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JAUNDICE (Fr. jaunisse, from jaune, y...

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Originally appearing in Volume V15, Page 282 of the 1911 Encyclopedia Britannica.
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JAUNDICE (Fr. jaunisse, from jaune, yellow), or IUTERUS (from its resemblance to the See also:colour of the See also:golden See also:oriole, of which See also:Pliny relates that if a jaundiced See also:person looks upon it he recovers but the See also:bird See also:dies) , a See also:term in See also:medicine applied to a yellow coloration of the skin and other parts of the See also:body, depending in most instances on some derangement affecting the See also:liver. This yellow colour is due to the presence in the See also:blood of bile or of some of the elements of that secretion. Jaundice, however, must be regarded more as a symptom of some morbid See also:condition previously existing than as a disease per se. Cases with jaundice may be divided into three See also:groups. 1. Obstructive Jaundice.—Any obstruction of the passage of bile from the liver into the intestinal See also:canal is sooner or later followed by the See also: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 See also: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 See also:tumour growing from the duct; (5) pressure on the duct from without, from the liver or other See also:organ, or tumours arising from them. Obstructions from these causes may be partial or See also: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 See also: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 See also:place an increase in its See also: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 See also:atrophy in its whole texture. The bile thus retained is absorbed into the See also: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, which in such circumstances See also:act in some measure vicariously to the liver and excrete a portion of the retained bile, are See also:apt to become affected in their structure by the See also: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 See also:

common or hepatic duct, there will probably be the symptoms of intense suffering characterizing hepatic See also:colic (see Colic). In the cases most frequently seen—those, namely, arising from See also:simple See also:catarrh of the bile ducts due to gastro-duodenal irritation spreading through the common duct—the first sign to attract See also:attention is the yellow appearance of the See also:white of the See also: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, See also: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 See also:saffron yellow, while in extreme degrees of obstruction it may be of dark See also:brown or greenish See also:hue. The colour can scarcely, if at all, be observed in artificial See also: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 See also:porter, but after See also:standing in the See also:air it acquires a greenish tint. Its froth is greenish-yellow, and it stains with this colour any white substance. It contains not only the bile colouring See also:matter but also the bile acids. The former is detected by the See also:play of See also:colours yielded on the addition of nitric See also:acid, the latter by the See also:purple colour, produced by placing a piece of lump See also:sugar in the urine tested, and adding thereto a few drops of strong sulphuric acid.

The contents of the bowels also undergo changes, being characterized chiefly by their See also:

pale See also:clay colour, which is in proportion to the amount of hepatic obstruction, and,to their consequent want of admixture with bile. For the same See also: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 See also:pulse. The appetite is usually but not always diminished, a See also:bitter See also:taste in the mouth is complained of, while flatulent eructations arise from the See also:stomach. Intolerable itching of the skin is a common See also:accompaniment of jaundice, and cutaneous eruptions or boils are occasionally seen. Yellow See also:vision appears to be See also:present in some very rare cases. Should the jaundice depend on advancing organic disease of the liver, such as See also:cancer, the tinge becomes gradually deeper, and the emaciation and debility more marked towards the fatal termination, which in such cases is seldom long postponed. Apart from this, however, jaundice from obstruction may exist for many years, as in those instances where the walls of the bile ducts are thickened from chronic catarrh, but where they are only partially occluded. In the common cases of acute catarrhal jaundice recovery usually takes place in two or three See also:weeks. The treatment of this See also:form of jaundice bears reference to the cause giving rise to the obstruction. In the See also:ordinary cases of simple catarrhal jaundice, or that following the passing of See also:gall-stones, a light nutritious See also:diet (See also:milk, soups, &c., avoiding saccharine and farinaceous substances and alcoholic stimulants), along with See also:counter-irritation applied over the right See also:side and the use of laxatives and cholagogues, will be found to be advantageous.

See also:

Diaphoretics and diuretics to promote the See also:action of the skin and kidneys are useful in jaundice. In the more chronic forms, besides the remedies above named, the See also:waters of See also:Carlsbad are of See also:special efficacy. In cases other than acute catarrhal, operative interference is often called for, to remove the gall-stones, tumour, &c., causing the obstruction. 2. Toxaemic Jaundice is observed to occur as a symptom in certain fevers, e.g. yellow See also:fever, See also:ague, and in pyaemia also as the effect of certain poisons, such as See also:phosphorus, and the venomof snake-bites. Jaundice of this See also: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. See also: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 See also:group there are the jaundice of new-See also:born infants, which varies enormously in severity; the cases in which a slight form of jaundice obtains in several members of the same See also:family, without other symptoms, and which may persist for years; and lastly the group of cases with hypertrophic cirrhosis. The name See also: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)

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