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JAUNDICE & LIVER FAILURE

Jaundice is a cause for concern and there are many misconceptions associated with it. Dr Vikram Ananthakrishnan (M.S., F.R.C.S) answers some frequently asked questions about this common ailment and about the liver.

What causes jaundice?

Jaundice can be broadly classified as infective and obstructive jaundice.

A virus called Hepatitis A, is a common cause of infective jaundice. This virus is transmitted through water and food. Children are often affected.

The other viruses such as Hepatitis B and Hepatitis C viruses are transmitted through blood. Viruses responsible for these infections spread through the body secretions like saliva, sweat, semen, vaginal fluids of infected persons. Close contact and sexual intercourse are important factors in spread. Homosexuals contract these infections more easily. Blood, blood products, contaminated needles and tattooing, are also important sources through which infection spreads. These viruses are more resistant to the various methods of sterilisation than the AIDS virus. They are a major cause for concern as they spread rapidly. There are more people infected by Hepatitis B virus in the world than the AIDS virus.

Hepatitis B and Hepatitis C infections can lead to chronic liver diseases, cirrhosis and eventually liver cancer & liver failure.

The other viruses associated with jaundice are Hepatitis D and E. Hepatitis E infection can be acquired from contaminated water.

Diseases like Leptospirosis can also cause jaundice.

Stones or growths, blocking the pathway of bile, cause a type of jaundice called obstructive jaundice. Occasionally, drugs can also cause jaundice.

How is Leptospirosis transmitted and how is it treated?

This is an infection caused by water or food contaminated with rats’ urine. Patients develop fever and later jaundice and eventually (renal) kidney failure. If left unrecognised leptospirosis can be fatal. The infection is treated with antibiotics like penicillin and doxycycline.

Amongst the different types of infective jaundice, which is worse?

Hepatitis C is the most dangerous type of jaundice. Like Hepatitis B it also leads to chronic liver disease.

Which form of jaundice requires surgery?

Sometimes stones & growths block the pathway of bile drainage from the liver (where it is made) to the small intestine (where it acts on the food to digest and break down fats). This can also cause jaundice. Stones in the bile pathway usually originate in the gall bladder. This often requires removal of the gall bladder along with the stones in the biliary pathway. Growths may require major surgery for their removal. In case they are very advanced, a bypass operation may need to be done to relieve the jaundice.

What are the tests (investigations) done for jaundice?

These can be broadly classified as blood tests, scans and endoscopy.

Blood tests are done to assess the overall function of the liver. These tests are collectively called Liver Function Tests.

These tests will show if there is on going destruction of the liver. Blood tests will help identify the type of jaundice.

They will show whether the synthetic function of the liver is good. The various clotting tests can be done to see if the liver is producing adequate proteins for clotting purposes.

Ultrasound scan is done to see if there are any gross architectural abnormalities in the liver. What cannot be captured by ultrasound can be done by CT scan and the MRI. M.R.I has now become the gold standard in looking for abnormalities in the liver and the surrounding organs when there is obstructive jaundice.

Endoscopy may be performed to look at the oesophagus (food pipe), stomach and the first few inches of the small intestine. A special variety of endoscope may also be used wherein a dye can be injected into the bile ducts and the pancreatic ducts and pictures can be taken. This gives complete visualisation of the pathway that bile takes to drain into the small intestine. It also studies the ducts of the pancreas. It is called E.R.C.P. (endoscopic retrograde cholangio pancreaticogram).

What is the diet recommended for jaundice patients?

Foods that are rich in glucose are recommended in jaundice. These help the liver cells to regenerate and also provide the required nourishment for the body. Fats are to be taken in reduced quantities. Deep fried foods & alcohol are to be avoided.

What is the treatment for Jaundice?

The treatment for jaundice depends upon the type of jaundice. For viral hepatitis, causing jaundice, there is no definitive treatment. Only supportive measures are given. The virus is slowly eliminated from the body with the help of the immune system.

In case it is jaundice caused by blockage to the pathway of bile, surgery may be needed.

What is the role of immunisation in Jaundice?

Hepatitis B is one of the common causes of jaundice that can have serious consequences. Immunising a person can prevent this viral infection and its consequences. The vaccine is easily available and is usually given in three doses either at monthly intervals or two doses are given at monthly intervals and the third six months after the first dose. Immunisation with the vaccine now begins from the infant period itself. A single booster dose is required once every five years to maintain the protection.

What is the role of Herbs in treating Jaundice?

The common herb used is Keezhanelli. Its role in treatment is not fully proven.

Liver Disease

What are the functions of the liver?

The liver has a variety of functions. Its two main functions are synthesising and detoxifying.

Synthesising:

  • It helps to break down and store various nutrients like carbohydrates, proteins and fat.

  • Whenever there is excess glucose in the blood, it converts it to fat and stores it.

  • If the blood glucose levels are low it breaks down fat and protein into glucose.

  • It stores vitamins A, D, K , B12, Folate.

  • Liver is responsible for a variety of protein syntheses. It helps in the synthesis of substances for clotting of blood, as well as albumin (the most important protein).

Detoxyfying

It breaks down drugs, alcohol and poisons absorbed from the intestines.

It is said that, “Liver failure is power failure.”

What is the relation between alcohol and Liver disease?

The liver takes up alcohol from the blood stream. (One of the main functions of the liver is to clean up the blood of various poisons and the intestines from invading organisms.) The liver breaks down alcohol (metabolises) and thus bears the brunt of this poison. Intake of 3 units of alcohol or more in men and 2 or more units in women for more than five years causes disease.

What is cirrhosis of the liver?

Cirrhosis of the liver is the end result of various insults on the liver. The insults could be poisons or viruses. It is a process wherein the normal liver tissue is replaced by non-functioning fibrous tissue. This alters the blood flow within the liver causing other pathways to open thus resulting in various complications.

What are the complications of cirrhosis liver?

Complications are:

  • Fluid retention causing large and distended abdomen.

  • This retention of fluids with a reduction in the synthesis of proteins can lead on to swelling of the legs (Oedema).

  • There can be Anaemia (low Haemoglobin) and susceptibility to infections.

  • The blood flow through the liver could be blocked causing alternate pathways to open up. This leads to dilatation of veins especially in the lower end of the food pipe (oesophagus). These veins can rupture causing massive bleeding. The liver can fail in its function of removing various poisons in the body causing altered behaviour patterns and eventually coma and death.

What are the signs of liver failure?

Signs of liver failure include, jaundice, bleeding tendency, distension of the abdomen, swollen feet, reduced urine output, altered consciousness, tremors in the hand, wasting of the muscles etc.

Dr. Vikram Ananthakrishnan M.S., D.N.B., F.R.C.S.
Dr.Vikram Ananthakrishnan completed his M.S. in General Surgery from the Grant Medical College, Bombay and then his Diplomate of The National Board, India (D.N.B). He completed his F.R.C.S. from Royal College of Surgeons, Glasgow, U.K.

Dr.Vikram is currently an Assistant Professor in the Department of General Surgery at Sri Ramachandra Medical College, Chennai. He is also a visiting consultant at The Apollo Hospitals, Chennai.

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