A Clinical Case Study on Jaundice: Causes, Diagnosis, Treatment, Management and Public Awareness

Abstract

Jaundice is a clinical condition marked by the yellowish discoloration of the skin, sclera, and mucous membranes due to elevated serum bilirubin levels. It is not a disease in itself, but a visible sign of underlying hepatic or systemic pathology. This clinical case study presents a detailed investigation of a patient diagnosed with jaundice, emphasizing the underlying cause, diagnostic evaluation, treatment protocol, management strategies, and the importance of public health education. The study begins with a comprehensive review of jaundice classifications—pre-hepatic, hepatic, and post-hepatic (obstructive)—and explores the physiological and pathological mechanisms leading to hyper bilirubinemia. In this particular case, the patient presented with classical symptoms including yellowing of the skin and eyes, dark urine, fatigue, and abdominal discomfort. A systematic diagnostic approach including liver function tests (LFTs), complete blood count (CBC), imaging studies (ultrasound and CT scan), and serological tests helped in identifying the cause as obstructive jaundice due to gallstones. The treatment regimen included supportive care with intravenous fluids, antiemetic, and antibiotics, followed by surgical intervention (cholecystectomy) to remove the obstruction. The patient responded well to the treatment, with normalization of liver enzymes and gradual resolution of symptoms. The study also outlines dietary and lifestyle modifications recommended for liver health, along with post-treatment monitoring. In addition to clinical insights, this case study emphasizes the importance of public awareness regarding the early signs of jaundice and the need for prompt medical evaluation. Lack of awareness, delayed diagnosis, and reliance on unqualified medical advice can lead to severe complications including liver failure.Community education programs, regular health check-ups, and improved sanitation are suggested as key measures to prevent hepatic diseases leading to jaundice. This case highlights not only the clinical approach to diagnosing and treating jaundice but also underscores the critical role of public health in preventing and managing liver-related disorders. The integration of medical care with community health awareness can significantly improve outcomes and reduce the burden of jaundice-related complications.

Keywords

Jaundice, Diagnosis, Casestudy, herbal treatment, public awareness

Introduction

Jaundice is a common medical condition that affects liver function. It occurs due to an excess of bilirubin in the blood, causing a yellowish tint to the skin, Eyes, and mucous membranes. Jaundice is a medical condition characterized by the yellowing of the skin, sclera (whites of the eyes), and mucous membranes due to an increased level of bilirubin in the blood. Bilirubin is a yellow pigment produced as a byproduct of the breakdown of red blood Cells (RBCs). Normally, the liver processes bilirubin and excretes it through bile (1) However, when this process is disrupted due to liver dysfunction, bile duct obstruction, or excessive RBC destruction, bilirubin accumulates in the bloodstream, leading to Jaundice. Jaundice is not a disease in itself but a symptom of underlying medical conditions, Ranging from mild infections to severe liver disorders. It can affect individuals of all age Groups, from newborns to adults, and requires proper diagnosis and treatment to Prevent complications. Jaundice itself is not a disease but rather a symptom of underlying medical conditions. It Can be caused by liver disorders, infections, genetic disorders, or blockages in the bile Ducts. In many cases, jaundice can indicate serious health problems, such as hepatitis, Cirrhosis, or gallbladder disease. Early diagnosis and treatment are essential to prevent Complications and ensure proper liver function The condition can affect people of all ages, from newborns to the elderly. Neonatal Jaundice is a common occurrence in newborns due to the immaturity of their liver, but In most cases, it resolves on its own. However, in adults, jaundice often signifies an Underlying health issue that requires medical attention. The severity of jaundice Depends on the cause and the extent of bilirubin accumulation (2) in the blood In the human body, the liver plays a crucial role in filtering toxins, producing bile, and Metabolizing various substances. Any disruption in liver function can result in abnormal Bilirubin processing. This can be due to infections such as viral hepatitis, excessive Alcohol consumption, autoimmune diseases, or hereditary conditions. Additionally, Certain medications and toxins can impair liver function, leading to jaundice. Modern medical advancements have improved the diagnosis and management of Jaundice. Blood tests, imaging studies like ultrasound or MRI, and liver function tests Help determine the root cause of the condition. Depending on the cause, treatment Options may include medications, lifestyle modifications, or surgical interventions. In cases where jaundice is due to infections, antiviral or antibiotic treatments may be Necessary. (3) Maintaining liver health is crucial in preventing jaundice. This can be achieved by Following a balanced diet, avoiding excessive alcohol consumption, getting vaccinated Against hepatitis viruses, and staying hydrated. Regular health check-ups and early Detection of liver-related disorders can significantly reduce the risk of complications Associated with jaundice. Jaundice continues to be a significant public health concern worldwide, affecting Millions of people each year. With early detection, proper medical care, and lifestyle Modifications, the condition can be effectively managed, ensuring a healthier life for individuals affected by it Risk of jaundice. (4) People at increased risk of exposure to different types of viral hepatitis, such as hepatitis B and hepatitis C, may develop jaundice at the time of infection or later if liver disease or liver cancer occurs. Other risk factors for developing jaundice include consuming raw shell fish. Jaundice, also known as hyperbilirubinemia, is defined as a yellow discoloration of body tissues resulting from the accumulation of excess bilirubin. (5)

Types of Jaundice

1. Hepatic Jaundice – Caused by liver damage that prevents proper bilirubin metabolism.
2.  Hemolytic Jaundice – Results from excessive breakdown of red blood cells, increasing Bilirubin levels.
3. Obstructive Jaundice – Occurs when bile ducts are blocked, preventing bilirubin Excretion (6)

1. Hepatic jaundice: -Hepatic jaundice, also known as hepatocellular jaundice, is a type of jaundice that occurs due to damage or dysfunction of liver cells (hepatocytes). The liver plays a crucial role in processing bilirubin, a yellow pigment formed by the breakdown of red blood cells. Under normal conditions, bilirubin is processed by the liver and excreted through bile. However, when the liver is damaged, it loses its ability to properly metabolize and eliminate bilirubin, causing it to accumulate in the blood and leading to jaundice.

Causes of Hepatic Jaundice

Hepatic jaundice can result from various liver-related conditions, including:

• Viral Hepatitis (Hepatitis A, B, C, D, and E): Viral infections can cause inflammation of the liver, leading to impaired bilirubin processing. Chronic hepatitis B and C can lead to long-term liver damage and jaundice.
• Alcoholic Liver Disease: Excessive alcohol consumption damages liver cells, leading to fatty liver, alcoholic hepatitis, and eventually cirrhosis, which impairs bilirubin metabolism.
• Liver Cirrhosis: This is a condition where liver tissue becomes scarred and loses its function, preventing the proper processing of bilirubin. Cirrhosis is caused by chronic alcohol abuse, viral hepatitis, or metabolic disorders.
• Drug-Induced Liver Injury: Certain medications, such as paracetamol overdose, anti-tuberculosis drugs (isoniazid, rifampicin), antibiotics, and chemotherapy drugs, can cause liver toxicity, leading to hepatic jaundice.
• Autoimmune Hepatitis: A condition where the body’s immune system mistakenly attacks liver cells, leading to liver inflammation and jaundice.
• Liver Cancer (Hepatocellular Carcinoma): Malignant tumors in the liver can obstruct normal liver function, leading to jaundice
• Fatty Liver Disease (NAFLD and NASH): Non-alcoholic fatty liver disease (NAFLD) and its severe form, non-alcoholic steatohepatitis (NASH), cause fat accumulation in the liver, leading to inflammation and dysfunction.
• Genetic and Metabolic Disorders: Conditions such as Wilson’s disease (copper accumulation in the liver) and Hemochromatosis (iron overload) can impair liver function and cause jaundice.

Symptoms of Hepatic Jaundice

Since hepatic jaundice is directly related to liver damage, its symptoms include both general jaundice symptoms and liver disease symptoms, such as:

• Yellowing of the skin and eyes (due to increased bilirubin levels)
• Dark urine (because excess bilirubin is excreted through the kidneys)
• Pale or clay-colored stools (due to decreased bile flow)
• Fatigue and weakness (caused by impaired liver function)
• Loss of appetite and weight loss
• Nausea and vomiting
• Swelling in the abdomen (ascites) due to fluid buildup in severe liver disease
• Easy bruising and bleeding (due to reduced liver production of clotting factors)
• Mental confusion (Hepatic Encephalopathy) in advanced liver failure cases

Diagnosis of Hepatic Jaundice

To diagnose hepatic jaundice, doctors perform several tests to assess liver function and identify the underlying cause. The common diagnostic methods include:

• Liver Function Tests (LFTs): Measures bilirubin levels, liver enzymes (ALT, AST, ALP), and proteins (albumin) to evaluate liver health.
• Complete Blood Count (CBC): Detects infections, anemia, or liver inflammation.
• Viral Marker Tests: Identifies hepatitis viruses (HBV, HCV, HAV, HEV) in the blood.
• Ultrasound or CT Scan: Helps visualize liver size, fatty deposits, tumors, or cirrhosis.
• Liver Biopsy: In cases of chronic liver disease, a small liver tissue sample is taken for examination to confirm cirrhosis, fatty liver, or cancer.
• Genetic and Metabolic Tests: Detects inherited disorders like Wilson’s disease and hemochromatosis.

Treatment for Hepatic Jaundice

Treatment of hepatic jaundice depends on the underlying liver condition. Some of the common treatment approaches include:

1. Medications: Antiviral drugs (for hepatitis B and C) Corticosteroids (for autoimmune hepatitis) Chelation therapy (for Wilson’s disease)
2. Lifestyle Modifications: Avoid alcohol and hepatotoxic drugs Eat a liver-friendly diet (low fat, high fiber, rich in antioxidants) Stay hydrated and maintain a healthy weight
3. Liver Transplant: In cases of severe liver failure or liver cancer, a liver transplant may be the only option
4. Supportive Care: Intravenous fluids for hydration Vitamin supplements (especially Vitamin K for clotting disorders) Regular liver monitoring to assess disease progression

Prevention of Hepatic Jaundice

Although some causes of hepatic jaundice are unavoidable, many preventive measures can reduce the risk of liver damage:

• Get vaccinated against hepatitis A and B to prevent viral hepatitis infections.
• Avoid excessive alcohol consumption to reduce the risk of alcoholic liver disease.

• Maintain a healthy diet rich in fruits, vegetables, and lean proteins to prevent fatty liver disease.
• Exercise regularly to maintain liver health and prevent obesity-related liver diseases.
• Avoid unnecessary medications and consult a doctor before taking high-dose drugs.
• Undergo regular liver check-ups if you have a family history of liver disease. (7)

2. Hemolytic jaundice: also known as pre-hepatic jaundice is a type of jaundice that occurs due to the excessive breakdown (hemolysis) of red blood cells (RBCs), leading to an overproduction of bilirubin. The liver is responsible for processing bilirubin and excreting it through bile, but when the breakdown of RBCs is too rapid, the liver becomes overwhelmed and cannot excrete bilirubin efficiently. This results in an excess buildup of unconjugated (indirect) bilirubin in the blood, causing jaundice. Unlike hepatic jaundice, which is caused by liver dysfunction, hemolytic jaundice originates from disorders affecting the red blood cells.

Causes of Hemolytic Jaundice

Hemolytic jaundice is primarily caused by conditions that increase the destruction of red blood cells. Some of the common causes include:

1. Hemolytic Anemia: A group of disorders where RBCs are destroyed faster than they are produced. These include:

Sickle Cell Anemia – A genetic disorder where RBCs are abnormally shaped and break down easily.

Thalassemia – A genetic disorder affecting hemoglobin production, leading to RBC destruction.

Hereditary Spherocytosis – A condition where RBCs have an abnormal spherical shape, making them fragile.

2. Malaria: The Plasmodium parasite destroys red blood cells, leading to hemolysis and increased bilirubin levels.
3. Autoimmune Hemolytic Anemia: The body’s immune system mistakenly attacks its own RBCs, leading to their destruction.
4. G6PD Deficiency (Glucose-6-Phosphate Dehydrogenase Deficiency): A genetic enzyme deficiency that makes RBCs more susceptible to destruction, especially after consuming certain foods (like fava beans) or medications.
5. Blood Transfusion Reactions: If a person receives mismatched blood during a transfusion, the immune system attacks the transfused RBCs, causing massive hemolysis.
6. Drug-Induced Hemolysis: Certain medications, such as quinine, sulfa drugs, and certain antibiotics, can trigger RBC destruction.
7. Snake or Insect Bites: Some snake venoms and toxins destroy RBCs, leading to.

Diagnosis of Hemolytic Jaundice:

Hemolytic jaundice occurs due to excessive destruction of red blood cells (RBCs), leading to an increased level of unconjugated (indirect) bilirubin in the blood. The liver functions normally, but it cannot process the excess bilirubin quickly enough. Diagnosis involves clinical evaluation and laboratory investigations:

1. Clinical Symptoms:

Yellowing of skin and eyes (jaundice)

Fatigue and weakness

Enlarged spleen (splenomegaly)

Normal-colored urine (not dark)

2. Laboratory Tests

Peripheral Blood Smear: Shows abnormal RBCs (e.g., spherocytes, schistocytes).

Reticulocyte Count: Increased – the body produces more RBCs to compensate for the loss.

Unconjugated Bilirubin: Elevated in blood.

Serum Haptoglobin: Decreased – a marker of hemolysis.

Lactate Dehydrogenase (LDH): Increased – another marker of RBC breakdown.

Direct Coombs Test: Positive if the cause is autoimmune hemolysis.

Urine Test: Increased urobilinogen; bilirubin is usually absent.

3. Imaging (if needed):

Ultrasound: To check the size of liver and spleen. Liver is usually normal; spleen may be enlarged.

Treatment of Hemolytic Jaundice

Treatment of hemolytic jaundice depends on the underlying cause. Some of the common treatment approaches include:

1. Medications:  Corticosteroids Used in autoimmune hemolytic anemia to suppress immune system attack on RBCs. Folic Acid Supplements Helps in RBC production and recovery from anemia.

Hydroxyurea Used in sickle cell anemia to reduce RBC destruction. Antimalarial Drugs If malaria is the cause of hemolysis.

2. Blood Transfusion: In severe anemia cases, transfusion of healthy RBCs helps restore oxygen levels in the body.
3. Splenectomy (Surgical Removal of the Spleen): If the spleen is overactive in destroying RBCs, its removal may help reduce RBC loss.
4. Avoiding Trigger Factors: Patients with G6PD deficiency should avoid certain drugs (e.g., sulfa drugs, aspirin) and foods (e.g., fava beans). Patients with autoimmune hemolytic anemia should avoid exposure to cold in some cases.
5. Plasmapheresis: In cases of severe autoimmune hemolysis, this procedure removes harmful antibodies from the blood. (8)

3. Obstructive Jaundice: -

Obstructive jaundice, also known as post-hepatic jaundice, occurs when there is a blockage in the bile ducts that prevents bile and bilirubin from being excreted from the liver into the intestines. As a result, conjugated (direct) bilirubin accumulates in the liver and enters the bloodstream, causing yellowing of the skin and eyes. Unlike hepatic jaundice, which is caused by liver disease, and hemolytic jaundice, which results from excessive red blood cell breakdown, obstructive jaundice is caused by a physical obstruction in the bile flow pathway.

Treatment of Obstructive Jaundice

The treatment for obstructive jaundice depends on the underlying cause:

1. Gallstone Removal (Cholecystectomy or ERCP): If gallstones are blocking the bile duct, they can be removed using an endoscopic procedure (ERCP) or surgery.
2. Bile Duct Stenting: If a tumor is compressing the bile duct, a stent (tube) is placed to keep the duct open.
3. Surgical Removal of Tumors: If a tumor is causing the obstruction, surgery, chemotherapy, or radiation therapy may be required.
4. Biliary Bypass Surgery: If the bile ducts are completely blocked, a bypass surgery may be performed to create an alternate route for bile flow
5. Antibiotics: If the patient has an infection (such as cholangitis), antibiotics are prescribed. (9)

Diagnosis of Obstructive jaundice

Obstructive jaundice occurs when there is a blockage in the bile ducts, leading to a buildup of conjugated (direct) bilirubin in the blood. Diagnosis includes clinical evaluation, lab tests, and imaging.

1. Clinical Symptoms:

Yellowing of skin and eyes

Dark-colored urine (cola/tea colored)

Pale or clay-colored stools

Itching (pruritus)

Right upper abdominal pain (especially if gallstones are involved)

Nausea, vomiting, weight loss (if tumor is present) (10)

2. Laboratory Investigations:

Serum Bilirubin: Elevated conjugated (direct) bilirubin

Alkaline Phosphatase (ALP): Markedly increased – a key indicator of bile duct obstruction

Alanine Transaminase (ALT) & Aspartate Transaminase (AST): Mild to moderate elevation

Gamma-Glutamyl Transferase (GGT): Increased – supports cholestasis

Prothrombin Time (PT): May be prolonged (due to vitamin K malabsorption) (11)

 Urine and Stool Tests:

Urine: Dark-colored due to conjugated bilirubin

Stool: Pale due to absence of stercobilin (12)

3. Imaging Studies

Ultrasound (USG): First-line test to detect biliary dilation, gallstones, or masses

CT Scan / MRI: Detailed view of liver, pancreas, and bile ducts

MRCP (Magnetic Resonance Cholangiopancreatography): Non-invasive and highly accurate for bile duct obstruction

ERCP (Endoscopic Retrograde Cholangiopancreatography): Diagnostic and therapeutic; helps visualize and relieve obstruction (13)

CAUSES OF JAUNDICE

Main Causes of Jaundice:

Jaundice can be classified based on where the problem occurs:

1. Pre-Hepatic Causes (Before the Liver)

These causes arise due to excessive breakdown of red blood cells, leading to an overload of bilirubin before it reaches the liver. The liver cannot process the excess bilirubin efficiently.

• Hemolytic anemia Increased destruction of RBCs, leading to excess bilirubin production.
• Sickle cell disease Abnormal RBCs break down easily.
• Malaria Parasite induced RBC destruction
• Thalassemia Genetic disorder affecting hemoglobin production.
• Autoimmune diseases the immune system attacks RBCs.
• Blood transfusion reactions Mismatched blood transfusions can cause RBC destruction. (14)

2. Hepatic Causes (Liver-Related)

These occur due to liver diseases that impair bilirubin processing and metabolism.Hepatitis (viral, alcoholic, or autoimmune) – Inflammation of the liver affects bilirubin metabolism.

• Liver cirrhosis – Scarring of the liver reduces its ability to process bilirubin.
• Liver cancer – Tumors can block bilirubin processing.
• Genetic disorders – Conditions like Gilbert’s syndrome and Crigler-Najjar syndrome affect bilirubin metabolism.
• Alcoholic liver disease – Chronic alcohol use damages liver cells.
• Fatty liver disease (NAFLD/NASH) – Liver fat (15)

3. Post-Hepatic Causes (After the Liver – Obstructive Jaundice)

These causes involve blockages in the bile ducts, preventing bilirubin from being excreted.

• Gallstones – Stones block bile flow, leading to bilirubin buildup.
• Pancreatic cancer – Tumors in the pancreas can obstruct the bile duct.
• Bile duct strictures – Narrowing of bile ducts due to inflammation or scarring.
• Primary sclerosing cholangitis – Chronic inflammation of bile ducts.
• Biliary atresia (in newborns) – A congenital defect causing bile duct obstruction. (16)

Other Risk Factors and Conditions:

• Newborn jaundice: Due to immature liver function in newborns.
• Pregnancy-related jaundice: Conditions like HELLP syndrome and intrahepatic cholestasis of pregnancy.
• Sepsis or severe infections: Can cause liver dysfunction.
• Certain medications: Drugs like acetaminophen (paracetamol), steroids, and antibiotics can cause liver damage. (17)

Symptoms of Jaundice

Jaundice itself is not a disease but a symptom of an underlying condition affecting bilirubin metabolism. The symptoms vary depending on the cause and severity of jaundic

• Primary Symptoms (Direct Symptoms of Jaundice)

These symptoms occur due to excess bilirubin accumulation in the body:

Yellowing of the Skin and Eyes – The most noticeable symptom. The skin and sclera (white part of the eyes) turn yellow due to bilirubin buildup.

Dark Urine (Tea-Colored or Brown Urine) – Excess bilirubin is excreted through urine, making it darker than usual.

Pale or Clay-Colored Stools – When bilirubin does not reach the intestines due to a blockage or liver dysfunction, stools become light-colored.

Secondary Symptoms (Due to Underlying Causes of Jaundice)

These symptoms vary depending on whether jaundice is due to liver disease, infections, or bile duct obstruction. (18)

• Symptoms Due to Liver Disease (Hepatic Jaundice)

Fatigue and Weakness: Liver dysfunction affects metabolism, leading to low energy.

Loss of Appetite and Weight Loss:  Common in hepatitis and chronic liver disease

Nausea and Vomiting: The liver’s inability to process toxins can cause digestive issues.

Abdominal Pain (Especially in the Upper Right Side): Seen in liver infections, fatty liver, and cirrhosis.

Swelling in the Abdomen (Ascites): Fluid buildup due to liver damage.

Itchy Skin (Pruritus): Due to bile salts accumulating in the skin. (19)

• Symptoms Due to Hemolytic Jaundice (Excess RBC Breakdown) Anemia (Low Red Blood Cell Count):  Leads to weakness, dizziness, and shortness of breath.

Enlarged Spleen (Splenomegaly): The spleen works harder to remove damaged RBCs. (20)

Rapid Heart Rate (Tachycardia): The body compensates for low oxygen levels.

• Symptoms Due to Bile Duct Obstruction (Post-Hepatic Jaundice)

Severe Itching (Due to Bile Salt Accumulation in the Skin) Severe Upper Abdominal Pain (Especially in Gallstones or Pancreatic Cancer Cases) Fever and Chills (Seen in Bile Duct Infections Like Cholangitis)

• Additional Symptoms in Specific Conditions

Newborn Jaundice: Lethargy, difficulty feeding, and excessive sleepiness in newborns.

Alcoholic Liver Disease: Red palms, spider-like blood vessels on the skin, and swollen abdomen (21)

Chronic Liver Failure: Mental confusion, personality changes (hepatic encephalopathy).

When to See a Doctor. Seek immediate medical attention if jaundice is accompanied by: High fever and chills, Severe abdominal pain Confusion or unconsciousness Unexplained weight loss Persistent vomiting (22-23)

AIM AND OBJECTIVE

AIM:

To study the clinical aspects of jaundice including its causes, diagnosis, treatment, and management, and to evaluate the level of public awareness regarding the condition for better health outcomes and preventive strategies.

OBJECTIVES:

1. To understand the pathophysiology and etiology of jaundice.
2. To analyze various diagnostic methods used in identifying jaundice and its underlying causes.
3. To evaluate the available treatment and management strategies for different types of jaundice.
4. To assess complications associated with delayed or improper treatment of jaundice.
5. To study a clinical case of jaundice for practical insight into real-world diagnosis and treatment.
6. To examine the level of public awareness and knowledge about jaundice and its prevention.
7. To suggest possible public health interventions to improve awareness and early diagnosis of jaundice.

Diagnosis of Jaundice:

To diagnose jaundice, doctors focus on identifying the underlying cause by conducting a combination of physical examinations, blood tests, and imaging studies.

1. Medical History and Physical Examination

Patient History: The doctor asks about symptoms, travel history, alcohol consumption, medications, family history of liver disease, and any recent infections.

Physical Examination: The doctor checks for yellowing of the skin and eyes, liver enlargement, spleen enlargement, and signs of liver disease (e.g. fluid buildup in the abdomen). (29)

2. Laboratory Tests (Blood Tests)

Blood tests are essential for determining bilirubin levels and identifying the cause of Jaundice

1. 1. Bilirubin Test

Total Bilirubin – Measures overall bilirubin levels in the blood.

Direct (Conjugated) Bilirubin – Indicates if bilirubin is being processed properly by the liver

Indirect (Unconjugated) Bilirubin – Helps determine if jaundice is due to excessive RBC breakdown.  (30)

1. 2. Liver Function Tests (LFTs)

Alanine Aminotransferase (ALT) & Aspartate Aminotransferase (AST) – High levels indicate liver damage. Alkaline Phosphatase (ALP) & Gamma-Glutamyl Transferase (GGT) – Elevated in bile duct obstruction.

Albumin & Total Protein – Low levels suggest chronic liver disease. (31)

1. 3. Complete Blood Count (CBC)

Checks for anemia (low RBC count), infections, and abnormal white blood cells.

1. 4. Prothrombin Time (PT) & INR

Measures blood clotting ability; prolonged clotting time suggests liver dysfunction.

1. 5. Viral Hepatitis PanelHepatitis A, B, C, D, and E Tests – Identify viral infections causing jaundice.
   6. Hemolysis Tests (If Hemolytic Jaundice is Suspected) Reticulocyte Count Measures new RBC production.

Haptoglobin & Lactate Dehydrogenase (LDH) Helps diagnose hemolytic anemia. (32)

3. Imaging Tests

If liver or bile duct problems are suspected, imaging tests help identify blockages, tumors, or liver abnormalities.

Ultrasound (USG Abdomen):  First-line test to check for liver size, gallstones, and bile duct obstructions.

CT Scan (Computed Tomography):  Provides detailed images of the liver, pancreas, and bile ducts.

MRI/MRCP (Magnetic Resonance Cholangiopancreatography): Detects bile duct blockages and liver abnormalities.

Liver Biopsy: If liver disease or cancer is suspected, a small liver tissue sample is taken for analysis.

4. Specialized Tests

Endoscopic Retrograde Cholangiopancreatography (ERCP) – Helps diagnose and treat bile duct obstructions.

Autoimmune Liver Disease Tests: If autoimmune hepatitis is suspected Genetic Testing If hereditary liver diseases (like Gilbert’s syndrome) are suspected. (33)

5. TREATMENT FOR JAUNDICE

• Dietary Management: Avoid oily and spicy food, increase water intake.
• Medications: Liver-supportive drugs and antiviral therapies.
• Herbal Remedies: Turmeric, Phyllanthus Niruri, and Guduchi. Echinopus echinatus General Treatment for Jaundice Since jaundice is a symptom of an underlying condition, its treatment depends on the cause. However, some general treatments can help manage jaundice and support liver function. (33)
• Diet and Lifestyle Changes:

Drink plenty of water: Helps flush out toxins and improve liver function

Eat a healthy diet: Include fresh fruits, vegetables, whole grains, and lean proteins. Avoid oily, spicy, and processed foods

Reduces liver strain. Stop alcohol consumption Alcohol worsens liver conditions. Get adequate rest Helps the body recover. (34)

• Medications and Supplements:

Liver-supportive medicines:  Such as hepatoprotective drugs (e.g., Ursodeoxycholic acid, S-adenosyl methionine).

Vitamin supplements: Especially vitamin B-complex and C to support liver health. Avoid harmful medications: Reduce the use of drugs like paracetamol (acetaminophen) that can damage the liver. (35)

• Hydration and Detoxification:

Increase fluid intake: Coconut water, fresh fruit juices, and herbal teas help in detoxification.

Consume fiber-rich foods: Aids digestion and prevents constipation.

• Monitoring and Medical Support:

Regular liver function tests (LFTs) – To monitor liver health.

Consult a doctor if symptoms worsen – Severe jaundice may require hospitalization. These general treatments support recovery from jaundice, but proper medical evaluation is necessary to address the root cause effectively. (36)

• Herbal treatment

Echinopus echinatus produce hepatoprotective action In a study, flavonoids were isolated from the roots of E. echinopus and the whole plant of E. echinatus, suggesting that these flavonoids may contribute to the hepatoprotective effects of the extracts. An ethanolic extract from the aerial parts of Echinops echinatus Roxb .was evaluated for its hepatoprotective activity. Rabbits were treated with doses of 500 and 750 mg/kg/day orally for 7 days, alongside carbon tetrachloride (CCl?) intoxication at 0.75 ml/kg subcutaneously. Silymarin, a standard hepatoprotective drug, was administered at 100 mg/kg/day orally for the same duration.The CCl?-intoxicated group exhibited significantly elevated levels of serum markers SGOT, SGPT, and ALP, while total bilirubin (TB) levels remained unchanged compared to the normal control group. Histopathological analysis of liver tissue further confirmed the hepatoprotective activity of the extract, indicating its potential therapeutic benefits in liver protection. (37)

5. METHODOLOGY

The case study will follow a structured methodology including:

• Patient Selection:

A real-life case of a jaundice patient will be analyzed to take their information, history sign symptoms etc

• Data Collection:

Medical history, clinical symptoms, their family history and overall health consult to face to face discussion with the patients

• Diagnostic Approach:

LFTs, bilirubin levels, imaging tests (ultrasound, CT scan), and hepatitis screening.

• Treatment & Management:

Medications, give herbal medication such as echinopus echanatus plant extraxt, lever friendly medication and suppliments and also supportive care.

• Follow-up &Prognosis:

Monitoring the patient’s recovery and assessing treatment effectiveness (38)

• Analysed all documents

To collect and analysed and make a plan to public awareness

• Public awareness

Provide information to the public about the lever disease and disorder (jaundice) through the face to face interaction (39)

5.  CASE STUDY

Here’s a sample case study of a patient with jaundice, covering history, symptoms, diagnosis, and treatment. (40)

1. Patient Information:

Name of patient:- Mr. Aman sharma

Age :- 36 years

Gender: - Male

Occupation: - proprietor

Address: - shelgao (maharashtra)

Chief Complaint: Yellowish discoloration of skin and eyes for 10 days

2. History of Present Illness:

Noticed yellowing of eyes and skin 10 days ago.

Dark-colored urine and pale stools for 7 days.

Complains of fatigue, loss of appetite, and mild nausea.

No history of fever, vomiting, or abdominal pain

No previous liver disease, And any Habits such as alcohol and smoking

3. Past Medical History:

No history of diabetes, hypertension, or tuberculosis.

No history of previous jaundice or blood transfusion.

4. Family History:

No family history of liver disease or genetic disorders.

5. Clinical Examination:

General Appearance: Mildly weak, yellowish skin and sclera.

Vital Signs:

Blood Pressure: 150/100 mmHg

Heart Rate: 94 bpm

Temperature: Normal (100.6°F) (41)

6. Diagnostic Tests:

Liver Function Test (LFT): Total Bilirubin: 6.5 mg/dL (High)Direct Bilirubin: 4.2 mg/dL (High)AST/ALT: 250/300 IU/L (Elevated, suggesting liver damage)

Alkaline Phosphatase: 180 IU/L (Mildly elevated)

Complete Blood Count (CBC): Normal, no signs of infection.

Hepatitis Panel: Negative for Hepatitis A, B, C.

Ultrasound Abdomen: Fatty liver changes detected. No gallstones or bile duct obstruction.

7. Treatment Plan:

Lifestyle Modifications: Complete alcohol cessation if drink High-protein, liver-friendly diet.

Medications: Liver protective drugs (Ursodeoxycholic acid, S-Adenosyl Methionine). Multivitamins (B-complex, Vitamin E). Hydration therapy (IV fluids if necessary).

8. Prognosis:

If avoid harmful substances such as alcohol and liver haters substance completely stopped then and then recovery is possible. To take a healthy diet and lifer friendly substance

9. Follow-up Plan:

Repeat LFT after 2 weeks. Monitor for complications like cirrhosis. (42)

5. PUBLIC AWARENESS

Theme of this study is: “Jaundice and Public Health: A Call for Awareness and Action” The following are information are produced to aware the public and produce public awareness about the lever disease and Jaundice The following points to be covered during the public awareness and provide a very essential information about the Hepatic disease and Jaundice

What is Jaundice?

Jaundice is a condition where the skin, eyes, and urine turn yellow due to increased levels of a substance called bilirubin in the blood.

Common Symptoms:

• Yellowing of eyes and skin
• Dark yellow urine
• Pale-colored stool
• Fatigue and weakness
• Loss of appetite
• Nausea or vomiting
• Painin the upper right abdomen

Major Causes

• Infection like Hepatitis A, B, C
• Dirty drinking water and poor sanitation
• Liver damage from alcohol or medicines
• Gallstones or liver blockage
• Inherited blood disorders

How to Prevent Jaundice:

• Drink clean and safe water
• Wash hands before eating
• Eat fresh and home-cooked food
• Avoid alcohol and self-medication
• Get vaccinated against Hepatitis A & B
• Avoid sharing needles, razors, or toothbrushed

Important Tips:

• Don’t ignore yellow eyes or urine
• See a doctor immediately if symptoms appear
• Follow a healthy lifestyle and hygiene
• Protect your liver – it keeps you alive!

Remember:

Early diagnosis = Easy treatment

Awareness is better than regret! (43)

Actual Mode of Transmission of Jaundice

There are different types of jaundice, and the mode of transmission depends on the underlying cause:

Hepatitis A & E: These types of viral jaundice spread through the fecal-oral route, usually by consuming contaminated food or water. It is not spread through physical touch or casual contact.

Hepatitis B & C: These spread through blood and body fluids, such as by sharing needles, unsafe transfusions, or unprotected sex. They do not spread through sharing food, water, or hugging.

Hemolytic or Obstructive Jaundice: These are non-infectious and do not spread from person to person.

Therefore, avoiding or isolating jaundice patients due to fear of infection is often unnecessary and harmful. (44)

1. Communicable Jaundice (Infectious)

Caused by viral infections like: Hepatitis A (fecal-oral route – contaminated food/water) Hepatitis B & C (blood, sexual contact, needle sharing) These are transmissible from person to person. So, in these cases, jaundice is a symptom of a communicable disease.

2. Non-Communicable Jaundice (Non-infectious):

Caused by: Hemolysis (Hemolytic Jaundice) Gallstones or tumors (Obstructive Jaundice) Liver damage from alcohol or drugs These conditions are not spread from person to person. So, in these cases, jaundice is a symptom of a non-communicable disease. (45)

Public Awareness Conclusion

As a part of this clinical case study on jaundice, a public awareness campaign was conducted to educate the general population about the causes, symptoms, diagnosis, treatment, and prevention of jaundice. The campaign focused on eliminating common myths, encouraging early diagnosis, and promoting supportive behavior towards patients.

The awareness activities include: -

Distribution of informative about jaundice

Face-to-face interaction with people in the community Explanation of hygienic practices to prevent Hepatitis A & E Clarification of the non-communicable nature of obstructive and hemolytic jaundice Short Q&A with the public to assess their understandingThe response from the public was encouraging. Many individuals expressed that they were unaware of the real causes and modes of transmission of jaundice. Through this campaign, a significant improvement in awareness and attitude towards jaundice patients was observed. This activity not only enhanced public knowledge but also helped develop my own communication skills and sense of social responsibility as a pharmacy student. (46,47)

5. SUMMARY

This clinical case study titled “A Clinical Case Study on Jaundice: Causes, Diagnosis, Treatment, Management, and Public Awareness” was undertaken to gain in-depth knowledge about jaundice and to spread awareness among the general public. Through this project, a detailed understanding of various types of jaundice including hemolytic, hepatic, and obstructive was achieved. The study involved analyzing the etiology, signs and symptoms, diagnostic procedures, treatment approaches, and preventive measures.

• Introduction of the Case

This case study focuses on Mr. Aman Sharma, a 36-year-old male patient from Shelgao, Maharashtra. The patient presented with yellowing of skin and eyes for the past 10 days. Additional symptoms included dark-colored urine, pale stools, fatigue, mild nausea, and loss of appetite. No history of alcohol consumption, smoking, fever, vomiting, abdominal pain, or prior liver disease was reported.

• Clinical Examination and Diagnosis

General Condition: Mildly weak with noticeable yellowish discoloration of the skin and sclera.

Blood Pressure: 150/100 mmHg

Heart Rate: 94 bpm

Temperature: Normal (100.6°F)

Diagnostic Tests: Liver Function Test (LFT): Total Bilirubin – 6.5 mg/dL; Direct Bilirubin – 4.2 mg/dL

AST/ALT: 250/300 IU/L – indicating liver cell injury Alkaline Phosphatase: 180 IU/L – mildly elevated

CBC: Within normal limits – no infection

Hepatitis Panel: Negative for Hepatitis A, B, and C

Ultrasound Abdomen: Fatty liver changes detected, no gallstones or bile duct obstruction

• Treatment and Management Plan

Lifestyle Modifications: Complete avoidance of   liver-harming substances Adoption of a liver-friendly, protein-rich diet

Medications: Ursodeoxycholic Acid and S-Adenosyl Methionine for liver protection-complex vitamins and Vitamin EAdequate hydration (oral/IV as needed) Rest and Monitoring: The patient was advised rest and regular follow-up.

• Prognosis and Follow-up

Prognosis is favorable if the patient strictly avoids alcohol and follows dietary advice. Repeat LFTs were recommended after 2 weeks to monitor liver function. Monitoring for long-term complications such as cirrhosis was advised.

• Public Awareness Campaign

As part of this study, a public awareness initiative was conducted with the theme:

“Jaundice and Public Health: A Call for Awareness and Action”

Purpose: To educate people about symptoms, causes, prevention, and myths regarding jaundice.

Topics Covered:

What is jaundice and its types

Common symptoms: yellow skin/eyes, dark urine, pale stools, etc.

Modes of transmission (infectious vs. non-infectious)

Preventive measures: hygiene, clean water, vaccination, safe practices

• Awareness Activities Conducted

Distribution of informative leaflets and posters in the community

Face-to-face interaction and group discussions

Explanation of hygienic practices to prevent Hepatitis A & E

Correction of common misconceptions (e.g., jaundice is always contagious)

Short Q&A sessions to assess public understanding

Use of educational charts and slogans

• Outcome of Awareness Campaign

The campaign received a positive response from the local community.

Many people expressed they were unaware of actual causes and modes of transmission.

The activity led to:

Improved community knowledge

Reduction in stigma toward jaundice patients

Enhanced communication and social responsibility skills in the pharmacy students

CONCLUSION

This project presented a comprehensive clinical case study of jaundice, focusing on the patient’s medical history, diagnosis, treatment, and a public health awareness initiative. Through the case of Mr. Aman Sharma, it was demonstrated how jaundice can arise without viral infection or alcohol abuse and still present serious liver dysfunction due to fatty liver disease. Diagnostic tools such as Liver Function Tests and ultrasound imaging played a critical role in identifying the cause and extent of the condition. The treatment plan highlighted the Importance of early diagnosis, lifestyle modification, and liver-supportive medication. With proper management and follow-up, the prognosis for such patients remains positive, provided liver-harming substances are avoided and nutritional guidelines are followed. In addition, the public awareness campaign conducted as part of this project helped in educating the community about jaundice its causes, symptoms, modes of transmission, and prevention strategies. This initiative clarified myths such as the fear of touching or isolating jaundice patients unnecessarily. It also reinforced the importance of hygiene, vaccination, and safe practices to prevent infectious forms of jaundice like Hepatitis A and B. Overall, this project not only enhanced understanding of jaundice from a clinical and pharmacological perspective but also emphasized the crucial role of pharmacists in community health education, disease prevention, and patient counseling. It also helped build a strong foundation in applying theoretical knowledge to real-world public health concerns.

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