(ICTERUS)
=Jaundice= is a symptom and not a disease. It consists of the
discoloration of the skin and other tissues by material derived from
the bile. The discoloration may vary from a mere paleness to a yellow
or brown olive hue.
=Toxic= jaundice occurs in acute yellow atrophy, pernicious anemia,
pyemia, specific fevers, and the action of poisons.
=Obstruction= by foreign bodies as gall-stones and parasites are
important causes. Inflammation and swelling of the biliary ducts and
duodenum are common causes as well as stricture of the duct by tumors
and various growths, either internal or external, to the biliary ducts.
In some instances pressure from without by the pancreas, stomach,
kidneys, enlarged glands, fecal matter, a pregnant uterus, etc., has
been the cause. Irritations and obstructions of the splanchnic nerves,
due to lesions in the lower dorsal vertebræ and the ribs from the sixth
to the eleventh, will often markedly affect the liver. Also lesions at
these points may predispose to inflammation and tumefaction of the bile
ducts.
=Symptoms.=—Besides the discoloration of the skin, there is itching
of the skin, on account of bile pigment deposits; even eruptions may
occur. The mucous membranes are often colored and a constant symptom
is the bright yellow discoloration of the sclerotic coat of the eye.
The secretions are colored. It may be first noticed in the urine. The
perspiration is colored, rarely the saliva and tears. There is frequent
sweating.
As very little bile passes into the intestine, the feces are pale
and gray, and sticky. The bowels are generally constipated, but
diarrhea may occur, owing to decomposition resulting from absence of
the normal ingredients. Other symptoms may be associated with the
gastro-intestinal derangements, as nausea, fetid breath and loss of
appetite. A slow pulse may occur, due probably to some stimulating
effect on the inhibitory action of the vagus nerve. Lesions are often
found at the atlas and axis, affecting the vagus. Pain back of the
right scapula is a symptom of liver trouble; it has been suggested that
it is due to a stimulus passing up the vagus to the spinal accessory,
and thence to the trapezius muscle.
Various cerebral symptoms may be present, as great depression,
irritability, headache and vertigo. In severe cases there may be
delirium and coma.
In =hemolytic= and =toxic jaundice= the destruction of blood is due to
some toxic agent. The feces are not clay colored and the urine is less
stained with bile. The general symptoms may be very severe depending
upon the underlying cause.
=Diagnosis.=—To mistake for jaundice the dirty yellowish discoloration
of the skin commonly termed sallowness is an error often made. This
condition indicates malaria, uterine disease or general ill health.
Very likely it is an anemia and is readily diagnosed from the jaundice
as the secretions and conjunctiva are not stained. Addison’s disease
somewhat resembles jaundice, but the feces are normal, the urine and
sclerotic coat are not colored, but exposed portions of the body and
flexures of the joints are deeply stained.
=Prognosis.=—Depends entirely on the cause producing it. Ordinary cases
run from two to six weeks, while others may not recover for several
months. Jaundice from impaction of the bile ducts may be manifest for
only a few days. Toxic form may terminate fatally, owing to the disease
causing it. The extent of resorption of bile and destruction of red
blood cells in the liver varies to a considerable degree.
=Treatment.=—The treatment for the different forms resulting
secondarily will be found under the diseases causing them. A simple
icterus, caused by disturbance through the innervation of the liver
and bile ducts directly, can be relieved readily by thorough treatment
of the liver and bile ducts as described under catarrhal jaundice.
Carefully raise the intestines if they are prolapsed, especially the
colon and duodenum.