gulsot

Gulsot, or jaundice, is a yellowing of the skin and the whites of the eyes caused by elevated bilirubin in the blood. It occurs when bilirubin production exceeds clearance or when bilirubin handling by the liver is impaired.

Causes and classification: Jaundice can be categorized as prehepatic (before the liver, typically from increased red blood cell breakdown), hepatic (liver disease or impaired liver function), or posthepatic (obstruction of bile flow). Common causes include hemolytic anemias, viral or alcoholic liver disease, cirrhosis, biliary obstruction from gallstones or pancreatic cancer, and drug-induced liver injury. Neonates commonly develop physiological jaundice due to immature bilirubin metabolism, and breastfeeding jaundice can also occur.

Symptoms: The hallmark is yellowing of the skin and eyes. Dark urine and pale stools may accompany hepatic or obstructive causes. Itching, fatigue, abdominal pain, or systemic signs may occur depending on the underlying disorder.

Diagnosis: Evaluation begins with history and physical examination, followed by laboratory tests measuring total and direct bilirubin, liver enzymes (ALT/AST, alkaline phosphatase), and bilirubin fractions. A complete blood count and reticulocyte count help assess hemolysis. Imaging such as abdominal ultrasound or MRCP may identify biliary obstruction. In newborns, bilirubin levels guide risk assessment for potential complications and treatment decisions like phototherapy.

Management: Treatment targets the underlying cause. In newborns, phototherapy or exchange transfusion may be used for high bilirubin levels. In adults, management ranges from antiviral therapy for hepatitis to relieving biliary obstruction endoscopically or surgically, with supportive care as needed.

Prognosis: Outcome depends on the underlying cause and timeliness of treatment. Untreated severe hyperbilirubinemia can lead to serious complications, including brain injury in newborns or progressive liver disease in adults.