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.
Many tests are available for determining the cause of jaundice, but the history
and physical examination are important as well.
History
The history can suggest possible reasons for the jaundice. For example, heavy
use of alcohol suggests alcoholic liver disease, whereas use of illegal,
injectable drugs suggests viral hepatitis. Recent initiation of a new drug
suggests drug-induced jaundice. Episodes of abdominal pain associated with
jaundice suggests blockage of the bile ducts usually by gallstones.
Physical examination
The most important part of the physical examination in a patient who is
jaundiced is examination of the abdomen. Masses (tumors) in the abdomen suggest
cancer infiltrating the liver (metastatic cancer) as the cause of the jaundice.
An enlarged, firm liver suggests cirrhosis. A rock-hard, nodular liver suggests
cancer within the liver.
Blood tests
Measurement of bilirubin can be helpful in determining the causes of jaundice.
Markedly greater elevations of unconjugated bilirubin relative to elevations of
conjugated bilirubin in the blood suggest hemolysis (destruction of red blood
cells). Marked elevations of liver tests (aspartate amino transferase or AST and
alanine amino transferase or ALT) suggest inflammation of the liver (such as
viral hepatitis). Elevations of other liver tests, e.g., alkaline phosphatase,
suggest diseases or obstruction of the bile ducts.
Ultrasonography
Ultrasonography is a simple, safe, and readily-available test that uses sound
waves to examine the organs within the abdomen. Ultrasound examination of the
abdomen may disclose gallstones, tumors in the liver or the pancreas, and
dilated bile ducts due to obstruction (by gallstones or tumor).
Computerized tomography (CT or CAT scans)
Computerized tomography or CT scans are scans that use x-rays to examine the
soft tissues of the abdomen. They are particularly good for identifying tumors
in the liver and the pancreas and dilated bile ducts, though they are not as
good as ultrasonography for identifying gallstones.
Magnetic resonance imaging
(MRI)
Magnetic Resonance Imaging scans are scans that utilize magnetization of the body to examine the soft
tissues of the abdomen. Like CT scans, they are good for identifying tumors and
studying bile ducts. MRI scans can be modified to visualize the bile ducts
better than CT scans (a procedure referred to as MR cholangiography), and,
therefore, are better than CT for identifying the cause and location of bile
duct obstruction.
Endoscopic retrograde
cholangiopancreatography (ERCP) and endoscopic ultrasound
Endoscopic retrograde cholangiopancreatography (ERCP) provides the best means
for examining the bile duct. For ERCP an endoscope is swallowed by the patient
after he or she has been sedated. The endoscope is a flexible, fiberoptic tube
approximately four feet in length with a light and camera on its tip. The tip of
the endoscope is passed down the esophagus, through the stomach, and into the
duodenum where the main bile duct enters the intestine. A thin tube then is
passed through the endoscope and into the bile duct, and the duct is filled with
x-ray contrast solution. An x-ray is taken that clearly demonstrates the
contrast-filled bile ducts. ERCP is particularly good at demonstrating the cause
and location of obstruction within the bile ducts. A major advantage of ERCP is
that diagnostic and therapeutic procedures can be done at the same time as the
x-rays. For example, if gallstones are found in the bile ducts, they can be
removed. Stents can be placed in the bile ducts to relieve the obstruction caused
by scarring or tumors. Biopsies of tumors can be obtained.
Ultrasonography can be combined with ERCP by using a
specialized endoscope capable of doing ultrasound scanning. Endoscopic ultrasound
is excellent for diagnosing small gallstones in the gallbladder and bile ducts that can be missed
by other diagnostic methods such as ultrasound, CT, and MRI. It also is the best
means of examining the pancreas for tumors and can facilitate biopsy through the
endoscope of tumors within the pancreas.
Liver biopsy
Biopsy of the liver provides a small piece of tissue from the liver for
examination under the microscope. The biopsy most commonly is done with a long
needle after local injection of the skin of the abdomen overlying the liver with
anesthetic. The needle passes through the skin and into the liver, cutting off a
small piece of liver tissue. When the needle is withdrawn, the piece of liver
comes with it. Liver biopsy is particularly good for diagnosing inflammation of
the liver and bile ducts, cirrhosis, cancer, and fatty liver.
With the exception of the treatments for specific causes of jaundice mentioned
previously, the treatment of jaundice usually requires a diagnosis of the
specific cause of the jaundice and treatment directed at the specific cause,
e.g., removal of a gallstone blocking the bile duct.
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