population. Gilbert's syndrome is caused
by a mild reduction in the activity of the enzyme responsible for conjugating
the glucuronic acid to bilirubin. The increase in bilirubin in the blood usually
is mild and infrequently reaches levels that cause jaundice. Gilbert's syndrome
is a benign condition that does not cause health problems.
Developmental abnormalities of bile ducts
There are rare instances in which the bile ducts do not develop normally and the
flow of bile is interrupted. Jaundice frequently occurs. These diseases usually
are present from birth though some of them may first be recognized in childhood
or even adulthood. Cysts of the bile duct (choledochal cysts) are an example of
such a developmental abnormality. Another example is Caroli's disease.
Jaundice of pregnancy
Most of the diseases discussed
previously can affect women during pregnancy, but
there are some additional causes of jaundice that are unique to pregnancy.
Cholestasis of pregnancy. Cholestasis of pregnancy is an uncommon condition that
occurs in pregnant women during the third trimester. The cholestasis is often
accompanied by itching but infrequently causes jaundice. The itching can be
severe, but there is treatment (ursodeoxycholic acid or ursodiol). Pregnant
women with cholestasis usually do well although they may be at greater risk for
developing gallstones. More importantly, there appears to be an increased risk
to the fetus for developmental abnormalities. Cholestasis of pregnancy is more
common in certain groups, particularly in Scandinavia and Chile, and tends to
occur with each additional pregnancy. There also is an association between
cholestasis of pregnancy and cholestasis caused by oral estrogens, and it has
been hypothesized that it is the increased estrogens during pregnancy that are
responsible for the cholestasis of pregnancy.
Pre-eclampsia. Pre-eclampsia, previously called toxemia of pregnancy, is a
disease that occurs during the second half of pregnancy and involves several
systems within the body, including the liver. It may result in high blood
pressure, fluid retention, and damage to the kidneys as well as anemia and
reduced numbers of platelets due to destruction of red blood cells and
platelets. It often causes problems for the fetus. Although the bilirubin level
in the blood is elevated in pre-eclampsia, it usually is mildly elevated, and
jaundice is uncommon. Treatment of pre-eclampsia usually involves delivery of
the fetus as soon as possible if the fetus is mature.
Acute fatty liver of pregnancy. Acute fatty liver of pregnancy (AFLP) is a very
serious complication of pregnancy of unclear cause that often is associated with
pre-eclampsia. It occurs late in pregnancy and results in failure of the liver.
It can almost always be reversed by immediate delivery of the fetus. There is an
increased risk of infant death. Jaundice is common, but not always present in
AFLP. Treatment usually involves delivery of the fetus as soon as possible.
Next: What is neonatal jaundice (jaundice in newborn infants)? »
- vitamin k-injection, Aqua-Mephyton, Vitamin K - Consumer information about the medication VITAMIN K - INJECTION (Aqua-Mephyton, Vitamin K), includes side effects, drug interactions, recommended dosages, and storage information. Read more about the prescription drug VITAMIN K - INJECTION.
- CT Scan (Computerized Axial Tomography) - CT Scan (Computerized Axial Tomography, CAT scan) is a procedure that assists in diagnosing tumors, fractures, bony structures, and infections in the organs and tissues of the body.
- Liver Cancer - Get information on liver cancer, its symptoms, causes, diagnosis, staging, prognosis, treatment, and prevention.
Latest Medical News
Digestion RSS