Jaundice : Causes & Risk Factors

Jaundice is a yellow color in the skin, the mucous membranes, or the eyes. The yellow pigment is from bilirubin, a byproduct of old red blood cells.

Causes & Risk Factors
Causes in children include:

  1. Autoimmune hepatitis
  2. Biliary atresia
  3. Breastfeeding jaundice
  4. Breast milk jaundice
  5. Disorders present since birth that cause problems processing bilirubin(Gilbert syndrome, Dubin-Johnson syndrome, Rotor syndrome, orCrigler-Najjar syndrome)
  6. Hemolytic anemia
  7. Malaria
  8. Newborn jaundice (physiologic jaundice)
  9. Viral hepatitis (hepatitis A, hepatitis B, hepatitis C, hepatitis D, and hepatitis E)

Breastfeeding jaundice may occur in the first week of life in more than 1 in 10 breastfed infants. The cause is thought to be inadequate milk intake, leading to dehydration or low caloric intake. It is a type of physiologic or exaggerated physiologic jaundice.

Breast milk jaundice is far less common and occurs in about 1 in 200 babies. Here the jaundice isn’t usually visible until the baby is a week old. It often reaches its peak during the second or third week. Breast milk jaundice can be caused by substances in mom’s milk that decrease the infant’s liver’s ability to deal with bilirubin. Breast milk jaundice rarely causes any problems, whether it is treated or not. It is usually not a reason to stop nursing.

Causes in adults include:

  1. Alcoholic liver disease (alcoholic cirrhosis)
  2. Autoimmune hepatitis
  3. Biliary stricture
  4. Blocked bile ducts (by infection, tumor or gallstones)
  5. Cancer of the pancreas
  6. Chronic active hepatitis
  7. Disorders present since birth that cause problems processing bilirubin (Gilbert syndrome, Dubin-Johnson syndrome, Rotor syndrome, or Crigler-Najjar syndrome)
  8. Drug-induced cholestasis
  9. Drug-induced hepatitis
  10. Hemolytic anemia
  11. Ischemic hepatocellular jaundice (jaundice caused by not enough oxygen or blood to the liver)
  12. Intrahepatic cholestasis of pregnancy (bile pools in the gallbladder because of the pressure in the abdomen with pregnancy)
  13. Malaria
  14. Primary biliary cirrhosis
  15. Viral hepatitis (hepatitis A, hepatitis B, hepatitis C, hepatitis D, and hepatitis E)

Tests & Diagnostics
In most cases, the sign of jaundice is identified based on the appearance of the patient’s sclera and complexion. The liver and spleen are palpated to check for enlargement and to evaluate any abdominal pain. The location and severity of abdominal pain and the presence of masses in the abdomen, together with the presence of fever, help to distinguish among the causes for jaundice.

The differential diagnosis of the cause of jaundice is primarily based on blood-test results.

Laboratory testing reveals the total bilirubin and its components. Liver enzymes, such as aspartate aminotransferase (AST) and alanine aminotransferase (ALT), should be evaluated; elevations would be signs of inflammation or destruction of liver cells. Microscopic analysis of blood smears for signs of hemolysis is performed.

Liver disease is usually assessed from blood studies and physical-examination findings, but a biopsy may be necessary to clarify less obvious disease.

Diseases of the biliary system may be identified by imaging techniques, especially with the use of contrast dye.

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