As summers and monsoon come, there is a spurt in cases of jaundice in Delhi and India, in general. It causes a lot of concern due to weakness, less productivity and can also cause severe liver damage which in a small percentage of cases, can lead to death.
Jaundice is a symptom of liver injury and not a disease by itself. Many different forms of liver diseases can lead to jaundice as a symptom. The common jaundice that we see in community is caused by Hepatitis A or Hepatitis E virus. Both of these viruses are transmitted via contaminated water and food. The incidence increases in summer and monsoon, but the disease is endemic and seen all through the year. It starts off as fever, tiredness, loss of appetite, vomiting and diarrhea, and after a few days, development of dark urine, yellow eyes (jaundice). Diagnosis is made with blood tests and Ultrasound. Both Hepatitis A and E are self limiting conditions and improve in 2-6 weeks in most cases. No specific treatment is needed, but supportive treatment like medicines for vomiting, fever etc. and intravenous fluids may be needed. 0.5 – 2% of patients can develop severe hepatitis with liver failure and there is a risk of death in these cases. In pregnant women, with Hepatitis E, the risk of severe liver injury and liver failure can be as high as 15 – 25%. It is advisable to consult a doctor, if you have jaundice, be investigated fully and follow up with the doctor.
The other 2 viruses which cause liver disease and jaundice are Hepatitis B and Hepatitis C. These are transmitted via blood or blood products like plasma, sexual intercourse or from mother to child at birth. They can cause long term progressive damage to liver which progresses to cirrhosis, and can cause liver failure and liver cancer. Hepatitis B is very prevalent in India. Upto 4-5% of Indians have this virus. In majority of cases, they are carriers which means their liver is not inflamed however they carry the virus which can infect others.
Hepatitis B is also one of the commonest causes of severe liver failure, and worldwide one of the commonest causes of liver cancer.
Hepatitis B is completely preventable with due precautions. All the blood, plasma etc that is used for transfusion has to be tested for Hepatitis B. It is very important to get blood from authorized blood banks only. Unprotected sex is a very common cause of Hepatitis B. Use of condoms decreases the risk but does not eliminate it. There is a highly effective vaccine available widely for Hepatitis B. It is recommended at birth for all babies. Any adult who has not been vaccinated and has not had Hep B, should get vaccinated, since it protects one from a severe and dangerous disease. All pregnant women should be tested for Hepatitis B, HIV and Hepatitis C. The child can then be protected at birth by due precautions and treatment. Hepatitis C causes less severe initial disease but has higher chance of becoming chronic and causing long term damage to liver, cirrhosis and liver cancer. It is present in about 1% of Indians.
The other common and unfortunately increasing cause of liver damage and jaundice is alcohol. Regular, frequent or large volume binge drinking can cause progressive and immediate liver damage and can present with jaundice. It is the commonest cause of cirrhosis, progressive liver failure and can increase the risk of liver cancer. There are no good guidelines on what is safe alcohol limits in Indians. Western data does not apply as well to Indians due to genetic variation in ability to handle alcohol safely. Besides liver, it also causes damage to pancreas, nerves, brain, heart and increases the risk of certain cancers like esophagus, liver etc. Unfortunately the availability and use of alcohol in India is increasing at a very rapid pace, resulting in increasing incidence of alcohol related diseases as well as social menace like drunk driving, crime, and heinous crimes like rape and murder. Limited and controlled use of alcohol can decrease personal as well as social problems.
Another form of jaundice is called obstructive jaundice, caused by obstruction of bile flow due most commonly to stones in bile duct. The other cause of obstructive jaundice is tumour in bile duct or pancreas gland.
It is therefore recommended that jaundice should always be investigated, so that exact cause is found and proper treatment started.