VI.

PENATALAKSANAAN
Penatalaksanaan ikterus obstruktif ialah dengan pembedahan membuang penyebab obstruksi. Pembedahan eksplorasi dilakukan untuk mendiagnosa apakah obstruksi disebabkan oleh batu kandung empedu atau tumor. Apabila disebabkan oleh adanya karsinoma (biasanya pada kepala pankres), ahli bedah mungkin akan membuat bypass dari kandung empedu ke jejunum (Black, 1997)

aundice
Jaundice is common in new born babies. It is the key sign of many disorders of the liver and gall bladder. It can develop suddenly or gradually.

Causes
Jaundice may occur when the flow of bile from the liver, through the biliary system to the intestine, is blocked. The bile stagnates in the liver, which in turn means that the yellow pigment bilirubin, flows back in to circulation.

Obstrtuctive Jaundice: Is caused by gallstones. It usually happens when the bile ducts are blocked and bile can not pass into the intestines. Haemolytic Jundice: Occurs when too much bilirubin is produced by the breakdown of red blood cells. Liver damage, as a result of hepatitis or chronic malaria may also contribute to jaundice. Alcoholism and poisons are rare causes. Jaundice is very common in healthy newborn babies, because of an immature liver.

Signs & Symptoms

The very first sign of jaundice are yellowing of the skin and the whites of the eyes, darkened urine and some times pale stools. The skin may become itchy before occurrence. The symptoms are exterme weakness, sudden loss of appetite, nausea and dull pain in the liver region.
Herbal Medicines 1. Sugarcane juice: This is one home remedy effective in the treatment of jaundice. Plenty of this juice can be given to the patient, to promote more urination as well as for nutrition and general health. 2. Barley water: This can be given, if the patient is diabetic, since sugarcane juice is contraindicated in such people. This also causes more urination. 3. Triphala powder: A mixture of Amla, Harada and Behada can be given duly making a decoction. 20gms of powder, added to a glass of water, is reduced to 14 quantity. This should be filtered and given twice a day. 4. 20ml of expressed juice of fresh neem leaves and 20ml of pure honey should be well mixed, and to this mixture is added 3gms of black pepper powder and

stirred well. This should be taken in two equal doses, in the morning and evening. It makes a good home remedy for jaundice. Ayurvedic Remedies 1. 'Jaundex' syrup in the dose of 10ml thrice a day along with one tablet of "Nirocil", in many instances, clears the jaundice within one week. This should be used under a doctor's surveillance preferably. 2. Punarnava Mandoor, 1 tab thice daily for 2 to 3 weeks. 3. Navrayas Loh can also be given in the dose of 125mg thrice daily. 4. Liv 52 tablet (Himalaya Drugs) is a very popular drug, given in the dose of 1 to 2 tablets thrice daily. 5. Livpar tablet (Gufic) is also very good in controlling jaundice in the above doses.

Jaundice causes
Jaundice Symptoms, Causes, Remedy and Diet

Obstruction of the bile ducts

Jaundice may be caused by an obstruction of the bile ducts which normally discharge bile salts and pigment into the intestine. The bile gets mixed with blood and this gives a yellow pigmentation to the skin. The obstruction of the bile ducts could be due to gallstones or inflammation of the liver, which is known as hepatitis, and is caused by a virus.
Haemolytic anaemia, typhoid, malaria

Other causes of jaundice are haemolytic anaemia and certain diseases affecting the liver such as typhoid, malaria, yellow fever, and tuberculosis.

Home remedies for Jaundice

Jaundice home remedies and natural cures, Questions and answers

Jaundice treatment using Bitter Luffa

The juice of bitter luffa is regarded as an effective remedy for jaundice. It is obtained by pounding and squeezing the bitter luffa through cloth. The juice should be placed on the palm of the hand and drawn up through the nostrils. This will cause a profuse outflow of a yellowcoloured fluid through the nostrils. The toxic matter having been evacuated in a considerable quantity, the patient will feel relieved. This is, however, a strong medicine and may cause sideeffects like giddiness, migraine, and, at times, high fever for a short duration in patients with a delicate nature. Its use should, therefore, be avoided by such patients. If the juice of green bitter luffa is not available, it can be substituted by two to three drops of the fluid obtained by soaking

its dry crusts overnight in water. This will produce an identical effect. Seeds of bitter lnffa which are easily available can also be used for the same purpose after rubbing in water.
Jaundice treatment using Radish Leaves

The green leaves of radish are another valuable remedy for jaundice. The leaves should be pounded and their juice extracted through cloth. Half a litre of this juice should he taken daily by an adult patient It induces a healthy appetite and proper evacuation of bowels, and this results in gradual decrease of the trouble. In most cases, complete cure can be ensured within eight or ten days.
Jaundice treatment using Tomato

Tomatoes are valuable in jaundice. A glass of fresh tomato juice, mixed with a pinch of salt and pepper, taken early in the morning, is considered an effective remedy for this disease.
Jaundice treatment using Snake Gourd Leaves

The leaves of snake gourd have also been found useful in jaundice. An infusion of the leaves should be prepared by mixing 15 gm of dry leaves in 250 ml of boiling water. Next, a decoction of coriander seeds in 500 ml of water till it is reduced by one-third. The infusion should be given in doses of 30 to 60 ml, mixed with the decoction of coriander seeds, thrice daily.
Jaundice treatment using Pigeon Pea Leaves

The green leaves of pigeon pea, a leguminous plant-the beans of which are used for dals-are considered useful in jaundice. The juice extracted form these leaves should be taken in doses of 60 ml daily. Marked improvement will follow its use.
Jaundice treatment using Almonds, Dried Dates and Cardamoms

A mixture of almonds, dried dates and cardamoms is regarded as an effective remedy for jaundice. Eight kernels of almonds, two dried dates, and five small cardamoms should be soaked overnight in water. The outer coating of the almond kernels and the inner seeds of dried dates should be removed the next morning and the whole material should be rubbed into a fine paste. Then , fifty grams of sugar and an equal amount of butter should be mixed in it and the patient should lick this mixture.
Jaundice treatment using Sugarcane Juice

One glass of sugarcane juice, mixed with the juice of half a lime, and taken twice daily, can hasten recovery from jaundice. It is, however, very essential that the juice must be clean and preferably prepared at home. Resistance is low in jaundice and any infected beverage could make matters worse.

Jaundice treatment using Lemon

Lemon is also beneficial in the treatment of jaundice. The patient should be given 20 ml of lemon juice mixed with water several times a day. This will protect the damaged liver cells.
Jaundice treatment using Barley Water

Barley water drunk several times during the day is another good remedy for this disease. One cup of barley should be boiled in three litres of water and simmered for three hours.
Jaundice treatment using Jaundice Berry

The herb jaundice berry, botanically known as Berberis vultaris is very useful in jaundice.The pulverized bark should be given several times a day in doses of one-fourth of a teaspoon in the treatment of this disease, or the fluid extract should be given 2-4 ml doses.

Jaundice Diet
Jaundice : Home Remedies suggested by users

Diet therapy and physical rest

A mild form of viral jaundice can be cured rapidly by diet therapy and physical rest. Recovery is, however, slow in jaundice caused by obstruction in the bile ducts, depending upon the cause and removal of the cause.
Juice fast, thereafter an all-fruit diet

The patient should be put on a juice fast for a week, and he should rest until the acute symptoms of the disease subside. After the juice fast, he may adopt an all-fruit diet for a further three to five days, taking three meals a day of fresh Juicy fruits at five-hourly intervals.
Simple light carbohydrate diet can be then taken.

Thereafter, a simple light carbohydrate diet with exclusion of fats, best obtained from vegetables and fruits, may be resumed. Digestive disturbances must be avoided. No food with a tendency to ferment or putrefy in the lower intestines like pulses and legumes should be included in the diet.

Other Jaundice treatment

Moderate exercise, fresh air baths are helpful

The patient should undertake only moderate exercise, fresh air baths, and adequate rest.

Jaundice Treatments - more information

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Jaundice - Frequently asked questions

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Treatment for itching and burning due to wasp sting: How do I treat the itching and burning and aching of a wasp sting in my hand? Try these home remedies: Apply pure aloe vera gel Apply a paste of baking soda mixed with... Natural cures for Jaundice: what is a home remedies for jaundice cure The green leaves of radish are a valuable remedy for jaundice . The leaves should be pounded... Protection against jaundice: How does one protect their child from jaundice? Hepatitis A spreads by putting something in the mouth that has been contaminated with the... Health advice on Jaundice: Sir, i have a bit of fever and my urine is flowing Yellow..and a light pain in my liver side..is it a sort of viral jaundice...or how do i confirm myself and how to overcome this.

Jaundice, also known as icterus , is the yellow staining of the skin and the whites of the eyes... Diet for mild jaundice: My doctor has said that I am having mild jaundice. What diet should I take to cure it. I have addressed a similar question on diet during jaundice. Please visit this link to read it -... Question on Jaundice in infants: Is jaundice contagious in infants? Most jaundice in newborn babies is a normal event and is not serious. In most cases, this... Question on jaundice: Is jaundice contagious Jaundice refers to the yellow color of the skin. The yellow color is typically that of... Health advice on jaundice relapse: Hi my name is cathy [22 years old]I had jaundice when i was 12 but still i am showing Hbs antigen positive.Is that possible? why? Investigate immune building nutrients and herbs - the best to you. Mitch Health advice for Jaundice: If someone is suffering from JAUNDICE at the age of 35 to 45 how many days she or he has to take rest,what kind of medicines have to take and what type of food, fruits have to eat.Thanks. Jaundice is the most common of all liver disorders. It is a condition in which yellow... Health advice on Jaundice relapse: I was suffering from Jaundice for last 4 months. But now I am Ok. Is their any chance of getting this Infection again if I eat Junk food or any Fatty Diet.Is their any kind of Vaccine for Jaundice Please help me. Vaccine is administered for hepatitis A,B,C and E. Proper dietary regimen is essential to...

6 Jaundice remedies suggested by our users Starfruit juice for jaundice

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suggested by Pragya on Thursday, March 1, 2007

Starfruit juice(carambola),diluted with about 1/2 a glass of water should be had as often as possible.Tender coconut water,papaya & pineapple juices are excellent in jaundice.

New Borns with Jaundice

suggested by carmen on Sunday, November 19, 2006

To get rid of jaundice in new born babies, breastfeed the baby every two hours or less to move the bowels and keep your baby under direct morning sunlight (between 8-10)for one hour everyday till jaundice vanishes. Newborn babies with jaundice

suggested by Christina on Thursday, November 16, 2006

Breastfeed, breastfeed, breastfeed. The more you nurse, the more the baby needs to move his/her bowels This gets rid of the bilirubin. So breastfeed continuously. (May have to wake a sleepy baby...) Jaundice treatment

suggested by Yacouba on Tuesday, November 7, 2006

2. Another remedy for jaundice that I use to my patient is: Take 3 spoons of the powder obtained from the plant called "Momordica Balsamina" to be mixed with 3 eggs. Prepare an omelette, give the patient everyday for one week. sorry for my poor English. Yacouba from Niamey, Nige aundice is when the whites of your eyes (sclerae) and possibly your skin develop a yellowish color. Jaundice is a symptom caused by a larger problem of too much bilirubin in your blood, called "hyperbilirubinemia." When you notice parts of your body turning yellow, it's time to go see a doctor, because something may be wrong. Several things are known to cause yellow skin, and liver disease is one of the most common and important. What Causes Jaundice? Jaundice is caused by too much bilirubin in the blood. Bilirubin is a yellow pigment (a chemical in the body that has a color) that your body makes from old red blood cells in the spleen, an organ next to your stomach. The bilirubin then goes to the liver, where it's combined with other molecules to make bile. This is a normal process that happens every day. It's your body's way of recycling unused things, such as old red blood cells, and forming them into necessary products, such as bile. You use bile every time you need to digest fats after a meal, such as from a big steak dinner. Bile is a fluid that's essential in nutrition, because it helps break down the fats into a form the body can use.

This is an important system, but it can be disrupted. If the liver becomes damaged, such as from hepatitis, it may not be able to make bile. The body, though, is constantly breaking down old red blood cells and using the salvaged iron to make bilirubin. If the liver can't use the bilirubin to make bile, the bilirubin starts concentrating in the blood and may even leak in to surrounding tissues, such as the sclerae and skin. When the tissues become overly saturated with bilirubin, it becomes noticeable as jaundice. Jaundice is a symptom of liver disease, but there are other

reasons your body may develop hyperbilirubinemia. Two of these reasons are overproduction of red blood cells and some obstruction of the liver's ducts, such as a tumor. Doctors will search for these, and other, possibilities when evaluating you for jaundice.
Do I Have Jaundice? The easiest way to verify jaundice is by physical examination. Though jaundice can turn the skin a yellow tint, it's easiest to see jaundice by looking at the whites of the eyes, because bilirubin is especially attracted to the sclerae. It's often difficult to see jaundice in the sclerae, however, under fluorescent lighting. In these instances, you may be able to better see jaundice in the tissue under your tongue. Another indicator of jaundice is a darkening of your urine.

Before you can see jaundice on your skin, you need to have a certain amount of bilirubin in your blood and tissues. Normally, adults have anywhere from 0.3 to 1 mg/dL (which stands for milligrams per deciliter) of bilirubin in their blood, which is a very small amount. For comparison, a large grain of sand weighs around 11 milligrams and one deciliter is about 7 tablespoons! To actually see jaundice in your skin, you'll need at least 3 mg/dL of bilirubin in your blood.

Hepatitis Symptoms

Are There Tests for Jaundice? Yes, there are tests to measure the amount of bilirubin in your blood. Sometimes doctors can rule out certain causes of hyperbilirubinemia by finding out how much bilirubin is in your blood. High levels of bilirubin (anything over 7 mg/dL) are probably caused by liver disease. Severe liver disease can cause levels as high as 40 mg/dL! Doctors usually need a combination of tests to determine which type of liver disease is causing the problem. In addition to finding out the bilirubin levels, doctors need to know prothrombin times and the levels of liver enzymes and albumin. All of these are additional blood tests.

There is a urine test for bilirubin, called the "Ictotest," which (if positive) always implicates the liver as the cause of your jaundice.
Do I Have Hepatitis? It's important to note that not all causes of hyperbilirubinemia are from hepatitis, or even other liver diseases. Sometimes the problem is with the blood or even a genetic disease. For these reasons, it's important for a physician to evaluate all cases of jaundice.

If the doctor suspects that acute viral hepatitis is creating the jaundice, you'll need blood tests to identify the viral agent. Most likely, this will include blood tests for hepatitis A IgM antibody, hepatitis B surface antigen and core IgM antibody and a hepatitis C viral RNA test. Since other viruses can cause acute hepatitis, you may also be tested for the Epstein-Barr virus and the

cytomegalovirus. Jaundice, however, isn't a reliable symptom of acute viral hepatitis. Many people have acute viral hepatitis and never have jaundice.

Hepatitis Overview More About Diagnosing Hepatitis Types of Hepatitis

Is Jaundice an Emergency? Usually not, but there are situations that can lead to an emergency. This is why it's important to have a physician evaluate all cases of jaundice. What's the Treatment for Jaundice? Jaundice is treated by correcting the problem that caused the hyperbilirubinemia. For those with acute viral hepatitis, usually no treatment is necessary because the body will clear the virus by itself.

Sources:

More About Treating Hepatitis

Dienstag, JL. Acute Viral Hepatitis. In: AS Fauci, E Braunwald, DL Kasper, SL Hauser, DL Longo, JL Jameson, J Loscaizo (eds), Harrisons Principles of Internal Medicine, 17e. New York, McGraw-Hill, 2008.

Kumar V, Abbas A, Fausto N. Robbins and Cotran Pathologic Basis of Disease, 7e. Philadelphia, Elsevier, 2005. 885-888.

Sjogren, MH. Hepatitis A. In: M Feldman, LS Friedman, LJ Brandt (eds), Gastrointestinal and Liver Disease, 8e. Philadelphia, Elsevier, 2006. 1639.

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Chinese-Med HospitalLiver Cancer is well helped by the experts in China with natural treatwww.tcmtreatment.com Kidney Problems?Know Which Foods Boost Kidney Function... And Which Ones Harm! www.TheKidneyDiseaseSolution.com Antibodies and HybridomasOver 375,000 antibody listings. The original antibody directory.www.linscottsdirectory.com From Army camps and hospitals for the past three months have come rumors of a mysterious epidemic of jaundice. (One rumor: 1,500 jaundiced men in famed Walter Reed Hospital.) Last week War Secretary Henry Stimson was ready to talk. Jaundice had indeed attacked the armed forces. There have been 62 deaths, 28,585 hospital cases4,528 of them overseas. Mr. Stimson hastily added that the disease is not contagious nor dangerous to the civil population. He could not say definitely what the disease is nor what causes it. (Jaundice, usually thought of as a disease, is really a symptomcoloration of the skin by bile pigments. When a man has jaundice, his doctor has still to figure out whether he has a liver disease, an intestinal upset, a blood disorder.)

The True Story. In early April, soldiers began to come down with jaundice in such numbers that Army doctors and civilian experts on the Army's Epidemic Control Board began frantically searching the cause. Along with yellow skin went nausea, nervousness, lack of appetite, constipation. Sometimes a soldier would be out of kilter for six weeks. Highest-ranking sufferer: Lieut. General Joseph Stilwell, who came down with it after his famed foot march across Burma mountains. The experts finally decided that the disorder might be connected with the Army's inoculation against yellow fever. (To those who jumped to the conclusion that the disease was yellow fever itself, the doctors pointed out that yellow fever is violent, with a 10% to 85% mortality, while the mysterious ailment was relatively mild.) The doctors ordered the Army to shift to a new batch of vaccine. It was taking soldiers anywhere from a few weeks to four months after inoculation before they came down with jaundice. (Incubation period for yellow fever: three or four days.) Therefore, even after the suspect vaccine was discarded, the number of cases was expected to increase for a while, as the number of men inoculated had also increased. Soldiers could be expected to come down in July. They did.

How Come? The doctors went to work meanwhile to figure out what was the matter with the vaccine. So far they have little to report. The vaccine, provided by the Rockefeller Foundation since 1936, consists of yellow-fever virus rendered harmless in the laboratory. The cc ampules must be kept in frozen storage, must not rise above 37 F. before use. There are three possible causes for the trouble: 1) the Army slipped up on vaccine handling; 2) the toned-down virus sometimes made people sick; 3) this particular batch had been contaminated by another germ. The situation was further clouded by the fact that a few of the Army's civilian office workers also got jaundice. And the careful Navy, which was inoculating with another batch of Rockefeller vaccine, at first proudly let it be known that there were no Navy cases, later admitted that a few inoculated men diderturn yellow. There have also been reports of a similar disease among the Russians on the Eastern Front, and the Russian Army does not inoculate for yellow fever.

aundice (cont.)
In this Article What is jaundice? What causes jaundice?

What problems does jaundice cause? What diseases cause jaundice? What is neonatal jaundice (jaundice in newborn infants)? How is the cause of jaundice diagnosed? How is jaundice treated? Patient Discussions: Jaundice - Effective Treatments Jaundice Glossary Jaundice Index

What problems does jaundice cause? Jaundice or cholestasis, by themselves, causes few problems (except in the newborn, and jaundice in the newborn is different than most other types of jaundice, as discussed later.) Jaundice can turn the skin and sclerae yellow. In addition, stool can become light in color, even clay-colored because of the absence of bilirubin that normally gives stool its brown color. The urine may turn dark or brownish in color. This occurs when the bilirubin that is building up in the blood begins to be excreted from the body in the urine. Just as in feces, the bilirubin turns the urine brown. Besides the cosmetic issues of looking yellow and having dark urine and light stools, the symptom that is associated most frequently associated with jaundice or cholestasis is itching,

medically known as pruritus. The itching associated with jaundice and cholestasis can sometimes be so severe that it causes patients to scratch their skin "raw," have trouble sleeping, and, rarely, even to commit suicide. It is the disease causing the jaundice that causes most problems associated with jaundice. Specifically, if the jaundice is due to liver disease, the patient may have symptoms or signs of liver disease or cirrhosis. (Cirrhosis represents advanced liver disease.) The symptoms and signs of liver disease and cirrhosis include fatigue, swelling of the ankles, muscle wasting, ascites (fluid accumulation in the abdominal cavity), mental confusion or coma, and bleeding into the intestines. If the jaundice is caused by blockage of the bile ducts, no bile enters the intestine. Bile is necessary for digesting fat in the intestine and releasing vitamins from within it so that the vitamins can be absorbed into the body. Therefore, blockage of the flow of bile can lead to deficiencies of certain vitamins. For example, there may be a deficiency of vitamin K that prevents proteins that are needed for normal clotting of blood to be made by the liver, and, as a result, uncontrolled bleeding may occur.
How is jaundice treated? With the exception of the treatments for specific causes of jaundice mentioned previously, the treatment of jaundice usually requires a diagnosis of the specific cause of the jaundice and treatment directed at the specific cause, e.g., removal of a gallstone blocking the bile duct.