The Human Liver, Jaundice & Hepatitis

I have been down with Jaundice since July and thought it would be better to share what I learned about the disease. It started with back-ache and then developed into high fever. Me, being the kind of person who does not visit a doctor so often, was hesitant to consult the doctor thinking that the fever would go off in a couple of days.

However, things started to change when I started to vomit and with each vomit, I was more tired. I realized that I had never been so sick in my life and decided to consult the doctor. As I feared, the doctors confirmed Jaundice and I have been advised to take rest and maintain a diet.

Ironically, even with the vast developments in Aloppathy, the Modern Medicine has no cure for the disease. All they do is give you some intravenal fluids, flush out the excess billirubin, give you tablets so that the billirubin does not mix with blood and reach the brain causing death. In some very rare cases, where nothing else can be done, the doctors advise a liver transplant. Well, here's what I learned about it. whoooo!!!!!

What is Jaundice?

Jaundice means the yellow appearance of the skin and whites of the eyes that occurs when the blood contains an excess of the pigment called bilirubin. Bilirubin is a natural product arising from the normal breakdown of red blood cells in the body and is excreted in the bile, through the actions of the liver.

Although jaundice is most often the result of a disorder affecting the liver it can be caused by a variety of other conditions affecting for example the blood or spleen. It should be thoroughly investigated so that the underlying cause can be identified and treated.

The liver is an organ in vertebrates, including humans. It plays a major role in metabolism and has a number of functions in the body including glycogen storage, plasma protein synthesis, and drug detoxification. It also produces bile, which is important in digestion. It performs and regulates a wide variety of high-volume biochemical reactions requiring specialized tissues.

The adult human liver normally weighs between 1.3 - 3.0 kilograms, and is a soft, pinkish-brown “boomerang shaped” organ. It is the second largest organ (the largest organ being the skin) and the largest gland within the human body. Its anatomical position in the body is immediately under the diaphragm on the right side of the upper abdomen. The liver lies on the right of the stomach and makes a kind of bed for the gallbladder (which stores bile).

The liver is among the few internal human organs capable of natural regeneration of lost tissue; as little as 25% of remaining liver can regenerate into a whole liver again.

Many diseases of the liver are accompanied by jaundice caused by increased levels of bilirubin in the system. The bilirubin results from the breakup of the hemoglobin of dead red blood cells; normally, the liver removes bilirubin from the blood and excretes it through bile.

Some functions of liver relating to Hepatitis:

The liver breaks down hemoglobin, creating metabolites that are added to bile as pigment. The liver produces and excretes bile required for dissolving fats. Some of the bile drains directly into the duodenum, and some is stored in the gallbladder. The liver breaks down toxic substances and most medicinal products in a process called drug metabolism. This sometimes results in toxication, when the metabolite is more toxic than its precursor. The liver converts ammonia to urea.

How does a person get jaundice?

The red blood cells in our circulation carry oxygen to all parts of the body and have a life span of about 120 days. At the end of their life they are broken down and removed from the circulation by special cells called phagocytes, which are found within the bone marrow, spleen and liver. New red cells are of course continually manufactured and this also takes place within the bone marrow.

Following breakdown of the red cells some of their component parts such as amino acids and iron can be re-used by the body. Other components such as bilirubin need to be removed. Knowing how this removal pathway works is the key to understanding how jaundice occurs.

Most waste products of the body are excreted in the urine via the kidneys but the liver and bile system is the other main physical route out of the body for these substances. 'Waste products' refers to the many compounds that arise in the course of the body's metabolism but almost all forms of drugs must also be eliminated either via the urine or bile routes.

In the case of bilirubin released from old red cells, it passes through the bloodstream to the liver, where the liver cells process it. These cells carry out many complex chemical functions and also produce the liquid bile, which is the 'vehicle' by which the cells discharge their output to the bile duct system. This is a branching network of tiny tubes throughout the liver, which merge in the same way as the branches of a tree. Ultimately a single main bile duct comes out of the liver and joins the first part of the small intestine (duodenum). Bile (and therefore bilirubin) then passes out through the small and large intestines and is excreted in the stool (faeces).

Bile is green in colour, but bacteria in the large bowel act to change the bilirubin to substances that are brown, which gives stool its characteristic colour. Some of the bilirubin is reabsorbed back into the body through the bowel wall, eventually appearing in the urine as a substance called urobilinogen (although the typical yellow/orange colour of urine is in fact due a different pigment called urochrome). Therefore, any failure of the bilirubin removal pathway will lead to a build-up of bilirubin in the blood. When this happens the individual's skin turns yellow, causing jaundice.

What are the symptoms?

The symptoms, other than that of the jaundice itself, will relate to the underlying cause. For example someone with haemolysis might also be anaemic and tired. If a gallstone were responsible there would probably have been a preceding history of pain in the abdomen. Weight loss, lack of apetite, heavy back pain, Nausea, Stomach Ache, Vomiting, Itchinng all over the body, Colored Urine, Fatigue, coloration of the eyes, Mild fever are the common symptoms of Jaundice.

When jaundice is due to obstruction of the bile duct the person will often notice that their urine becomes dark and stools become pale, as the excess bilirubin 'spills over' into the urine and no longer colours the stool. Obstructive jaundice is also often accompanied by intense itching.

How is jaundice diagnosed?

The diagnosis is made by recognition of the patient's appearance and accompanying symptoms. A blood test will confirm the raised bilirubin level and other tests such as those for hepatitis and haemolysis are also done on the blood. Ultrasound is a good way to inspect the liver and bile ducts for signs of obstruction, and often can give useful information on the pancreas gland. CT scanning also helps diagnose obstructive jaundice accurately.

Hepatitis

Hepatitis is a gastroenterological disease (inflammation of the liver). It is caused mainly by various viruses but also by some poisons, autoimmunity or hereditary conditions. A number of liver function tests are available to test the proper function of the liver. These test for the presence of enzymes in blood that are normally most abundant in liver tissue, metabolites or products.

Some chronic forms of hepatitis show very few of symptoms and only present when the longstanding inflammation has led to the replacement of liver cells by connective tissue; the result is cirrhosis. Certain liver function tests can also indicate hepatitis.

Hepatitis A

Hepatitis A or infectious jaundice is an enterovirus transmitted by the orofecal route, transmitted to humans through methods such as contaminated food. It causes an acute form of hepatitis and does not have a chronic stage.

The patient’s immune system makes antibodies against hepatitis A that confer immunity against future infection. Normally, it can be spread through personal contact, consumption of raw sea food or drinking contaminated water.

Hepatitis A is transmitted fecal-orally, generally by ingesting contaminated water or food. Strict personal hygiene and the avoidance of raw and unpeeled foods can help prevent an infection.Infected persons already begin excreting the hepatitis A virus with their stool two weeks after the appearance of the first symptoms.

The time between the infection and the start of the illness can run from 15 to 45 days, and approximately 15% of sufferers may experience relapsing symptoms from six months to a year following initial diagnosis. Hepatitis A is caused by the Hepatitis A Virus (abbreviated HAV). Only 3 out of 4 people with Hepatitis A have symptoms.

Ways to prevent hepatitis A include the following:

Wash hands with soap and warm water before preparing or eating food, and after sexual activity. Keep bathrooms clean and disinfected after every use. Cook shellfish thoroughly before eating. Drink water from approved sources only.

Recovery

There is no specific treatment for Hepatitis A. Sufferers are advised to rest, avoid alcohol, eat a well-balanced diet, and stay hydrated. Approximately 15% of people diagnosed with Hepatitis A may experience a symptomatic relapse for up to nine months after contracting the disease.

Fatigue would be high for the first three weeks, then it will start to recede. However, this should not be taken as a symptom of being well. More rest is advised at this time.

There are traditional systems for treating the Jaundice in India which at times are to take herbs known as 'ottamoolis'. Some of them are highly effective also. However, before taking home medicines such as 'kizhutharnelli (am not sure of the plant's english / scientific name)' run tests to confirm which variety of Hepatitis infection has affected you. Kizhutharnelli is very good in treating Hepatitis A, whereas it does not have any effect on Hepatitis B or E.

Young children who catch hepatitis A often have a milder form of the disease, usually lasting from 1-3 weeks, whereas adults tend to experience a much more severe form of the disease.
They are often confined to bed and minimal activity for about 4 weeks and have to stop their work for one to three months or longer. Many adults take up to 6-12 months and occasionally longer to recover entirely. Symptoms that may be experienced after the first month or two are low immunity: It is much easier to catch minor infections and for these infections to linger longer than they normally would.

Many people experience a slow but sure improvement, over this later period. They are generally able to function fairly normally, still needing more sleep and reduced athletic activity. It is common for recovering patients to experience occasional “off” days, during which they need to rest more.

WARNING:

I am not a doctor, hence I can't guarantee that the symptoms or causes are limited to this. If you or one of your friends or relatives suspect that you may have jaundice, it is essential that you arrange to see your doctor in order that the underlying cause is identified and any possible treatment initiated as soon as possible. Treatment will depend upon the diagnosis behind the symptom of jaundice.

The best thing to do is to get vaccinated. Vaccination would cost you approximately around Rs.4,500/- (against Hep A n Hep B). But that would save you months. Please make sure that you do vaccination in consultation with your doctor only.

Seek immediate medical attention if you have the symptoms. Jaundice is actually a state, not a disease, but can cause you life, if you do not attend to it properly. Act in Time, Save Life.