Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
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.
Gallstones are stones that form when substances in the bile harden. Gallstones (formed in the gallbladder) can be as small as a grain of sand or as large as a golf ball. There can be just one large stone, hundreds of tiny stones, or any combination. The majority of gallstones do not cause symptoms.
Liver cancer is the fifth most common cancer in the world and the majority of patients with liver cancer will die within one year as a result. Patients with associated cirrhosis caused by chronic hepatitis B or C infections, alcohol, and hemochromatosis are at the greatest risk of developing liver cancer. Many patients with liver cancer do not develop symptoms until the advanced stages of the tumor which usually makes prognosis poor. The combination of an imaging study (ultrasound, CT, or MRI scans) and an elevated blood level of alpha-fetoprotein will most effectively diagnose liver cancer, while a liver biopsy can make a definitive diagnosis. Medical treatments, including chemotherapy, chemoembolization, ablation, and proton beam therapy, are not very effective. Surgical removal of the tumor or a liver transplant may be most effective in certain cases.
Cirrhosis of the liver refers to a disease in which normal liver cells are replaced by scar tissue caused by alcohol and viral hepatitis B and C. This disease leads to abnormalities in the liver's ability to handle toxins and blood flow, causing internal bleeding, kidney failure, mental confusion, coma, body fluid accumulation, and frequent infections. Symptoms include yellowing of the skin, itching, and fatigue.
Pancreatic cancer is a malignant tumor of the pancreas. Pancreatic cancer has been called a "silent" disease because early pancreatic cancer usually does not cause symptoms.
Liver disease can be cause by a variety of things including infection (hepatitis), diseases such as gallstones, high cholesterol or triglycerides, blood flow obstruction to the liver, and toxins (medications and chemicals). Symptoms of liver disease depends upon the cause; however, common symptoms may include nausea, vomiting, upper right abdominal pain, and jaundice. Treatment depends upon the cause of the liver disease.
Hepatitis C is an inflammation of the liver due to the hepatitis C virus (HCV), which is usually spread by
blood transfusion, hemodialysis, and needle sticks, especially with intravenous
drug abuse. Chronic hepatitis C may be treated with interferon, usually in combination with anti-virals.
A hematoma is a collection of blood that is outside a blood vessel. There are different areas where hematomas occur including the inside the skull, scalp, ear, septum, bones, finger and toenails, and intra-abdominal. Treatment for hematomas depend on the type and location of the hematoma.
The hepatitis B virus is a unique, coated DNA virus belonging to the Hepadnaviridae family of viruses. The course of the virus is determined primarily by the age at which the infection is acquired and the interaction between the virus and the body's immune system. Successful treatment is associated with a reduction in liver injury and fibrosis (scarring), a decreased likelihood of developing cirrhosis and its complications, including liver cancer, and a prolonged survival.
Leptospirosis is an infectious disease caused by bacteria. The illness progresses in two phases. Symptoms in the first phase include headache, muscle aches, eye pain with bright lights, chills, and fever. Symptoms in the second phase begin after a few days of feeling well and include fever, aches, and a stiff neck. Some people develop meningitis and abdominal pain.
Malaria is an infectious disease transmitted by the bite of an infected Anopheles mosquito. Symptoms of malaria include chills, pain, fever, and sweating. Though mild cases of malaria can be treated with oral medication, severe cases require intravenous drug treatment and fluids.
Polycythemia (elevated red blood cell count) causes are either primary (aquired or genetic mutations) or secondary (diseases, conditions, high altitude). Treatment of polycythemia depends on the cause.
Tylenol liver damage (acetaminophen) can occur from accidentally ingesting too much acetaminophen, or intentionally. Acetaminophen is a drug contained in over 200 OTC and prescription medications from NyQuil to Vicodin. Avoiding unintentional overdoses include reading medication labels, write down the dosages of medications you are taking, do not drink excessive alcohol while taking acetaminophen. In severe cases, a liver transplant may be necessary.
Hepatitis is most often viral, due to infection with one of the hepatitis viruses (A, B, C, D, E, F (not confirmed), and G) or another virus (such as those that cause infectious mononucleosis, cytomegalovirus disease). The main nonviral causes of hepatitis are alcohol and drugs. Many patients infected with hepatitis A, B, and C have few or no symptoms of illness. For those who do develop symptoms of viral hepatitis, the most common are flu- like symptoms including: loss of appetite, nausea, vomiting, fever, weakness, tiredness, and aching in the abdomen. Treatment of viral hepatitis is dependant on the type of hepatitis.
Primary Biliary Cirrhosis is a chronic disease characterized by progressive inflammation and destruction of small bile ducts within the liver. The bile ducts transport bile from the liver to the intestine for the absorption of fat and elimination of waste products. The causes of Primary Biliary Cirrhosis may involve autoimmunity, infection, or genetic predisposition, acting alone or in combination. There are many medications and treatment options available for those with this and other associated diseases of Primary Biliary Cirrhosis.
The liver is the largest solid organ in the body, and is actually an gland. The liver has a wide variety of critical functions such as manufacturing proteins and metabolizing fats and carbohydrates. The liver also eliminates harmful biochemical waste products from the body (alcohol, drugs, toxins). The liver secretes bile that aids in digestion. Examples of diseases of the liver include cirrhosis, hepatitis, cancer, and fatty liver. Symptoms of liver disease include bleeding, easy bruising, edema, fatigue, and jaundice.
Pancreatic cysts are collections of fluid within the pancreas. Some are benign, malignant, or pseudocysts. There are two major types of pancreatic cysts, inflammatory cysts and non-inflammatory cysts. Non-inflammatory cysts include: serous cyst adenomas, mucinous cyst adenomas, intraductal papillary mucinous neoplasm (IPMN), and solid pseudopapillary tumor of the pancreas. Symptoms of pancreatic cysts include abdominal pain, jaundice, fever, chills, and sepsis. Treatment depends on the type of cyst, and patient health.
Toxoplasmosis (toxo) is a parasitic infection that causes flulike symptoms, swollen lymph nodes, and muscle aches and pains that may last from a few days to several weeks. Toxoplasmosis can be contracted by touching the hands to the mouth after gardening, cleaning a cat's litter box, or anything that came into contact with cat feces. Toxoplasmosis can also be contracted by eating raw or partly cooked meat, especially pork or lamb, or touching the hands to the mouth after contact with raw or undercooked meat.
G6PD deficiency (Glucose 6-phosphate dehydrogenase) leads to a condition called hemolytic anemia. Causes of G6PD deficiency is an abnormal gene located in the X-chromosome, therefore, it is more common in males. Hemolytic anemia caused by G6PD deficiency generally occurs after exposure to malaria medications, antiitching drugs, and fava beans. Pneumonia and other infections can also precipitate hemolytic anemia in individuals with G6PD deficiency. Treatment is generally discontinuing the drug or compound treating infection. Blood transfusions are necessary in some individuals.
Gallbladder cancer is a rare form of cancer with symptoms that include jaundice, abdominal pain, fever, nausea and vomiting, abdominal lumps, and bloating. Risk factors include being female and Native American. Treatment of gallbladder cancer depends upon the stage of the cancer, the type of gallbladder cancer, and whether the cancer can be removed by surgery.
Primary sclerosing cholangitis (PSC) is a chronic, progressive disease of the bile ducts that channel bile from the liver into the intestines. There is an association between primary sclerosing cholangitis and ulcerative colitis and Crohn's disease. Symptoms of primary sclerosing cholangitis include abnormal liver blood tests, itching, fatigue, and jaundice. Primary sclerosing cholangitis is treated with medications and in some cases, liver transplant.
Alpha thalassemia is a disorder in which the alpha globin protein is underproduced. There are two pairs of genes that carry the code for the alpha chains of hemoglobin. When one gene is impaired, that person is in a carrier state and suffers no medical problems. When four genes are impaired, the production of fetal and adult hemoglobin is prevented, resulting in hydrops fetalis and leading to death before birth.
Anabolic steroids are synthetic substances that are related to testosterone and promote skeletal muscle growth and the development of male sexual characteristics in both men and women. In the 1930s, it was discovered that anabolic steroids could promote skeletal muscle growth in lab animals, which lead to anabolic steroid abuse by bodybuilders and weight lifters.
Digestion is the complex process of turning food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food.
Alpha-1 antitrypsin deficiency is an inherited disorder that may cause liver and lung disease in adults. Signs and symptoms include shortness of breath, wheezing, weight loss, respiratory infections, fatigue, vision abnormalities. Advanced lung disease from alpha-1 antitrypsin deficiency include emphysema. Liver damage from alpha-1 antitrypsin deficiency causes a swollen abdomen, swollen legs or feet, and jaundice.
Hepatitis means inflammation of the liver. Hepatitis A is one type of liver disease caused by a virus. Since hepatitis A is a virus, it can pass from person to person from eating or drinking contaminated food or coming into contact with contaminated materials containing the virus. Symptoms of hepatitis A include stomach pain, diarrhea, dark yellow urine, jaundice, and more. There is a vaccine to prevent contracting hepatitis A.
Yellow fever is an infectious disease transmitted by infected mosquitoes. Side effects are rare with the yellow fever vaccine. Symptoms include fever, chills, back pain, nausea, vomiting, and headache. Treatment is aimed at relieving symptoms.
Choledochal cysts are cysts of the bile ducts. There are several different types of choledochal cysts. These cysts are congenital, however, their cause is not known. Symptoms of choledochal cysts in infants include an enlarged liver and jaundice. In older people, the cysts cause abdominal pain, jaundice, cholangitis, gallstones, and pancreatitis. Treatment for choledochal cysts is surgery.
Jaundice in infants occur when the baby's liver may not be developed enough to efficiently rid the body of bilirubin. Symptoms of jaundice include yellowish colored eyes, and yellowing of the skin. Some babies are more at risk to develop jaundice. Kernicterus is a type of brain damage that occurs when a baby has jaundice and is not treated. Treatment of infant jaundice is generally with phototherapy so that kernicterus should not develop.
Digestion RSS
Healthy Living Tips
This site complies with the