Jaundice (पीलिया) — सम्पूर्ण Hindi Guide
यह लेख पीलिया के हर पहलू को clinical और practical दृष्टि से कवर करता है — प्रकार, pathology, symptoms, tests, medicines, treatment, और डाइट-राय। नीचे Table of Contents से सीधे ज़रूरी हिस्से पर जाएँ।
सामग्री-सूची (Jump to)
Introduction & Bilirubin Basics Types of Jaundice — Pre-hepatic / Hepatic / Post-hepatic Pre-hepatic (Hemolytic): Pathology, Symptoms, Tests, Treatment, Diet Hepatic (Intrinsic): Causes, Pathology, Symptoms, Tests, Treatment, Diet Post-hepatic (Obstructive): Causes, Pathology, Symptoms, Tests, Treatment, Diet General Symptoms Diagnosis & Investigations Treatment — Medical, Surgical & Supportive Common Medicines & Rationale Dietary Guidelines — Avoid / Recommended Complications & Prognosis Prevention & Vaccination FAQ Internal Resources & Links ConclusionIntroduction — Jaundice और Bilirubin का संक्षेप विज्ञान
Jaundice / पीलिया त्वचा, conjunctiva और म्यूकस मेम्ब्रेन का पीलापन है, जो रक्त में बिलिरुबिन के बढ़ने का clinical संकेत है। बिलिरुबिन haemoglobin degradation का product है — unconjugated (indirect) बिलिरुबिन liver में conjugate होकर direct बिलिरुबिन बनता है और bile से बाहर निकलता है।
किसी भी स्टेप में बढ़ोतरी/रुकावट (RBC hemolysis, hepatocellular dysfunction, biliary obstruction) से बिलिरुबिन बढ़ सकता है और पीलिया दिखता है।
Types of Jaundice — तीन मुख्य प्रकार
पीलिया तीन समूह में आता है — प्रत्येक का कारण, पाथोलॉजी, presentation और इलाज अलग होता है:
- Pre-hepatic (Hemolytic) — RBC टूटने से excess unconjugated bilirubin.
- Hepatic (Intrinsic) — hepatocyte dysfunction (viral, alcoholic, metabolic, autoimmune).
- Post-hepatic (Obstructive / Cholestatic) — bile duct obstruction → conjugated bilirubin ↑, pale stools, pruritus.
Pre-hepatic Jaundice (Hemolytic)
Pathology
RBC destruction (hemolysis) बढ़ने से bilirubin production अनियंत्रित बढ़ता है। Liver conjugation capacity temporarily overloaded रहती है।
Common causes
- Autoimmune hemolytic anemia
- Hemoglobinopathies (thalassemia), hereditary spherocytosis
- G6PD deficiency (drug/food triggered)
- Infections: malaria
- Transfusion reactions
Symptoms
- हल्का-से मद्धम पीलापन (scleral icterus early)
- थकान, weakness (anemia related)
- Splenomegaly possible
Tests / Pathology markers
- CBC (low Hb), reticulocyte count ↑
- Peripheral smear (schistocytes, spherocytes)
- Indirect bilirubin elevated; LDH ↑; haptoglobin ↓
- Direct Coombs test (autoimmune hemolysis)
Treatment
- Cause specific: steroids (autoimmune), transfusion (severe anemia), antimalarials (malaria)
- IV fluids, renal monitoring (pigment nephropathy risk in massive hemolysis)
- Splenectomy in refractory hereditary cases (select patients)
Medicines commonly used
- Corticosteroids (prednisone) for autoimmune hemolysis
- IVIG in severe immune hemolysis
- Antimalarials as per species (artemisinin based combinations)
Diet & Avoidance
- Hydration important to aid renal clearance
- Avoid triggers in G6PD (primaquine, sulfa drugs, fava beans)
- Iron supplementation only if iron deficiency proven; otherwise avoid unnecessary iron in hemolytic anemias
Primary goal: hemolysis का कारण ढूँढें और हटाएँ; liver-directed therapy सामान्यतः नहीं चाहिए।
Hepatic Jaundice (Intrinsic liver disease)
Pathology
Hepatocyte injury से bilirubin uptake, conjugation या excretion बाधित होते हैं। Hepatocellular inflammation/necrosis और cholestasis दोनों हो सकते हैं।
Common causes
- Viral hepatitis (A, B, C, E)
- Alcoholic hepatitis / chronic alcohol use
- Drug-induced liver injury (eg. paracetamol overdose, ATT drugs)
- NAFLD / NASH (metabolic)
- Autoimmune hepatitis, Wilson disease, hemochromatosis
Symptoms
- Yellow skin/eyes, dark urine, nausea, anorexia
- Abdominal discomfort, low-grade fever (if infective)
- Advanced: ascites, bleeding tendency, encephalopathy
Tests / Pathology
- LFT panel: ALT, AST (hepatocellular), ALP/GGT (cholestatic), total & direct bilirubin
- Albumin, PT/INR (synthetic function)
- Viral markers: HBsAg, Anti-HCV, HEV IgM (acute)
- Autoimmune serology, ceruloplasmin (in young patients), iron studies
- Imaging: ultrasound, FibroScan, CT/MRI; liver biopsy when indicated
Treatment approach
- Viral hepatitis: Hep A/E supportive; HBV antivirals (tenofovir/enecavir) if indicated; HCV DAAs (curative).
- Alcoholic hepatitis: alcohol abstinence, nutritional support, steroids in selected severe cases (Maddrey score).
- Drug-induced: stop offending drug; NAC for paracetamol overdose.
- Wilson / hemochromatosis: chelation therapy / phlebotomy as applicable.
Medicines commonly used
- Antivirals: Tenofovir/Entecavir (HBV); Sofosbuvir-based DAAs (HCV)
- UDCA for cholestatic conditions (selected)
- Vitamin K for coagulopathy correction (if INR elevated)
Diet & Support
- Avoid alcohol absolutely
- Light, frequent meals; sufficient calories to avoid catabolism
- Protein: maintain adequate intake; in encephalopathy manage per specialist guidance (often adjust but not long-term restrict)
- Fruits like guava (Vitamin C) and banana (electrolyte support) helpful — refer internal posts for details
Monitor INR, creatinine, electrolytes regularly; severe hepatic failure may require ICU care and liver transplant evaluation.
Post-hepatic (Obstructive) Jaundice — Cholestasis
Pathology
Bile duct obstruction (intra/extrahepatic) → conjugated bilirubin cannot be excreted → cholestasis, pruritus, fat-soluble vitamin malabsorption।
Causes
- Choledocholithiasis (common bile duct stones)
- Cholangiocarcinoma, pancreatic head carcinoma
- Post-operative strictures, PSC (primary sclerosing cholangitis)
- Drug-induced cholestasis
Symptoms
- Severe pruritus, pale/clay stools, dark urine
- RUQ pain (if biliary colic), fever if ascending cholangitis
Tests & Imaging
- ALP & GGT markedly raised; direct bilirubin high
- Abdominal US — biliary dilation; MRCP for ductal anatomy
- ERCP — diagnostic + therapeutic (stone extraction/stent)
Treatment
- ERCP with sphincterotomy & stone extraction for choledocholithiasis
- Biliary stenting or surgery for malignant obstruction
- IV antibiotics + urgent decompression for ascending cholangitis
Dietary advice
- Low-fat meals during acute phase
- Monitor & supplement fat-soluble vitamins (A, D, E, K) if chronic cholestasis
Ascending cholangitis (fever, jaundice, RUQ pain ± hypotension/confusion) is an emergency — urgent hospital referral required.
General Symptoms — क्या देखें (Quick)
- Scleral icterus (आँखों में पीलापन) और skin yellowing
- Dark urine, pale stools (obstructive)
- Pruritus, fatigue, nausea, abdominal discomfort
- Bleeding tendency (if synthetic liver function impaired)
- Confusion, asterixis — hepatic encephalopathy signs
Diagnosis & Investigations — कौन-सी जाँच कब जरूरी
Initial labs
- CBC, LFT panel (total/direct/indirect bilirubin, ALT, AST, ALP, GGT), albumin
- PT/INR (liver synthetic function)
- Renal panel, blood sugar, electrolytes
Cause-specific tests
- Viral markers (HBsAg, Anti-HCV, HEV IgM)
- Hemolysis workup (LDH, haptoglobin, reticulocyte count, peripheral smear)
- Autoimmune serologies, ceruloplasmin, iron studies depending on context
Imaging & procedures
- Abdominal ultrasound (first line)
- MRCP / CT abdomen (tumor evaluation)
- ERCP — both diagnostic & therapeutic for obstruction
- Liver biopsy — selected cases for diagnosis/staging
Treatment Principles — Medical, Surgical & Supportive
- Identify & treat underlying cause (antivirals, remove obstruction, treat hemolysis)
- Supportive care: hydration, nutrition, correction of coagulopathy (vitamin K), monitoring
- Surgical/endoscopic intervention for obstructive causes (ERCP, stenting, surgery)
- Newborn: phototherapy ± exchange transfusion based on bilirubin thresholds
Common Medicines & Rationale
| Indication | Examples | Notes |
|---|---|---|
| HBV (active) | Tenofovir, Entecavir | Long-term; monitor renal function (TDF) |
| HCV | DAAs (Sofosbuvir/Velpatasvir, Glecaprevir/Pibrentasvir) | High cure rates |
| Paracetamol overdose | NAC (N-acetylcysteine) | Early use prevents severe liver injury |
| Cholestatic pruritus | UDCA, Cholestyramine | UDCA improves bile flow; cholestyramine binds bile salts |
| Encephalopathy | Lactulose, Rifaximin | Reduce gut ammonia production and absorption |
दवा-निर्देश डॉक्टर के अनुसार लें; dosing, contraindications और monitoring ज़रूरी हैं।
Dietary Guidelines — Recommended & Avoid (Practical)
Principles
- Light, frequent meals; maintain calorie adequacy
- Adequate hydration; avoid alcohol completely
- Maintain protein to support healing — adjust only if encephalopathy
- Avoid fried, oily, very spicy and raw shellfish in endemic areas
Recommended foods (examples)
- Fruits: guava (vitamin C & fiber) — Guava — Benefits
- Banana for energy & potassium — Banana — Benefits
- Anjeer (figs) as energy-dense snack — Anjeer — Benefits
- Lean protein: eggs (boiled), dal, low-fat dairy (if tolerated)
- Steamed/boiled vegetables, soups, daliya, khichdi
Foods to avoid
- Alcohol (major risk factor)
- Fried/oily/spicy foods
- Raw/undercooked seafood in HAV/HEV areas
- Excess supplements without medical advice (esp. hepatotoxic herbs)
Cholestatic patients may need fat-soluble vitamin supplementation (A, D, E, K) after testing and under medical advice.
Complications & Prognosis
- Chronic liver disease / cirrhosis
- Hepatic encephalopathy
- Portal hypertension, variceal bleed
- Ascites, spontaneous bacterial peritonitis
- Progression to hepatic failure — may need transplant in select cases
Prognosis depends on cause, severity and timeliness of treatment — acute self-limited viral hepatitis often recovers, chronic causes require long-term care & surveillance.
Prevention & Public Health
- Hepatitis B vaccination (primary prevention)
- Safe injections & transfusion practices
- Safe water & sanitation (prevent HAV/HEV outbreaks)
- Avoid excessive alcohol; manage metabolic risk factors to prevent NAFLD
FAQ — अक्सर पूछे जाने वाले प्रश्न
पीलिया हमेशा लिवर की बीमारी है क्या?
नहीं। Pre-hepatic (hemolytic) स्थितियों में पीलिया RBC टूटने से आता है; hepatic और post-hepatic में लिवर/बाइल डक्ट की प्राथमिक भूमिका रहती है।
नवजातों में पीलिया कितना सामान्य है?
नवजातों में physiologic jaundice आम है और अधिकतर phototherapy से नियंत्रित होता है; उच्च स्तर पर exchange transfusion जरूरी हो सकता है।
क्या घरेलू नुस्खे काम करते हैं?
हल्के supportive उपाय (hydration, हल्का आहार) उपयोगी हो सकते हैं पर कारण के अनुसार चिकित्सकीय जांच और इलाज अनिवार्य है।
Internal Resources & Related Posts
Conclusion & Action Points
- Jaundice एक symptom है — कारण पहचानना clinician का प्राथमिक कार्य है (hemolysis, hepatocellular injury, or obstruction)।
- Emergency indicators: rapid bilirubin rise, high fever with jaundice, hypotension, confusion — immediate hospital referral चाहिए।
- Dietary support, hydration और cause-directed therapy मिलकर recovery में मदद करते हैं।
- Prevention: vaccination (HBV), sanitation, safe transfusion practices, alcohol moderation।
Disclaimer: यह जानकारी शैक्षिक है। निदान/इलाज के लिए अपने डॉक्टर/हॉस्पिटल से संपर्क करें।