Okay so I’m still doing the alphabet thing, today is brought to you by the letter J.
Before I go there though, I hope you enjoyed a good Christmas or whatever else you may or may not celebrate.
Like Immunity in episode 23, jaundice has two meanings in modern English. The first is to feel bitterness, resentment or cynicism and the other is a medical condition manifesting as a yellowing of the skin and the whites of the eyes, due to an excess of bilirubin which can be the result of an obstruction of the bile duct, liver disease or excessive breakdown of red blood corpuscles.
Unlike my sallow complexion, whenever you see jaundice it is serious. Not only will a person’s skin appear yellow, the whites of their eyes will go a deep yellow, their skin may become very itchy, many patients will feel nauseated and some will vomit, if infection is involved, the patient will have a raised body temperature, and the patient’s stools will become pale. If jaundice persists weight loss and loss of appetite are often experienced.
As I said before, there are three broad causes of jaundice.
Obstruction occurs when the bile duct which transports bile from the liver to the gallbladder and small bowel is blocked. This is often because of a stone but can be because of pressure from a tumour.
Hæmolytic jaundice occurs when excessive red blood corpuscles breakdown. The reasons can be manifold and can include ABO blood type incompatibility and rhesus isoimmunisation.
Liver disease can have many causes and not all liver disease causes jaundice. Of those that do, my main interest is in the causes of hepatitis or infection of the liver.
Did you know that glandular fever can be associated with hepatitis? Yes, it can.
Most people know about the hepatitis alphabet so let’s go through a few.
Hepatitis A virus infection is associated with poor hygiene and is spread via the faecal-oral route and so it’s also seen in high rates in men who have sex with men.
The Hepatitis B virus surface antigen was once known as the Australia antigen because Nobel laureate Blumberg found it in the serum of an Australian Indigenous person.
The Hepatitis C virus is spread efficiently in needles and found commonly in people who enjoyed recreational drug use in their youth. New therapeutic drugs are changing the landscape of HCV infection.
You can only be infected with the Hepatitis D virus if you’re also infected with HBV.
Hepatitis E viral infection is similar in epidemiology to HAV however, it’s particularly nasty in pregnancy with a high mortality rate.
Now just a short word about liver function tests and results. I sometimes see junior doctors getting excited when they see enzyme results in the hundreds. In good going viral hepatitis the enzymes will be in the thousands. I’m aware there are some alternative practitioners who get excited when they see something slightly out of range, that just reflects a poor understanding of pathology testing. You should always see a proper doctor.
So it’s a short show today. I trust you’re still recovering from Christmas. Just remember, heavy long-term alcohol use can also cause liver disease, and while the liver has an amazing ability to regenerate, if you abuse your liver for years it will not recover.
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