JAUNDICE or ICTERUS, a term in medicine applied to a yellow coloration of the skin and other parts of the body, of ten associated with some derangement affecting the liver. This yellow colour is due to the presence in the blood of bile or some of its constituents. Jaundice, however, must be regarded as a symptom of some morbid condition previously existing and not as a disease per se.
Cases with jaundice may be divided into two groups : I. Obstructive Jaundice.—Any obstruction of the passage of bile from the liver into the intestinal canal is sooner or later followed by the appearance of jaundice, which in such circum stances is due to absorption of bile into the blood. The obstruc tion is due to one of the following causes : ) Obstruction by foreign bodies within the bile duct, e.g., gallstones or parasites; (2) inflammation of the duodenum or the lining membrane of the duct; (3) stricture or obliteration of the duct; (4) a tumour growing from the duct; (5) pressure on the duct from without, from the liver or other organ, or tumours arising from them. Obstructions from these causes may be partial oi complete, and the degree of jaundice will vary accordingly, but it is to be noted that extensive organic disease of the liver may exist without the evidence of obstructive jaundice. By a blood test and the van der Bergh reaction, obstructive jaundice may be distinguished from all other varieties.
The effect upon the liver of impediments to the outflow of bile is an increase in its size, the whole biliary passages and the liver cells being distended with retained bile. The bile thus re tained is absorbed into the system, and shows itself by the yellow staining seen to a greater or less extent in all the tissues and many of the fluids of the body. The kidneys, in such circumstances, excrete a portion of the retained bile in the urine.
The symptoms accompanying obstructive jaundice necessarily vary according to the nature of the exciting cause. The first sign of jaundice itself is a yellow coloration of the white of the eye, which is speedily followed by a similar colour on the skin over the body generally. It may be also well seen in the roof of the mouth, but in the lips and gums is not observed till the blood is first pressed from them. The tint varies in depth and in complete obstruction of long duration may be olive-green or dark brown. The urine exhibits colour changes even before they can be de tected on the skin or elsewhere. It is always dark brown like porter, but after standing in the air it becomes greenish. It con tains both bile pigments and bile acids. The former are detected by the play of colours yielded on the addition of fuming nitric acid, the latter by the purple colour, produced by placing a piece of lump sugar in the urine tested, and adding thereto a few drops of strong sulphuric acid.
The contents of the bowels, owing to lack of bile, are clay coloured or white, contain undigested fats, and have an extremely offensive odour. Constitutional symptoms are always present. The patient becomes languid, drowsy and irritable, and has gener ally a slow pulse. Yellow vision appears to be present in some very rare cases. When not dependent upon serious organic disease, jaundice from obstruction may exist many years, as in those instances where the walls of the bile ducts are thickened from chronic catarrh, but are only partially occluded. In the common cases of acute catarrhal jaundice recovery usually takes place in two or three weeks.
The treatment of this form of jaundice is that of the underlying cause. With its removal the jaundice will disappear, but diapho retics and diuretics to promote the action of the skin and kidneys are useful. In the more chronic forms the waters of Carlsbad have a high repute.
Under this group there are the jaundice of new-born infants, which varies enormously in severity; the cases in which a slight form of jaundice obtains in several members of the same family, without other symptoms, and which may persist for years; and lastly perhaps, the group of cases with hypertrophic cirrhosis. (See also ALIMENTARY SYSTEM, DISEASES OF.) BIBLIOGRAPHY.-Sir H. Rolleston, in Oxford Medicine, 1925-26, iii. 303 (bibl.) ; D. Riesman, "Clinical Causes and Diagnostic and Prognostic Significance of Jaundice," Amer. Journ. Med. Sci., 1927, clxxiii. 668 (bibl.) ; C. G. Heyd, J. A. Killian and P. Klemperer, "Pathogenesis of Jaundice," Surg. Gynec. and Obstet., 1927, xliv. 489 bibl.) ; J. Rosenberg, "Schwierigkeiten der Klin. u. Anat. Diagnose d. hamolyt. Ikterus," Frankfurt. Ztschr. f. Path. 1926, xxxiv. 288 (bibl.) ; A. Landau and J. Held, "Contrib. a l'etude des icteres," Ann. de med. 1926, xix. 264 (bibl.) ; M. Boule, Recherches sur les icteres (3rd ed. 1922 ; bibl.) ; B. Dawson and W. E. Hume, "Jaundice of Infective Origin," Quart. Journ. Med., 1916-17, x. 90.