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Encyclopedia Britannica - Main :: INV-JED |
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JAUNDICE (Fr. jaunisse, from jaune, yellow), or IUTERUS (from its resemblance to the colour of the golden oriole, of which Pliny relates that if a jaundiced person looks upon it he recovers but the bird dies) , a term in medicine applied to a yellow coloration of the skin and other parts of the body
liver . This yellow colour is due to the presence in the blood of bile or of some of the elements of that secretion. Jaundice, however, must be regarded more as a symptom of some morbid condition previously existing than as a disease per se.Cases with jaundice may be divided into three groups. 1. 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 circumstances is due to the absorption of bile into the blood. The obstruction is due to one of the following causes: (I) 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 or 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.The effect upon the liver of impediments to the outflow of bile such as those above indicated is in the first place an increase in its size, the whole biliary passages and the liver cells being distended with retained bile. This enlargement, however, speedily subsides when the obstruction is removed, but should it persist the liver ultimately shrinks and undergoes atrophy in its whole texture. The bile thus retained 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
retained bile, are apt to become affected in their structure by the long continuance of jaundice. The symptoms of obstructive jaundice necessarily vary according to the nature of the exciting cause, but there generally exists evidence of some morbid condition before the yellow coloration appears. Thus, if the obstruction be due to an impacted gallstone in the common or hepatic duct, there will probably be the symptoms of intense suffering characterizing hepatic colic (see Colic). In the cases most frequently seenthose, namely, arising from simple catarrh of the bile ducts due to gastro-duodenal irritation spreading through the common ductthe first sign to attract attention is the yellow appearance of the white of the eye, which is speedily followed by a similar colour on the skin over the body generally. The yellow tinge is most distinct where the skin is thin, as on the forehead, breast, elbows, &c. It may be also well seen in the roof of the mouth, but in the lips and gums the colour is not observed till the blood is first pressed from them. The tint varies, being in the milder cases faint, in the more severe a deep saffron yellow, while in extreme degrees of obstruction it may be of dark brown or greenish hue. The colour can scarcely, if at all, be observed in artificial light. The urine exhibits well marked and characteristic changes in jaundice which exist even before any evidence can be detected on the skin or elsewhere. It is always of dark brown colour resembling porter
standing
The contents of the bowels also undergo changes, being characterized chiefly by their pale clay colour, which is in proportion to the amount of hepatic obstruction, and,to their consequent want of admixture with bile. For the same reason they contain a large amount of unabsorbed fatty matter, and have an extremely offensive odour. Constitutional symptoms always attend jaundice with obstruction. The patient becomes languid, drowsy and irritable, and has generally a slow pulse
The treatment of this form of jaundice bears reference to the cause giving rise to the obstruction. In the ordinary cases of simple catarrhal jaundice, or that following the passing of gall-stones, a light nutritious diet (milk, soups, &c., avoiding saccharine and farinaceous substances and alcoholic stimulants), along with counter-irritation applied over the right side and the use of laxatives and cholagogues, will be found to be advantageous. Diaphoretics and diuretics to promote the action of the skin and kidneys are useful in jaundice. In the more chronic forms, besides the remedies above named, the waters of Carlsbad are of special
2. Toxaemic Jaundice is observed to occur as a symptom in certain fevers, e.g. yellow fever, ague, and in pyaemia also as the effect of certain poisons, such as phosphorus, and the venomof snake-bites. Jaundice of this kind is almost always slight, and neither the urine nor the discharges from the bowels exhibit changes in appearance to such a degree as in the obstructive variety. Grave constitutional symptoms are often present, but they are less to be ascribed to the jaundice than to the disease with which it is associated. 3. Hereditary Jaundice.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 the group of cases with hypertrophic cirrhosis. The name malignant jaundice is sometimes applied to that very fatal form of disease otherwise termed acute yellow atrophy of the liver (see ATROPHY).End of Article: JAUNDICE (Fr. jaunisse, from jaune, yellow), or IUTERUS (from its resemblance to the colour of the golden oriole, of which Pliny relates that if a jaundiced person looks upon it he recovers but the bird dies) If you wish, you can link directly to this article.
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