Jaundice, or icterus, is a yellowish discoloration of tissue resulting from the deposition of bilirubin.

Tissue deposition of bilirubin occurs only in the presence of serum hyperbilirubinemia and is a sign of either liver disease or, less often, a hemolytic disorder.

The degree of serum bilirubin elevation can be estimated by physical examination. Slight increases in serum bilirubin are best detected by examining the sclerae, which have a particular affinity for bilirubin due to their high elastin content.

CLINICAL FEATURES:
As serum bilirubin levels rise, the skin will eventually become yellow in light-skinned patients and even green if the process is long-standing; the green color is produced by oxidation of bilirubin to biliverdin.

Another sensitive indicator of increased serum bilirubin is darkening of the urine, which is due to the renal excretion of conjugated bilirubin. Patients often describe their urine as tea or cola colored. Bilirubinuria indicates an elevation of the direct serum bilirubin fraction and therefore the presence of liver disease.

Increased serum bilirubin levels occur when an imbalance exists between bilirubin production and clearance. A logical evaluation of the patient who is jaundiced requires an understanding of bilirubin production and metabolism.

TYPES:
Unconjugated Hyperbilirubinemia
The critical determination is whether the patient is suffering from a hemolytic process resulting in an overproduction of bilirubin (hemolytic disorders and ineffective erythropoiesis) or from impaired hepatic uptake/conjugation of bilirubin (drug effect or genetic disorders).

Hemolytic disorders that cause excessive heme production may be either inherited or acquired. Inherited disorders include spherocytosis, sickle cell anemia, thalassemia, and deficiency of red cell enzymes.

Conjugated Hyperbilirubinemia
Elevated conjugated hyperbilirubinemia is found in two rare inherited conditions: Dubin-Johnson syndrome and Rotor’s syndrome.

Hepatocellular Conditions
Hepatocellular diseases that can cause jaundice include viral hepatitis, drug or environmental toxicity, alcohol, and end-stage cirrhosis from any cause.

Wilson’s disease, once believed to occur primarily in young adults, should be considered in all adults if no other cause of jaundice is found.

Autoimmune hepatitis is typically seen in young to middle-aged women but may affect men and women of any age.
Alcoholic hepatitis can be differentiated from viral and toxin-related hepatitis by the pattern of the aminotransferases.

Laboratory Tests
These include total and direct serum bilirubin with fractionation,
Aminotransferases
alkaline phosphatase
albumin
prothrombin time tests.

HOMOEOPATHIC APPROACH:

BRYONIA:
Stiching pains in the right hypochondriac region
Liver is swollen and congested and inflamed
Pains in the hypochondriac region are worse from any motion and better by lying on the right side
The patient is chilly and there is bitter taste in the mouth and the stools are hard and dry

MERCURIUS:
Much sensitiveness and dull pain in the region of the liver
Patient cannot lie on the right side
The liver is enlarged and the skin and conjunctiva are jaundiced
Stools are clay colored or yellowish green bilious stools with great deal of tenesmus

PODOPHYLLUM:
Indicated in torpid or chronically congested liver and when diarrhea is present.
The liver is swollen and sensitive, the face and eyes are yellow and there is bad taste in the mouth.
The tongue is coated white or yellow.

Author Bio: Steven is associated with the dermatology billing services and cardiology billing services

Category: Medicines and Remedies
Keywords: dermatology, billing, services