American Medical Association Family Medical Guide - American Medical Association [514]
Jaundice
Jaundice is a condition that results from excess bilirubin in the blood; bilirubin is a yellow pigment by-product of the breakdown of aging red blood cells. An excess of the yellow pigment discolors the skin and the whites of the eyes (see pages 118 and 127). Normally, the liver filters bilirubin from the bloodstream and excretes it into the bile ducts, which carry it to the gallbladder. From the gallbladder, bilirubin eventually flows into the small intestine, where most of it is broken down by bacteria that are normally present in the intestine. Bilirubin is eliminated from the body as pigmented compounds in stool.
Jaundice usually occurs as a result of liver diseases, including the viral infection hepatitis (see next page), cirrhosis (see page 790), cancers that spread to the liver, or blockage of a bile duct, or as a reaction to a medication. Jaundice can also result from an obstruction of the bile ducts—such as gallstones (see page 793) or pancreatic tumors (see page 800)—which can prevent bilirubin from entering the intestines, causing it to build up in the blood. Jaundice can occur in hemolytic anemia (see page 616), in which red blood cells are destroyed at an excessive rate, releasing bilirubin into the blood. In hemolytic anemia, the liver functions normally but is unable to remove bilirubin from the blood rapidly enough.
If you notice that the whites of your eyes are yellow and your skin tone is yellowish, see your doctor right away. He or she will examine you and may order various diagnostic tests to find the underlying cause of your symptoms. Treatment will depend on the underlying disorder. Once that disorder is treated or cured, the jaundice should clear up.
Hepatitis
Hepatitis is inflammation of the liver caused by one of several hepatitis viruses—A, B, C, D, or E. The diseases caused by the hepatitis viruses share many of the same symptoms, but the way in which they are transmitted and the progression of the diseases and their outlook differ. Hepatitis A, B, and C are the most common in the United States. Hepatitis D occurs only along with hepatitis B. Hepatitis E is much more common in developing countries than in the United States.
Hepatitis A
Hepatitis A is found in the feces of people who are infected and is spread from person to person by close contact or by consuming food or water contaminated with infected feces. From 90,000 to 180,000 people in the United States are infected with hepatitis A each year, but the disease is especially widespread in developing countries with inadequate sanitation systems. If you are planning to travel to a developing country, talk to your doctor about having a vaccination against hepatitis A (see next page).
Children, especially those under age 6, who are infected with hepatitis A often have no symptoms. Adults usually develop flulike symptoms such as fever, headache, aching joints, and weakness. Other symptoms include lack of appetite, nausea, abdominal pain, dark urine, and light-colored stool. Jaundice (yellowing of the skin and whites of the eyes; see previous page) usually develops after a few days. In nearly all cases, the symptoms gradually subside on their own in a few weeks or months. In rare cases, the infection eventually leads to liver failure, and a liver transplant (see page 790) is recommended. In very rare cases, the infection can be fatal.
Hepatitis A is diagnosed with a blood test that checks for antibodies (proteins the body produces to fight the virus), which are detectable 5 to 10 days before symptoms develop and can persist for up to 6 months. No treatment is available for hepatitis A. Once a person has been infected, he or she is immune to the disease for life.
Hepatitis B
Hepatitis B virus causes inflammation of