Jaundice or Pandu Roga

Jaundice is a disorder characterized by increased levels and deposits of bile pigment in the skin, giving the individual a yellowish skin color; usually caused by liver changes. Yellowness of the eyes, skin, and urine, whiteness of the feces, constipation, and loss of appetite is also seen.

Jaundice occurs when there are too many old red blood cells in the blood. If there are too many red blood cells retiring for the liver to handle, yellow pigment builds up in the body. When there is enough to be visible, jaundice results.

Jaundice is also called icterus and yellow skin. Jaundice is also known as Pandu roga in ayurvedic texts.

Bilirubin is a by-product of the daily natural breakdown and destruction of red blood cells in the body. The hemoglobin molecule that is released into the blood by this process is split, with the heme portion undergoing a chemical conversion to bilirubin. Normally, the liver metabolizes and excretes the bilirubin in the form of bile. However, if there is a disruption in this normal metabolism and/or production of bilirubin, jaundice may result.

Types of Jaundice:

1. Neonatal Jaundice: Most babies have some jaundice during the first week of life. The ordeal of birth can send many red blood cells to an early retirement, and babies’ livers are often unprepared for the load. Before Mom’s milk comes in and stooling begins in earnest, bilirubin accumulates more easily. Jaundice is even more common in premature babies.

2. Pathologic Jaundice: Pathologic jaundice is the term used jaundice presents a health risk. Pathologic jaundice can occur in children or adults. It arises for many reasons, including blood incompatibilities, blood diseases, genetic syndromes, hepatitis, cirrhosis, bile duct blockage, other liver diseases, infections, or medications.

Jaundice Causes:

Jaundice may be caused by several different disease processes:

1. Prehepatic Causes: i.e. before the bile is made in liver. Here, jaundice is caused by rapid increase in breakdown and destruction of red blood cells i.e. haemolysis overwhelming the liver’s ability to completely remove the increased levels of billirubin from the blood. For example, diseases like malaria, sickle cell anaemia, thalassaemia etc are the conditions with increased breakdown of blood cells.

2. Hepatic Causes: When the problem arises within the liver. Here, in this case, jaundice is caused by liver’s inability to properly metabolize and excrete billirubin. Examples include Hepatitis, Cirrhosis of liver, Gilbert’s syndrome, cancer etc.

3. Post-hepatic Causes: i.e. after the bile has been made in the liver. This type of jaundice is also called obstructive jaundice. It is caused by the conditions which interrupt the normal drainage of conjugated billirubin in the form of bile from the liver into the intestine. Examples of Obstructive Jaundice include gall stones in bile duct, pancreatic or bile duct carcinoma, pancreatitis, neonatal jaundice etc.

Symptoms of Jaundice:

1.    Yellow coloration of the eyes, skin, tongue and urine.
2.    Loss of appetite.
3.    Dull pain in the liver region.
4.    Nausea, severe constipation, extreme weakness.
5.    Fever, headache and undue fatigue.

Diagnosis of Jaundice:

1. Physical Examination: In many cases the diagnosis of jaundice is suggested by the appearance of the patient’s eyes and complexion. The doctor will ask the patient to lie flat on the examining table in order to feel (palpate) the liver and spleen for enlargement and to evaluate any abdominal pain. The location and severity of abdominal pain and the presence or absence of fever help the doctor to distinguish between hepatic and obstructive jaundice.

2. Blood Tests and Ultrasonography: Disorders of blood formation can be diagnosed by more thorough examination of the blood or the bone marrow, where blood is made. Occasionally a bone marrow biopsy is required, but usually the blood itself will reveal the diagnosis. The spleen can be evaluated by an ultrasound

3. Imaging Techniques: Disease in the biliary system can be identified by imaging techniques, of which there are many. X rays are taken a day after swallowing a contrast agent that is secreted into the bile. This study gives functional as well as anatomical information. There are several ways of injecting x ray dye directly into the bile ducts. It can be done through a thin needle pushed straight into the liver or through a scope passed through the stomach that can inject dye into the Ampulla of Vater. CT and MRI scans are very useful for imaging certain conditions like cancer in and around the liver or gall stones in the common bile duct.

Self Care for Jaundice

•    The patient should take rest till acute symptoms subside.
•    Include fruit juice in daily diet for few weeks.
•    Administer hot water enema daily.
•    A glass of warm water with 2 teaspoon of lime juice should be taken regularly.
•    Butter, oils and cream should be avoided for at least 2 weeks.
•    Fresh juice from radish leaves is a valuable remedy. Leaves should be pounded and strained. One pound of this juice provides immediate relief to an adult.
•    Water Treatment – Drink lots of water with lemon juice to protect damaged liver cells. Hot and cold compresses should be applied alternately to the abdomen. Cold friction twice a day is beneficial. A hot immersion bath for 10 minutes at 104 degree Fahrenheit daily eliminates bile pigment through skin and kidneys.
•    Yoga also is equally beneficial

Home Remedies:

1.    Barley water is very light and very effective in curing jaundice.
2.    Grind papaya leaves and make its paste by mixing it in honey. Taking this paste regularly for two weeks is the best remedy for jaundice.
3.    Amla is very good in curing jaundice as it is rich in Vitamin-C.
4.    Drinking lemon juice daily cures jaundice naturally.
5.    Paste of tulsi leaves should be mixed in freshly made radish juice. This drink is a wonderful remedy for jaundice.
6.    To keep the bowl movement normal, orange juice should regularly be given to the patient.
7.    Drinking sugarcane juice 3-4 times a day is also helpful in curing jaundice.
8.    Drinking juice of Radish leaves is also a useful remedy for jaundice.
9.    Use of turmeric in warm water is also useful.

Complications of Jaundice:

1.    Hyper pigmentation
2.    Renal failure
3.    Skin discoloration
4.    CSF xanthochromia

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