Michelle, a middle-aged banker got up like every other day, relishing the eventful day that lies ahead. Looking at her mirror, she noticed an unusual yellowish colouration in her eye balls, but she did not take it serious, leaving it unattended to. Alas! As she was going for her lunch, she felt quite weak but before she knew what was going on, she landed on the hospital bed! To her surprise, she was diagnosed of chronic malaria; meanwhile that yellowish colouration she ignored was a pointer to her eventual ailment.
Dr Adegboyega Akere, a consultant Gastroenterologist, University College Hospital (UCH), Ibadan, Oyo State, said “Jaundice occurs with yellowness of the sclera(the white part of the eye). It may also affect the skin; but typically seen in light- skinned people.”
Studies have shown that jaundice is typically seen when the level of bilirubin in the blood exceeds 2.5mg/dl (milligrammes per decilitre).
Dr Akere added that jaundice evolved as a result of high or more than normal level of bilirubin in the blood.
According to Dr Tolulope Adebayo, a Medical Officer at The Achievers’ University Clinic, Owo, Ondo State “jaundice can affect anyone with a condition or disease that disrupts the metabolism of bilirubin.”
Research has revealed bilirubin to be a yellow pigment or waste product that is formed in the body when red blood cells are broken down or destroyed in the blood stream and transported to the liver, where specialised cells help to combine it with digestive fluid called bile. The bile and bilirubin is converted into a substance called urobilinogen by bacteria inside the digestive system, which is passed out of the body in urine or stools.
“Bilirubin is a pigment released when worn-out and old red blood cells (RBC) are broken down, which becomes conjugated (made more water soluble) in the liver as it is further secreted into bile. From here, bilirubin gets into the intestine to aid digestion and metabolism in order to release stercobilin which colours the stool to give it its dark-brown colour,” Dr Akere confirmed.
Moreover, he said that jaundice could be in adults and children. “The yellow-tinted sign of the condition in children less than one month is described as neo-natal jaundice. It occurs from the first few days of childbirth.
‘‘Jaundice in newborn occurs when bilirubin builds up faster than a new born baby’s liver can break it down and pass it out from the body. They are still very young to handle bilirubin. In such cases, photo degradation or therapy (putting them under special light) or blood transfusion (pumping in another blood into their bodies) is used to break down the bilirubin.”
Studies have revealed that jaundice in adults could be caused by a variety of medical conditions, some of which are serious and potentially life threatening. The condition requires a comprehensive medical evaluation in order to ascertain its cause. Jaundice could indicate a serious problem with the functions of liver, gall-bladder, pancreas and other vital organs in the body.
While stressing on the causes of the symptom, Dr Akere said that the condition could arise from three aspects.
One of this, he said, was excess or massive breaking down of RBC in the body. “When RBC is broken down in excess, the amount of unconjugated bilirubin (not made water soluble) released will also be more than the required level, which makes bilirubin high in the blood and in-turn manifests in yellowness of the eye and skin. An instance of this could be seen in patients with sickle cell disease. These people have excess break down of RBC even before the usual lifespan of these cells. RBC is expected to be destroyed after 120 days. Other conditions associated with increased breaking down of red blood cells are G6PD deficiency (Glucose-6-Phosphate Dehydrogenase), an enzyme in RBC. When people deficient of this enzyme take some drugs or herbal concoctions, these drugs increase the destruction of their RBC, thereby causing jaundice. He also stated that chronic malaria could account for the discolouration of the eye and skin.
Dr Adebayo added that snake bite and thallassemia, a condition in which heamoglobin stored in red blood cells are abnormal, could also be reasons for yellowness of the sclera and skin.
Dr Akere, elaborated “liver problems or diseases associated with jaundice arise as a result of high level of conjugated bilirubin in the blood.”
He highlighted disease conditions that can affect the liver to include viral infections like Hepatitis (A, B, C) and Yellow Fever Virus.
“People that have liver cancer can also develop jaundice. Some drugs used in treating tuberculosis or concoctions, in some people, can damage the liver resulting into eye or skin yellowness.”
He also stated some likely symptoms that can occur from liver problems causing jaundice. “The patient can have fever, joint pain, vomiting, loss of appetite and abdominal pain.”
In the same vein, he said that jaundice can also be as a result of an obstruction of bilirubin to bile flow. “When there is an obstruction or blockage of bilirubin to the flow of bile, which could be caused either by cancer of the bile duct (where the bile flows), biliary stone, gall bladder stones and cancer at the head of the pancreas. Jaundice at this stage will manifests its colour in form of yellowish-green due to the greenish nature of the bile part. Patients with this problem could have signs of itching and white stools.”
However, Dr Akere emphasised on the misconception people have regarding jaundice. “Most times, people think yellowness of the sclera part of the eye and skin is only associated with yellow fever, but this is not so. Yellow fever is just one of the viruses that can affect the liver, leading to jaundice.
“It is therefore pertinent for people to see jaundice as a condition that shouldn’t be taken with levity but one that requires medical care once it is noticed.”
He added that medicines, either drugs or concoctions, shouldn’t be taken without appropriate prescription as this could affect the functions of the liver, stressing that every case of jaundice has to be diagnosed and not generalised. “Until the patient goes through appropriate evaluation and treatment of its cause, that yellowish colouration will not clear.”