Today I want to talk about a condition that can occur even when we are healthy, so it is not strictly speaking a disease but a symptom that is very evident when it occurs, but it can generate complications in extreme cases, I want to talk about Jaundice.

For many it is a known word, but for those who are not, it refers to the yellowish coloration of the skin due to an elevated concentration of a substance called Bilirubin. This substance is produced by the degradation of red blood cells, but for various reasons it is either produced in excess or the ability to be eliminated is diminished, which causes a particular coloration of the skin.

I will explain below, as usual, in a simple and practical way what this condition is, how it is generated, and what are its possible consequences.

Bilirubin is formed from the metabolism of red blood cells. This is after approximately 120 days of life, each of our erythrocytes loses properties to be able to continue doing their job, which causes them to be destroyed and taken out of circulation.

Let us remember that the red blood cells or erythrocytes have inside the Hemoglobin, which is the one that is in charge of transporting oxygen to the cells that need it, and in addition to collecting the CO ² and take it to the lungs to be eliminated. Hemoglobin is composed of a complex protein called Heme Group attached to an Iron molecule (Fe).

When hemoglobin is degraded by macrophages, the heme group is converted into Bilirubin, which is what finally gives the person that yellow coloration. This travels through the blood and is "trapped, processed and retained" in the liver, which through a complex and delicate system stores it in the Gallbladder along with Bile.

Here it plays a fundamental role in the digestion of fats which makes them more easily digestible, and is expelled when we eat from the Gallbladder, through the bile duct to the Duodenum, where it comes into contact with food so that it can fulfill its function, it is subsequently eliminated through the digestive system in the feces.

Also a portion of the bile is eliminated through the urinary tract, and this is what gives our urine that yellowish color. But what I have explained so far is the normal, common process that occurs in the human body in terms of bile metabolism. What happens to make a person jaundiced?

Here we could say in a general way that there are two probable ways that jaundice is present:

1. That a lot of hemoglobin is produced, so much so that it saturates the elimination system and accumulates.
2. The normal amount is being produced, but the disposal system is not working optimally.

And I could add a third (3) option which is the sum of the ones I've mentioned.

Pixabay/ Author: Vector8DIY

Abnormalities in the shape of red blood cells, such as the one that occurs in patients with sickle cell anemia, where an alteration of Hemoglobin shortens its life, and therefore it is rapidly destroyed.

We can also find parasitic diseases such as Malaria, where the parasite enters the red blood cell and reproduces until it bursts, causing the release of hemoglobin with the consequent production of bilirubin.

Autoimmune diseases in which antibodies form against the red blood cells themselves and increase their destruction.

There are many reasons that can cause the increased production of bilirubin, as you can see. But we also have the decrease in the elimination of this.

Pixabay/ Author: mohamed_hassan

For example, a person with hepatitis (regardless of the type) presents jaundice as a common feature in most cases, and this is due to the inflammation of the liver, which is the main organ responsible for removing hepatitis from the bloodstream. excess Bilirubin, cannot process it and ends up accumulating in the blood in amounts greater than normal, and later passes to the skin and other soft organs, such as the eyes, even the nervous system.

As I already said, bile accumulates in the gallbladder to be expelled to the duodenum in the process of digestion, for this reason, if there is a problem such as an obstruction of the bile ducts, the bile will be expelled out of the gallbladder or the bile ducts, passing into the bloodstream giving that yellowish color we call jaundice.

Pixabay/ Author: Tammydz

I hope you have been able to see in this way which are the most common processes by which jaundice can occur in a person. Although it is true that we can only see it as a symptom, it can be the expression of a truly serious disease, so we must make a differential diagnosis to determine the cause and treat it, since, as I said, bilirubin crosses the blood-brain barrier and can seriously affect the central nervous system.

We can also see Jaundice as a common trait in some newborns, but in this case it is because their liver is immature and cannot properly process bilirubin, therefore it does not remove it from the bloodstream to the extent that it is produced. . Bilirubin has a structure that is not soluble in water, but part of the process that takes place in the liver is that, making it water-soluble, for this reason we can eliminate it through urine.

Many will know that it is recommended that newborns be given a little sunlight to counteract jaundice, this is because UV light transforms the bilirubin that is in the skin into water-soluble, therefore it returns into the bloodstream and is excreted in the urine. An easy way to help the baby's body in this adaptation process.

For now I finish here with this topic, if you have any questions, doubts or suggestions, feel free to leave them in the comments, which I will answer as soon as possible.

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• Links consulted

• Bilirubin Metabolism and Jaundice with Special Reference
  to Unconjugated Hyperbilirubinaemia

• Jaundice in infants and children: causes,
  diagnosis, and management

• Jaundice Clinical Manifestation and Pathophysiology:
  A Review Article

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