GASTRO INTESTINAL DISEASE

JAUNDICE

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JAUNDICE IS characterized by Yellowish discoloration of the skin and (Conjunctiva) mucous membrane caused by an excess of bile pigment in the blood .

CAUSES

(A)– Pre-hepetic or Haemolytic- It means excessive destruction (haemolyssis of the Red Blood Cell).

  • Abnormal haemoglobin ex- Sickel-cell disease and Thalasaemia.
  • Abnormal R.B.C. – Congenital spherocytosis
  • Drugs and Poisons,Ex- Sulphonamide,snake venom,lead etc.
  • Infection- Protozoal malaria, Kala-azar,
  • Bacterial- Gas-Gangrene.
  • Viral- Small Pox.

(B) Intra -hepatic or hepatic- It means disease or disorder of the liver.

  • Infections- Infective hepatitis, Serum Hepatitis Well’s disease, infection mononucleosis.
  • Hepatitis Due to drugs – Para- aminosalicylic acid,phenlbutazone,norethandrolone,methyltestosterone,chlorpropamide.
  • Cirrhosis with liver cell failure .
  • Pregnancy (last trimester)
  • Neoplasm and reticulosis – Hepatoma and Hodgkin’s disease.
  • Congenital Hyper-bilirubinaemia – Najjar and Grigler type.
  • Dublin-Johnson type,Gilbert type,Rotor type.

(C) Post-hepatic or obstructive- It means blockage or disease in some part of liver or biliary passages.

  • Neoplasm- Ampulla of vater of bile ducts,gall bladder ,head of pancreas and neighbouring organs.
  • Gall stones in common bile ducts.
  • Chronic pancreatitis.
  • Stricture in CBD

RISKING FACTORS

  • Age– (i) New Born – (a) Physiological jaundice,CBD obstruction, Neonatal infections.
  • Infants- Congenital hyperbilirubinaemia.
  • Children & Young adults – Infective hepatitis.
  • Old age – Gall stones,Caricinoma.
  • Occupation – Sewer workers-Well’s disease. Any poison handling occupations.Recent therapy Drug jaundice.
  • Gastro Intestinal Upset – Infective Hepatitis, Neoplasm,Portal cirrhosis, Chronic Cholecystitis.
  • Malignant neoplasm.
  • Hepatic neoplasm.
  • Gall stones
  • CBD Stone.
  • Post operative Accidental common bile ducts ligation.

SYMPTOMS

  • Usually jaundice is deep,First noticed in the Conjunctiva.
  • Yellowish skin.
  • Pruritus or itching of the skin.
  • There may be marks of scratching.
  • Stools are often darker than usual.
  • Clay coloured stool.
  • Anemia.
  • Excess of urobilin in urine.
  • Anorexia, Nausea.
  • Urine dark yellowish .
  • Abdominal pain
  • Vomiting.
  • FEVER

COMPLICATIONS

  • Acute bilirubin Encephalopathy.
  • Hearing impairment.
  • Seziures.
  • Kernicterus.
  • Liver failure.
  • Brain damage.
  • Affect growth and motor development .
  • Death.

PREVENTION

  • Avoid the contaminated food and water.
  • Maintain Hygiene .
  • Take vaccination for Hepatitis A and B.
  • Avoid Alcohol.
  • Use of Condoms for safer sex.
  • Ensure safe injection.

INVESTIGATION

  • LIVER FUNCTION TEST
  • ULTRASONOGROPHY (WHOLE ABDOMEN)
  • CT-ABDOMEN
  • ENDOSCOPY
  • ERCP
  • CBC
  • MRI
  • Hepatitis A,B & C Test.

MANAGEMENT & TREATMENT

  • The aetiological factor is corrected where possible.
  • Rest in bed & warmth.
  • Diet should preferably be liquid or shops and almost fat free.
  • For hemorrhagic tendency Vitamin K(and for Xerophthalmia Vitamin A hypodermically).
  • For itching ,alkaline bath or Menthol in 80 in rectified spirit may be given.
  • Bowels should be kept regular. (FOR SEDATION, BARBITURATES ARE NOT BEING PRESCRIBED)
  • Treated with Anti viral medications,Iron supplements and steroids. On the basis of causes.
  • Some times treated with Surgery to remove obstruction.
  • Phototherapy For infants.
  • Blood transfusion.