JAUNDICE

 Causes, Symptoms, and Treatment Explained

Introduction

Jaundice is a common medical condition where the skin, eyes, and mucous membranes turn yellow due to high bilirubin levels in the blood. While it is not a disease itself, jaundice is often a warning sign of underlying problems with the liver, bile ducts, or red blood cell breakdown. Recognizing its causes and getting timely treatment is key to preventing complications.

Jaundice results from accumulation of bilirubin in the body tissues; cause may be hepatic or nonhepatic.
Hyperbilirubinemia may be due to abnormalities in the formation, transport, metabolism, and excretion of bilirubin.
Mild elevations of the aminotransferase levels are common in clinical practice and caused most commonly by nonalcoholic fatty liver disease.
Evaluation of obstructive jaundice begins with ultrasonography and is usually followed by cholangiography.

How Jaundice Develops (Pathophysiology)

Bilirubin Metabolism

Bilirubin is a yellow pigment produced when red blood cells break down. Normally, the liver processes bilirubin and eliminates it through bile into the intestines. Jaundice develops when this cycle is disrupted:

 

1. Production (Pre-hepatic Phase): Old or damaged red blood cells are broken down in the reticuloendothelial system (spleen, liver, bone marrow) by macrophages. Hemoglobin is converted to unconjugated bilirubin (also called indirect bilirubin). This form is lipid-soluble (fat-soluble) and toxic but is transported in the bloodstream bound to albumin.
2. Conjugation (Hepatic Phase): The unconjugated bilirubin is transported to the liver. In the liver cells (hepatocytes), an enzyme called glucuronosyltransferase conjugates it with glucuronic acid, converting it into conjugated bilirubin (also called direct bilirubin). This form is water-soluble and non-toxic.
3. Excretion (Post-hepatic Phase): The conjugated bilirubin is then excreted from the liver into the bile ducts, becoming a component of bile. Bile travels through the bile ducts to the small intestine. In the colon, bacteria convert bilirubin into urobilinogen, most of which is converted to stercobilin and excreted in the stool (giving feces its brown color). A small portion is reabsorbed and excreted in the urine as urobilin (giving urine its yellow color).

Main Causes of Jaundice

The causes are broadly categorized by the site of the disruption in bilirubin metabolism.

1. Pre-hepatic Causes (Increased Bilirubin Production)

These conditions lead to an excessive breakdown of red blood cells (hemolysis):

Hemolytic Anemias: Conditions where red blood cells are destroyed prematurely (e.g., sickle cell anemia, thalassemia, G6PD deficiency).

Reabsorption of Large Hematomas (Bruises): A large amount of blood accumulated under the skin or tissue is broken down, temporarily increasing bilirubin load.

Transfusion Reactions: Immune reaction to incompatible blood transfusion.

2. Hepatic Causes (Liver Cell Dysfunction)

These conditions directly affect the liver's ability to process or excrete bilirubin:

Viral Hepatitis: Acute or chronic inflammation of the liver (e.g., Hepatitis A, B, C, D, E).

Alcoholic Liver Disease: Damage ranging from fatty liver to alcoholic hepatitis and cirrhosis.

Non-Alcoholic Steatohepatitis (NASH) / Cirrhosis: Liver scarring from various chronic diseases.

Drug-Induced Hepatitis: Liver damage caused by certain medications (e.g., acetaminophen overdose, some antibiotics, or herbal supplements).

Genetic Disorders:

Gilbert's Syndrome: A common, benign condition resulting in a mild reduction in the conjugating enzyme activity.

Crigler-Najjar Syndrome, Dubin-Johnson Syndrome, Rotor Syndrome: Rarer inherited disorders affecting conjugation or transport.

3. Post-hepatic Causes (Obstructive/Cholestatic)

These conditions cause a blockage in the bile drainage system, preventing bile (and thus conjugated bilirubin) from entering the small intestine:

Gallstones (Cholelithiasis): Stones that pass out of the gallbladder and lodge in the common bile duct.

Pancreatic Cancer: A tumor in the head of the pancreas can compress and block the common bile duct.

Cholangiocarcinoma: Cancer originating in the bile ducts.

Biliary Stricture: Narrowing of the bile duct, often due to prior surgery or inflammation.

Sclerosing Cholangitis: Chronic inflammatory disease of the bile ducts.

Common Symptoms

Yellowing of skin and eyes

Dark-colored urine

Pale or clay-colored stools

Itching (especially in obstructive jaundice)

Fatigue, nausea, abdominal discomfort

Diagnosis

Doctors use a combination of medical history, physical exam, and tests to determine the cause of jaundice:

Blood tests:  liver function tests, complete blood count, kidney function tests.

Imaging: ultrasound, CT, MRI, or MRCP to check liver and bile ducts.

Special tests: viral markers, autoimmune tests, or genetic studies if needed.

Treatment and Management

The approach depends on the underlying cause:

Pre-hepatic jaundice: Treat conditions causing rapid red blood cell breakdown (e.g., malaria, hemolytic anemia).

Hepatic jaundice: Manage liver diseases with antivirals, immunosuppressants, alcohol abstinence, or liver transplant in severe cases.

Post-hepatic jaundice: Relieve obstruction through ERCP (stone removal), stenting, or surgery; treat infections or tumors as required.

Supportive Care Includes:

Adequate hydration and balanced nutrition

Avoiding alcohol and hepatotoxic medications

Vitamin supplementation (A, D, E, K) in cholestasis

Medications to relieve itching and discomfort

 Conclusion

Jaundice is an important clinical sign that should never be ignored. It may signal mild, treatable conditions or serious diseases such as hepatitis, gallstones, or liver cancer. Early diagnosis and proper management not only help relieve symptoms but also protect long-term liver health.

 

Irritable Bowel Syndrome

 IRRITABLE BOWEL SYNDROME

What is IBS?
Almost everyone has had constipation and diarrhea at one time or another. But many people have “Irritable bowel syndrome” which includes both diarrhea and constipation. They are caused by two entirely different mechanisms. Bowels habit is disturbed by diarrhea or constipation, occurring alone or alternating. Some forms of this IBS have in the past been called spastic colon and idiopathic or nervous diarrhea. Constipation occurs from a sluggish contraction of the bowel and diarrhea by an overactive bowel.

What are the causes?
Although the etiology of the irritable bowel syndrome is uncertain, some relate this to psychological disturbances, especially anxiety. Some relate their onset to an attack of infective diarrhea, or certain foods may precipitate symptoms.
• It is true that stress can affect bowel function. It has been demonstrated that the bowel can flush or become very pale in response to emotional reactions. Severe acute stress may cause diarrhea.
• A close look at dietary factors is a must in evaluating the cause for an irritable bowel, one cause i.e., lactose intolerance is a very common problem. The inability to digest lactose sugar in milk and dairy products. The undigested lactose acts like a laxative and causes the symptoms of an irritable bowel.
• Another and less common is gluten intolerance. Some individuals may have an allergic reaction to gluten protein, which is found in all cereals except rice and corn. This can cause diarrhea.
• Fat may also be a cause of diarrhea, they stimulate strong contractions of colon, contributing to pain and diarrhea.
• Alcohol is another often-unrecognized cause for such symptoms, particularly diarrhea. The patient may not think that his or her alcohol habit can be the cause. Alcohol is a cellular poison. Its initial contact with the lining of the bowel may cause some cellular damage. As the alcohol in the blood is recirculated regularly and bathes the intestinal cells, it creates further damage. Damaged cells mean inadequate digestion, followed by diarrhea and IBS.
• Coffee, tea, colas, and chocolate are all can cause IBS, as they stimulate muscular contractions and acts as a causative factor in diarrhea.
• Spices may also irritate the bowel. In some case, it may be due to food allergies or food poisoning.
• Diarrhea may also be a symptom of vitamin deficiency, e.g., niacin, B-12 or folic acid.
• Various infectious diseases may cause this, but this is usually of short duration. Parasites may be a cause like Giardiasis.
• The abuse of laxatives is a common cause, which is often overlooked.
• Disease of the pancreas may cause large, frequent, fatty stools. The pancreatic enzymes needed for digestion and when these are in short supply, symptoms follows.
What are the symptoms of IBS?

Diarrhea characteristically occurs in the morning, and almost never at night.
• Urge to defecate after meals.
• Pain in the lower abdomen, pain often occurs in attacks, usually relived by defecation and sometimes provoked by food.
• Bowel habit is variable. All most all patients notice ribbon like stools with or without mucus.
• Sensation of incomplete emptying of the rectum.
• Abdominal distension, excessive flatus, dyspepsia, heartburn, increased urine frequency 

How Ayurveda describes this symptom?
Ayurveda mentioned one disease known as ‘Grahani’. The symptom of this grahani resembles most of IBS symptoms.
Grahani is the seat of Agni and is called so because of holding up the food. Normally, it holds up the food (till it is digested) and releases it from the side after it is digested. But when it is deranged due to weak digestive fire, it releases the ingested material even in unripe condition.
Causes of deranged Agni: Agni is deranged by fasting, eating during indigestion, over eating, irregularly eating, intake of unsuitable, heavy, cold, too rough and contaminated food. Emaciation due to some disease, faulty adaptation to place, time and season, faulty administration of emesis, purgation and unction, and suppression of natural urges.  Agni thus deranged becomes unable to digest even the light food and the food being undigested gets acidified and toxic.
Symptoms

IBS is diagnosed in people whose symptoms include abdominal pain, bloating, gas, diarrhea, and constipation, or a combination of these symptoms. Though sometimes confused with inflammatory bowel disease, which includes Crohn's disease and ulcerative colitis, IBS is a separate condition.

Prodromal symptoms are - thirst, lassitude, debility, delayed digestion and heaviness in body.
Thirst, anorexia, abnormal taste in mouth, excessive salivation and feeling of darkness, eructation’s have metallic or fleshy odor and bitter sour taste, edema on feet and hands, joint pain, vomiting and fever, cutting pain in abdomen, lassitude, debility, dryness in throat and mouth, burning in cardiac region and throat. The patient passes stool as liquid, dried, thin & undigested with sound, broken, mixed with mucus and heavy.
Frequent motions, which are of sometimes, dry & sometimes watery consistency, is the classical symptom.

Nongastrointestinal symptoms

Other symptoms that don't affect the intestines, such as:

·         Anxiety or depression.

·         Fatigue.

·         Headache.

·         Unpleasant taste in the mouth.

·         Backache.

·         Sleeping problems (insomnia) not caused by symptoms of IBS.

·         Sexual problems, such as pain during sex or reduced sexual desire.

·         Heart palpitations (feeling like the heart skips a beat or is fluttering).

·         Urinary symptoms (frequent or urgent need to urinate, trouble starting the urine stream, trouble emptying the bladder).

A number of other problems may cause symptoms similar to those of irritable bowel syndrome (IBS), including:

·         Abuse of laxatives or antacids.

·         Use of sorbitol or other artificial sweeteners.

·         Lactose intolerance.

·         Inflammatory bowel disease.

·         Malabsorption syndrome, such as celiac disease.

·         Tumors of the digestive system.

·         Problems with the pancreas.

·         Parasitic infestation, especially in people who have traveled to areas with poor sanitation.

·         Thyroid disease.

·         Diverticulitis.

·         Diseases of the female reproductive organs, such as endometriosis.

·         Gallstones.

·         Gastroesophageal reflux disease (GERD).

Can I prevent this?
As the name itself suggests, it is very irritable. There are plenty of things you can do to take some irritability out of your bowels.
1. Try changing your diet.
2. Eliminate the use of milk and milk products from your diet. This should be simply to test and determine if you do have lactose intolerance. You should not eliminate milk or milk products on a permanent basis unless you make sure you have other adequate calcium sources.
3. Avoid excess tea, coffee, alcohol, cola, and carbonated beverages.
4. You should eat slowly and in a relaxed environment as possible, don’t eat during indigestion, or eating irregularly.
5. Avoid intake of unsuitable food, heavy, cold, contaminated or too sweet food, which is heavy to digest. Ayurveda explains how to eat, when & what? So follow such rules.
6. Omit strong spices; too oily i.e., fried food, fatty foods, and flatus alleviating foods.
7. Tobacco should be eliminated entirely. Avoid all forms of tobacco, including smoking, chewing, or snuffing.
8. Diet adjustments are not enough to improve your bowel function and avoid IBS. It is important to eliminate nervous tension if possible. Relive your anxiety and stress by adjusting your lifestyle. Most of those measures are the things we should all do for better health anyway.
9. Train your bowel, as this is also an important part of managing irritable bowel symptoms, when the problem is mostly constipation.
10. Don’t suppress the urge of urine & stool
11. Take fiber rich diet in case of constipation.

How Ayurveda help me for treating this disease?

Ayurveda suggests warm water for drinking first, when morbidity is situated in grahani and is flared up with the half burnt food. Appetizers, lightening, and digestive measures like liquid gruel etc. followed by ghee mixed with appetizers, vata alleviating drugs and enema’s is then advise as a line of treatment. If you have this problem, you must consult your physician for proper treatment. Ayurvedic treatment is based on semi digested (Sama) or properly digested (nirama) stool. According to this, physician decides your treatment.

Some formulations that will help you in reliving symptoms
1. Powder of four sours (Vrukshamla, Amlavetasa, Dadima and Badara) 640 gm, trikatu 120 gm (Pippali, Shunthi, Black Pepper), and five salts 160gm added with sugar 320gm should be used with vegetables, pulses, cooked cereals etc. It is efficacious in colic, indigestion, anorexia etc.
2. Panchakola is to be added in cereal soup, Radish soups with black pepper are recommended as diet.
3. Buttermilk, sour gruel, and arishta should be taken as post meal drink.
4. Buttermilk is specifically advised in this disease due to its appetizing nature, astringency and lightness in all ways. This aids recovery of disease. So take in profuse quantity.
5. One passing undigested diarrheic stools due to deficient Agni should take adequate
6. Dose of ghrita (ghee) mixed with appetizing drugs, as they are excellent stimulants of weak fire.
7. Ayurveda advise ‘Parpati Kalpa’ in this disorder, which is very efficient for treating this disorder, but strict dietary regimens one has to follow during this therapy.
8. Various Asavas / Arishta’s, Medicated ghee & appetizer drug formulations are advised some of them are -

Do’s - Eat old rice, jawar, gourd, coriander leaves, lentil, green grams soup, black pepper, dried ginger, wood apple, Pomegranate, nutmeg, skimmed milk, buttermilk, hot water, complete rest, adequate sleep.

Don’ts - Eat wheat, maize, barley, pigeon pea, pea, cow pea, spiked dolichos, black gram, gram, Soya bean, saga, kidney bean, potato, sweet potato, navalkoal, onion, coconut, groundnut, chili, oily food, chicken, red meat, crabs, prawns, fish, leafy vegetable like sorrel, drum stick etc, mango, pineapple, apple, watermelon, cashew, pumpkin gourd, papaya, fig, jack fruit, excess milk, day sleep, awakening at night,

Chronic Kidney Disease

 Chronic Kidney Disease (CKD)

Chronic Kidney Disease (CKD) is a long-term condition where the kidneys progressively lose their function over time. The kidneys play a crucial role in maintaining homeostasis in the body by filtering waste products, balancing electrolytes, and regulating fluid levels. When kidney function deteriorates, waste products and fluids can accumulate in the body, leading to potentially serious health issues.

This blog explores the types, causes, management of CKD, and the impact of diabetes on kidney health.

What is Chronic Kidney Disease (CKD)?

CKD is a condition characterized by the gradual loss of kidney function. The kidneys' primary role is to filter waste, excess fluids, and toxins from the blood. In CKD, this filtering process becomes less efficient, which can lead to the accumulation of harmful substances in the body.

Kidney function is measured by the glomerular filtration rate (GFR), which estimates how well the kidneys are filtering blood. A GFR of less than 60 mL/min/1.73 m² for three months or more is considered an indicator of CKD.

Types of Chronic Kidney Disease

CKD is classified into five stages based on the level of kidney function, as determined by the GFR:

1.   Stage 1 (Mild):
GFR is 90 mL/min/1.73 m² or higher. At this stage, kidney damage is present, but kidney function is normal. The patient may not experience noticeable symptoms.

2.   Stage 2 (Mildly Decreased Function):
GFR is between 60 and 89 mL/min/1.73 m². Kidney function is still relatively normal, but slight damage is present. There may be subtle signs or no symptoms.

3.   Stage 3 (Moderate Decrease in Function):
GFR is between 30 and 59 mL/min/1.73 m². This stage is divided into two subcategories: Stage 3a (GFR 45-59) and Stage 3b (GFR 30-44). Symptoms may begin to appear, including fatigue, swelling, and urinary changes.

4.   Stage 4 (Severe Decrease in Function):
GFR is between 15 and 29 mL/min/1.73 m². Kidney function is significantly impaired, and symptoms like high blood pressure, anemia, and bone disease may arise. Preparation for dialysis or a kidney transplant may be needed.

5.   Stage 5 (End-Stage Renal Disease or ESRD):
GFR is less than 15 mL/min/1.73 m². At this stage, kidneys can no longer function on their own, and dialysis or a kidney transplant is required for survival.

Causes of Chronic Kidney Disease

CKD can be caused by a variety of factors. The most common causes include:

1.   Diabetes Mellitus:
Diabetes is the leading cause of CKD. High blood sugar levels over time damage the blood vessels in the kidneys, impairing their ability to filter waste and leading to diabetic nephropathy, a specific type of kidney damage caused by diabetes.

2.   Hypertension (High Blood Pressure):
High blood pressure can damage the blood vessels in the kidneys, leading to reduced kidney function. The kidneys regulate blood pressure by adjusting the volume of sodium and fluid in the body, and hypertension can overwhelm this system.

3.   Glomerulonephritis:
This is an inflammation of the glomeruli, which are the tiny filtering units in the kidneys. It can be caused by infections, autoimmune diseases, or unknown reasons (idiopathic).

4.   Polycystic Kidney Disease (PKD):
PKD is a genetic disorder that leads to the growth of numerous cysts in the kidneys. Over time, these cysts can damage kidney tissue and lead to kidney failure.

5.   Chronic Obstructive Uropathy:
Conditions such as kidney stones, enlarged prostate, or urinary tract obstructions can impair the normal flow of urine and result in kidney damage.

6.   Medications and Toxins:
Long-term use of certain nephrotoxic drugs e.g., nonsteroidal anti-inflammatory drugs  (NSAIDs), Aminoglycosides and exposure to toxins can lead to kidney damage.

7.   Other Conditions:
Other medical conditions like lupus, HIV, and certain cancers can also cause kidney disease.

How Diabetes Affects the Kidneys

Diabetes, particularly when poorly controlled, is a major risk factor for kidney damage. The effect of diabetes on the kidneys is referred to as diabetic nephropathy.

1.   High Blood Sugar Damages Blood Vessels:
Over time, elevated blood sugar levels damage the tiny blood vessels (capillaries) in the kidneys that filter waste. This causes the kidneys to lose their ability to filter blood efficiently.

2.   Increased Blood Pressure:
Diabetes often causes an increase in blood pressure (hypertension), which further exacerbates kidney damage. High blood pressure can damage the glomeruli (filtration units of the kidneys), worsening kidney function.

3.   Protein Leakage:
One of the earliest signs of diabetic nephropathy is the leakage of protein (albumin) into the urine, a condition known as albuminuria. Protein in the urine is an indication that the kidneys’ filtration system is not working properly.

4.   Progression to End-Stage Renal Disease:
If not properly managed, diabetic nephropathy can progress to end-stage renal disease (ESRD), requiring dialysis or a kidney transplant. In fact, diabetes is the leading cause of kidney failure in the world.

Management of Chronic Kidney Disease

Managing CKD involves slowing the progression of the disease, controlling symptoms, and addressing underlying conditions. While CKD cannot be fully reversed, early detection and appropriate management can help maintain kidney function for a longer period.

1. Lifestyle Changes

• Dietary Modifications:
  A balanced, kidney-friendly diet is essential. This may include limiting salt, potassium, phosphorus, and protein intake to reduce kidney burden. A dietitian specializing in kidney disease can help create a customized eating plan.
• Exercise:
  Regular physical activity can help manage underlying conditions like hypertension and diabetes, as well as improve overall health. However, patients should consult a healthcare provider before starting a new exercise regimen.
• Weight Management:
  Maintaining a healthy weight can reduce the strain on the kidneys and help control diabetes and high blood pressure.

2. Medications

• Antihypertensive Medications:
  Controlling blood pressure is crucial to preventing further kidney damage. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are commonly prescribed as they not only lower blood pressure but also help protect the kidneys.
• Blood Sugar Control:
  For people with diabetes, controlling blood glucose levels is paramount in preventing or slowing diabetic nephropathy. Medications like metformin, insulin, or newer classes of drugs such as SGLT2 inhibitors may be used to manage blood sugar.
• Erythropoiesis-Stimulating Agents (ESAs):
  In patients with CKD, anemia is a common complication. ESAs may be prescribed to stimulate red blood cell production.
• Phosphate Binders:
  For patients in later stages of CKD, phosphate binders (sevelamer, tenapanor) may be used to control high phosphorus levels, which can cause bone disease.

3. Dialysis and Kidney Transplant

• Dialysis:
  Dialysis is a life-saving treatment for people with ESRD. There are two main types of dialysis: hemodialysis (where blood is filtered through a machine) and peritoneal dialysis (where the lining of the abdomen is used to filter waste). Dialysis helps remove waste products and excess fluid from the body when the kidneys can no longer do so effectively.
• Kidney Transplant:
  A kidney transplant is often the preferred treatment for patients with end-stage renal disease. A donor kidney can replace the function of the failing kidneys, but patients must take immunosuppressive medications to prevent rejection of the transplant.

Conclusion

Chronic kidney disease is a progressive condition that can lead to severe complications if not managed properly. Understanding the causes, symptoms, and management strategies for CKD can help individuals take proactive steps to maintain kidney health. Diabetes, as the leading cause of CKD, requires careful management to prevent kidney damage. With early diagnosis, lifestyle changes, medications, and proper medical care, the progression of CKD can be slowed, and patients can live healthier lives.