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Jaundice

Jaundice

Jaundice is a condition where the concentration of bilirubin in the blood and tissues increases far more than normal concentration. The person notices yellowish tinge to skin, eyes and mucus membrane. The urine becomes dark and the stools become clay-colored due to lack of bile pigments.

Pre-hepatic jaundice: Occurs due to malaria, thalassemia, Gilbert's syndrome or sickle cell anemia.

Intra-hepatic jaundice: Occurs due to liver conditions such as hepatitis, leptospirosis cirrhosis or
fatty liver disease. Neonatal jaundice is usually of this kind.

Post-hepatic jaundice: Occurs due to bile obstruction into the digestive system; usually due to gallstones. Pancreatitis or biliary strictures can lead to obstructive jaundice.

Leptospirosis

Leptospirosis is a bacterial infection caused by Leptospira interrogans bacterium. This is also known as infectious jaundice, swamp fever and hemorrhagic jaundice . Leptospirosis is more prevalent in tropical areas especially in areas where there are animals or rodents in urban dwellings. This infection spreads through contact with water, food, or soil containing urine from infected animals. It usually does not spread from person to person.


Typical symptoms of Leptospirosis include high fever, muscle aches, vomiting and jaundice. The patient might suffer chills and headache. Other symptoms of leptospirosis are diarrhea, abdominal pain and skin rash. Left untreated, leptospirosis can lead to meningitis, kidney failure and liver failure. Since the symptoms are not very specific, this disease is likely to be neglected. A blood test for Leptospirosis is done to diagnose the infection. This will show increased liver enzymes and WBC count of less than 10,000. A urine analysis will show abnormality. Leptospirosis is treated with antibiotics, such as doxycycline or penicillin.

Zieve's Syndrome

A syndrome that is characterized by acute metabolic condition that can occur during prolonged alcohol abuse. It was described initially in 1958 by Dr Leslie Zieve for patients with a combination of alcoholic liver disease Hemolytic Anemia and Hypertriglyceridemia. Zieve's syndrome exhibits liver and blood abnormalities caused by heavy alcohol consumption.


This is a condition associated with chronic alcoholism, frequently encountered in hospitalized alcoholics who have suddenly stopped alcohol. The underlying cause is liver delipidization and hemolytic anemia. This is distinct from alcoholic hepatitis which may be present simultaneously or develop later. The syndrome is defined by excessive blood lipoprotein, jaundice and abdominal pain.


Symptoms

Most common symptoms due to long-term history of chronic alcoholism include:

Nausea
Vomiting after heavy drinking
Anorexia
Abdominal pain
Hepatomegaly, enlarged spleen, late cirrhosis
Skin and yellow sclera
Hemolytic Anemia, Hemoglobinuria (hemoglobin is excreted in urine) and Hemosiderin (insoluble form of storage iron complex) in urine.
Hepatic dysfunction, Jaundice, Hyperlipidemia and reversible hemolytic anemia after alcohol abuse are prominent symptoms.


Causes of Zieve's Syndrome

Zieve's syndrome is caused by alcoholism due to liver cell damage and various degrees of cholestasis thus causing cancer. Fatty liver production of free fatty acids into blood stream, increased triglycerides that causes hyperlipidemia and increased cholesterol and phospholipid deposition, and damaged red blood cells which become hard and brittle and blocked by splenic sinusoids. In addition, alcoholism induced pancreatitis and vitamin E deficiency is associated with hemolysis.


Diagnosis of Zieve's Syndrome

The diagnosis is based from objective information about alcoholism, and blood test for the abnormalities. It is based on history and the triple disease – jaundice, hemolytic anemia and hyperlipidaemia. For jaundice, moderate and direct bilirubin test is done. Hemolytic anemia is visible in hemoglobinuria and hemosiderin urine. There could be drop in hemoglobin, reticulocytes, bone marrow erythroblastic hyperplasia, and increased erythrocyte fragility and shortened life of red blood cells.

Hyperlipidemia is detected by increase in cholesterol, triglycerides and phospholipids. Diagnostic tests include hemoglobin, bone marrow examination, blood lipids including cholesterol, phospholipids, triglycerides, serum bilirubin, alkaline phosphatase, and liver function test and liver biopsy. Ultrasonography is done to reveal the syndrome. There could be rapid serum level rise after alcohol withdrawal in patients with denial of drinking.


Treatment

Temperance for two to three weeks is essential for symptoms to disappear. A diet high in sugar-protein, vitamins and hepatoprotective drug is necessary. In addition to jaundice, treatment for high blood cholesterol and hemolytic anemia are essential. Basic therapy includes bed rest, adequate food intake, hydration and vitamin supplementation. The patient usually recovers from the symptoms very quickly, but the disease can recur if alcohol abuse persists.


Jaundice

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