Hepatocellular Jaundice - Causes, Diagnosis, and Treatment

Introduction

The word jaundice originated from jaune, which means yellow. Jaundice is also known as icterus. In jaundice, the plasma bilirubin (a pigment in bile secreted by the liver) exceeds 2.5 milligrams per deciliter. The normal serum bilirubin level is 0.5 to 1.5 mg/dl. The yellowing of skin, eyes, and nails characterizes jaundice. It is classified into three types - hemolytic, hepatocellular, and obstructive jaundice.

Hepatocellular jaundice results from the inability of the liver to transport bilirubin into the bile. Chronic pancreatitis, parasitic infection, inherited cholestatic liver disease, lymphoma, granuloma, and cancer can cause jaundice. Jaundice can be seen in pregnancy and newborn children. It is diagnosed with liver function tests. Hepatocellular jaundice can be treated.

What Is Hepatocellular Jaundice?

Jaundice is classified into three types - Hemolytic jaundice, hepatocellular jaundice, and obstructive jaundice. Hepatic jaundice is caused due to damage to liver cells. Bilirubin transportation is impaired due to damage to the liver cells, resulting in the inability of the liver cells to transport bilirubin. The liver's conjugated bilirubin (free bilirubin) cannot be excreted as it gets returned into the blood due to damaged liver cells. The transport of conjugated bilirubin into the canaliculi is impaired, causing cell edema (swelling). Swelling and edema obstruct biliary canaliculi (bile duct) resulting in further accumulation of bilirubin in the blood. Therefore, both conjugated and unconjugated bilirubin levels rise in the blood.

What Are the Causes of Hepatocellular Jaundice?

Hepatocellular jaundice is caused due to liver diseases. The following are the causes of hepatocellular jaundice:

• Hepatitis - The inflammation of the liver which causes liver damage is called hepatitis. Hepatitis is characterized by swelling and improper liver function. It can be caused due to viral infection. Hepatitis may be acute and chronic, leading to liver failure and death.

• Medication - Paracetamol toxicity, Halothane, herbal remedies, and antituberculosis drugs can potentially cause acute liver failure.

• Acute Liver Injury - Acute liver failure, or ALF, is a serious condition characterized by a rapidly progressive decline in liver function. ALF is defined as the onset of clinical features within eight weeks without pre-existing liver disease. Viral hepatitis (A, B, E) is responsible for causing jaundice.

• Chronic Liver Injury - Chronic liver injury refers to liver inflammation persisting for more than six months. Patients may remain asymptomatic in the early stages of chronic liver injury (absence of symptoms). However, in the long run, it may cause severe liver damage. Chronic viral hepatitis (B, C) is responsible for causing hepatocellular jaundice.

• Haemochromatosis - The condition in which excess iron accumulates in the body.

• Alpha-1 Antitrypsin Deficiency - Alpha1-antitrypsin is a genetically inherited disease carried from forefathers through genes. When alpha1-antitrypsin is secreted in the defective form or mutated form in the liver resulting in liver manifestation, including cholestatic jaundice in the neonatal period (neonatal hepatitis), which can resolve spontaneously, alpha-1 antitrypsin deficiency can cause chronic hepatitis, cirrhosis in adults, and liver cancer in the long term.

• Infection - Infection caused by a virus resulting in viral hepatitis (an inflammation of the liver).

• Alcoholic Hepatitis - Alcoholic liver disease is caused by the misuse of alcohol, resulting in liver fibrosis.

• Liver Cirrhosis - Liver cirrhosis refers to damage and inflammation of liver cells resulting in liver degeneration. Cirrhosis of the liver can also result in liver dysfunction.

• Exposure to Toxic Materials - Food poisoning or allergies can also alter the function of the liver, causing jaundice.

What Are the Hepatocellular Conditions That May Produce Jaundice?

Some hepatocellular conditions that may produce jaundice are as follows:

• Viral hepatitis (A, B, C, D, E).

• Alcohol.

• Drugs (Acetaminophen).

• Environmental toxins (wild mushroom, vinyl chloride).

• Ischemic hepatitis (an acute liver injury caused due to insufficient blood supply).

• Wilson's disease (the genetic disorder which causes excessive copper or accumulation in the liver, brain, and other organs).

• Budd-Chiari syndrome (a syndrome in which the blood clot blocks liver veins).

What Are the Signs and Symptoms of Hepatocellular Jaundice?

The following are the symptoms of hepatocellular jaundice:

• Itching.

• Dull ache or heavy sensation in the abdomen.

• Weight loss.

• Fever with chills.

• Dry eyes and mouth.

• Reduced response to any stimuli (loss of consciousness).

• Restlessness.

• Aggressive outbursts.

• Drowsiness.

• Fixed pupil.

• Abnormally reacting pupils.

• Weakness.

• Nausea and vomiting.

• Profuse sweating.

• Anxiety.

• Abnormal posturing.

• Fatigue.

• Difficulty in breathing.

The following are the signs of hepatocellular jaundice:

• Jaundice.

• Dark urine and pale stools.

• Low heart rate.

• High blood pressure.

• Hyperventilation (irregular breathing).

• Papilledema (swelling of the pupil).

• Hepatomegaly (enlarged liver).

• Splenomegaly (enlarged spleen).

• Reye's syndrome (swelling in the liver and brain).

How to Diagnose Hepatocellular Jaundice?

Hepatocellular jaundice can be present due to acute and chronic liver injury. A physical examination can easily detect the clinical presentation of acute and chronic liver injury. The most common feature of hepatocellular jaundice is the yellowing of skin, nails, and eyes accompanied by a dull ache or heavy sensation in the abdomen. The presence of scratch marks on the body can confirm generalized itching. Dark urine and clay-colored stools are observed by the patients, which gives evidence of hepatocellular jaundice.

Hepatocellular jaundice can be confirmed by following laboratory tests:

• Blood Test - The blood count is often abnormal and gives an underlying diagnosis. Increased levels of conjugated and unconjugated bilirubin confirm hepatocellular jaundice. The blood test confirms alpha1-anti-trypsin deficiency disease by the presence of low plasma alpha1-antitrypsin concentration.

• Liver Function Test (LFT) - Hepatocellular jaundice present due to parenchymal diseases shows an increase in transaminases level (aspartate aminotransferase, alanine aminotransferase). The increased ALT level is highly suggestive of ischemic hepatitis, drug-hepatotoxicity, and viral hepatitis. LFT can also show increased alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT) levels indicating biliary obstruction.

• Imaging - Imaging techniques (computed scan) are essential to determine the site and general nature of the structural lesion in the liver, indicating fibrosis, which is highly suggestive in liver cirrhosis and portal hypertension.

• Biopsy - Liver biopsy is important in detecting the underlying cause of hepatocellular jaundice. Biopsy confirms the extent of liver injury. A liver biopsy should be considered if there is suspicion of pre-existing liver disease.

How Is Hepatocellular Jaundice Treated?

The treatment after establishing hepatocellular jaundice by laboratory test depends on the underlying cause. The choice of therapeutic procedure depends on the severity and cause of hepatocellular jaundice. The underlying cause needs to be addressed to treat the symptoms of hepatocellular jaundice. Palliative care and appropriate and adequate medical attention are recommended for patients with hepatocellular jaundice.

Conclusion

Successful treatment relieves discomfort and helps prolong life. Hepatocellular jaundice can cause serious complications like liver failure if left untreated. It can be fatal if neglected. Cessation of alcohol drinking is strongly suggested. The best preventive measure to avoid hepatitis is to avoid intercourse with multiple partners and sharing needles. Vaccination against viral hepatitis prevents infection. Maintaining good personal hygiene and consumption of healthy food is highly recommended.