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Doctor's Diagnosis: Jaundice
"My father’s eyes are turning yellow. I think he’s got that disease you call jaundice. How will they treat it?” asked my friend Brian, who had been caring for his sick father.
I had to explain to him that, although jaundice is a serious problem, it is not a disease; it is what is called a sign, meaning an abnormality that can be observed on physical examination. Jaundice is a yellowing of the skin, the white part of the eyes and other areas, such as the lips, due to an excess of a substance called bilirubin.
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What is bilirubin?
Red blood cells, the ones that carry oxygen, are continuously being broken down by the body. One of the breakdown products, bilirubin, is taken up by the liver and then discharged into the bile. Eventually it enters the intestines, ultimately being eliminated from the body in both feces and urine.
Jaundice develops when there is a problem at any step in this complex sequence that results in the abnormal accumulation of bilirubin. For example, there may be so many red blood cells being broken down that the liver is overwhelmed, such as can happen in sickle-cell disease or after a blood transfusion. Or a liver that has been damaged may be unable to process bilirubin, resulting in jaundice.
There are many possible causes of such liver damage, including viruses, certain medications or alcohol abuse. Diseases that cause problems with the flow of bile, such as gallstones or cancer of the pancreas, also can result in jaundice.
There is no treatment as such for jaundice. The physician can only systematically determine the underlying problem and try to correct it.
There is one exception to this. Newborn babies frequently develop jaundice because their livers are not fully mature and cannot process bilirubin properly. Infants with very high levels often are placed under special lights that break down the bilirubin into harmless products that they’re able to eliminate.
Although my friend Brian was looking for a simple answer to his question about how they would treat his father's jaundice, he had to settle for my more complicated answer. In adults, there is no direct treatment; the doctors would first have to do some detective work and determine the underlying problem.
Dr. Stephen Picca of Massapequa is Board Certified in both Internal Medicine and Anesthesiology. He is retired from practice. Questions and comments can be sent to Dr. Picca at firstname.lastname@example.org.