2. 1st
UNDER GUIDANCE OF
PROF. DR.A.N. MATHUR
PROF. DR.DILIP DADHICH
PROF.DR.S.M.SHARMA
PRESENTED BY
DR.HEMANT BHARDWAJ
MD.PART

3. Jaundice originated
from French word
‘JAUNE’ that means
yellow

4. •JAUNDICE
•ICTARUS
•PILIYA

5. A yellowish discoloration of the
skin, sclerae(white part of eye)
mucous membranes and deeper
tissues with increased bilirubin
level in plasma.

6. Yellow conjunctiva

7. Normal skin Yellowish skin

8. Yellowish nails

9. The concentration of bilirubin in
the plasma must exceed above
1.5 Mg/dl ( > 35 micromole/l),
three times more then usual
value that is approximately
0.5 Mg/dl for the coloration to
be easily visible.

10. Bilirubin
Metabolism

11. BETWEEN 250 TO 300 MG(425-510
MMOL ) OF UNCONJUGATED
BILIRUBIN IS PRODUCED FROM
THE CATABOLISM OF HAEM
EVERY DAY. BILIRUBIN IN THE
BLOOD IS NORMALLY ALMOST
ALL UNCONJUGATED AND,
BECAUSE IT IS NOT WATER-
SOLUBLE, IS BOUND TO
ALBUMIN AND DOES NOT PASS
INTO THE URINE

12. UNCONJUGATED BILIRUBIN IS
CONJUGATED BY THE
ENDOPLASMIC RETICULUM
ENZYME, GLUCURONYL
TRANSFERASE, INTO BILIRUBIN
MONO- AND DIGLUCURONIDE.
THESE BILIRUBIN CONJUGATES ARE
WATER-SOLUBLE AND ARE
EXPORTED INTO THE BILE VIA
SPECIFIC CARRIERS ON THE
HEPATOCYTE MEMBRANE.

13. CONJUGATED BILIRUBIN IS
METABOLISED BY COLONIC
BACTERIA TO FORM
STERCOBILINOGEN, WHICH
MAY BE FURTHER OXIDISED TO
STERCOBILIN. BOTH
STERCOBILINOGEN AND
STERCOBILIN ARE THEN
EXCRETED IN THE STOOL

14. A SMALL AMOUNT OF
STERCOBILINOGEN (10%) IS
ABSORBED FROM THE BOWEL,
PASSES THROUGH THE LIVER
AND IS EXCRETED IN THE
URINE, WHERE IT IS KNOWN AS
UROBILINOGEN OR,
FOLLOWING FURTHER
OXIDISATION, UROBILIN.

15. Prehepatic or Hemolytic Pathologies prior to liver
Hepatocellular or Toxic Pathology of within liver
Post hepatic or Cholestatic Pathology after conjucation of
bilirubun

16. Pre-hepatic
 Haemolysis
 Congenital defects:
 Gilbert’s syndrome (uptake/conjugation defect)
 Crigler-Najar (conjugation defect)

17. Hepatocellular
Acute Chronic
 Viral hepatitis A, B, C..  Viral hepatitis B, C
 Drugs  End-stage liver disease
 Dose-dependant e.g. (of any cause)
paracetamol  Alcoholic
 Idiosyncratic  Autoimmune
 Toxins  Haemochromatosis
 Autoimmune hepatitis  Wilson’s disease
 Alcoholic hepatitis
 Tumours

18. Cholestatic
Gallstones
 Carcinoma of head of
pancreas
 Benign stricture
 Congenital
 Traumatic
 iatrogenic
 Carcinoma of
ampulla of bile ducts
 Sclerosing
Cholangitis
 pancreatitis

19.  Yellow discoloration of the skin,
mucous membranes, and the whites of
the eyes
 Light or dark colored stools
 Dark-colored urine, and
 Nausea and vomiting
 Abdominal pain
 Loss of appetite

20.  Fever
 Weakness
 Headache
 Confusion
 Swelling of the legs and abdomen
 Itching of the skin

21.  Pain
 Colour of stools and urine
 Drugs
 Recent blood transfusion
 Alcohol intake
 Contact with hepatitis infection
 Occupation
 F/H – Anaemia, Splenectomy, Gallstones

22. Pre-hepatic Hepatic Post-hepatic
Urine
-color normal Dark/normal Dark
-bilirubin No Bilirubin ? Bilirubin Bilirubin
-urobilinogen  Urobilinogen  Urobilinogen  Urobilinogen
Faces color Dark Pale Pale
Blood Bilirubin Bilirubin – Bilirubin
unconjugated mixed conjugated – conjugated
& unconjugated
Alkaline
phosphates normal increased increased
Reticulocyte
count
Coombs’ test

23.  Ultrasound
 Gallstones
 Bile duct dilatation
 Intra-hepatic lesions
 CT
 Liver lesions
 Pancreatic lesions
 CT-IVC
 MRI
 Liver lesions
 MRCP
 X-ray
 Gallstones – only 10% radio-
opaque
 PTC, ERCP – can also be means
of therapy
 Isotope scan – HIDA

24.  DEAFNESS
 CEREBRAL PALSY
 ACUTE BILIRUBIN
ENCEPHALOPATHY
 LIVER FAILOR
 COMA
 DEATH

25.  Foods Permitted for a patient of Jaundice:
 Bread or chapattis of wheat, rice, maize, jowar, bajra or
ragi.
 Egg
 Milk or milk products
 Soups
 Vegetable salad
 Patato
 Sugar, jiggery or honey
 Jam or Murabba
 Pastry as biscuits
 Fruits, Dry Fruits
 Water as desired

26.  Nuts,pulses
 Condiments and spices
 Papad, chutney or pickles

27. HOMOEOPATHI
C
MANAGEMENT

28.  Increased rate of hemolysis (reticulocyte count elevated)-
Syphilis
 glucuronyl transferase deficiency, autosomal-Psora
 Toxic liver injury Psora
 Drug toxicity Psora
 Iron overload (hemochromatosis) Psora
 Copper overload (Wilson disease) Psora
 Autoimmune hepatitis Psora/ Syphilis
 Choledocholithiasis- presence of a stone in the common bile
duct. Psora/ Sycosis
References- Miasmatic Diagnosis, Dr. S. K.
Banerjea

29.  SKIN - DISCOLORATION - yellow
 acal. acetan.ACON . aesc. agar-ph. agar. agn. Aloe alum-p. alum. alumn. Am-m. Ambr.
anders. Ant-c. ant-i. Ant-t. Arn. ars-i. Ars. asaf. astac. aur-m-n. aur-s. Aur. Bell. Berb. blatta-a.
bov. brass-n-o. Bry. bufo cadm-s. calc-ar. Calc-p. calc-s. calc-sil. Calc. calen. cann-s. Canth.
Carb-v. carbn-s. CARD-M . cas-s. Caust. cean. cedr. Cham. CHEL . chelo. chen-a.
chim. CHIN. Chinin-ar. CHION. chol. cina coca cocc. CON. convo-s. corn-f. Corn.
croc. CROT-H. cupr. Dig. Dol. dulc. elat. eup-per. euph. fab. fel ferr-ar. Ferr-i. ferr-pic.
Ferr. fl-ac. gels. granit-m. graph. Guat. hed. hell. Hep. hier-p. hip-ac. Hydr. Ign. ilx-a. ins.
IOD. iris Jug-c. kali-ar. kali-bi. kali-c. kali-i. kali-m. kali-p. Kali-pic. kali-s. kali-sil. LACH.
lact. laur. Lept. lina. lipp. loxo-recl. LYC. mag-m. mag-s. mang. med. Merc-c. merc-d. MERC.
morg-p. myric. nat-ar. nat-c. nat-ch. nat-f. Nat-m. nat-p. NAT-S. NIT-AC. NUX-V.
olnd. Op. petr. ph-ac.PHOS. pic-ac. plb-xyz. PLB. Podo. psor. Ptel. Puls. quas. ran-b.
rheum rhus-t. ric. sabad. Sang. saroth. Sec. SEP. Sil. Spig. sul-ac. sul-i. sulfa. Sulph. tab.
tarax. tarent. ter. thuj. tinas. trinit. verat. vip.

30.  SKIN AND EXTERIOR BODY - Color - yellow, jaundice
 ACON. Aloe AMBR. Ant-c. arn. Ars. asaf. AUR.
BELL. Berb. brom. BRY. bufo calc-p. Calc. CANTH.
CARB-V. Card-m. Caust. CHAM. CHEL. CHIN.
cina cocc. CON. Croc. Crot-h. cupr. Dig. dulc. euph.
FERR. gels. graph. hell. Hep. IGN. Iod. kali-c. LACH.
Laur. Lept. LYC. MAG-M. MERC. nat-c. nat-m. Nat-
s. Nit-ac. NUX-V. OP. petr. ph-ac. Phos. PLB.
PODO. psor. Puls. ran-b. rheum Rhus-t. sabad. sec.
SEP. sil. SPIG. sul-ac. SULPH. tarax. Verat.

31.  J - Jaundice
 aesc. astac. card-m. chion. iod. lept. mag-m. myric.
nat-p. pic-ac. tarax.

32.  ABDOMEN - Jaundice
 Acon. aloe am-m. arg-n. ars. astac. Aur-m-n. aur.
barbit. Berb. Bry. Card-m. cas-s. Cean. Cham. Chel.
chelo. Chin. Chion. chol. corn. crot-h. Dig. dol. eup-per.
hep. Hydr. iod. jug-c. kali-bi. kali-c. kali-pic. lach. Lept.
Lyc. merc-c. Merc-d. Merc. Myric. nat-m. Nat-p. nat-s.
nit-ac. Nux-v. ost. Phos. pic-ac. plb. Podo. ptel. rumx.
ruta sep. still. sulph. Tarax. Vip. Yuc.

33. Arsenic album-
Face pale and weak.
Gastric derangements; after cold fruits; ice cream; ice water;
sour beer; bad sausage; alcoholic drinks; strong cheese.
Diarrhoea, after eating or drinking; stool scanty, dark-
colored, offensive, and whether small or large, followed by
great prostration.

34. Berberis vulgeris
Pale, earthy complexion, with sunken cheeks and
hollow, blue-encircled eyes.
Colic from gall-stones. Bilious colic, followed by
jaundice; clay-colored stools, with bilious symptoms
and itching of the parts.

35. Bryonia
Pressure as from stone at pit of the stomach, relieved by
eructation. Constipation: inactive, no inclination; stool
large, hard, dark, dry, as if burnt; on going to sea.
Diarrhoea: during a spell of hot weather; bilious, acrid
with soreness of anus; like dirty water; of undigested
food; from cold drinks when overheated, from fruit or
sour krout;
< in morning,
<on moving, even a hand or foot.

36. Cardus Marinus
In complication with gall stone. Swelling of gall bladder
with tenderness; stools hard, difficult, knotty,
alternates with bright yellow diarrhoea.Jaundice with
intolerable itching, when lying down at night.

37. Chelidonium mejus
The constant pain under inferior angle of right scapula,
Desire for very hot drinks, unless almost boiling stomach
will not retain them (Ars., Casc.) Constipation: stool,
hard, round balls like sheep's dung (Op., Plumb.);
alternate constipation and diarrhoea. Diarrhoea: at night;
slimy, ligh-gray; bright-yellowish; brown or white, watery,
pasty; involuntary.
Face, forehead, nose, cheeks, remarkably yellow. Yellow-
gray color of the skin; wilted skin; of the palms of hands.
Tongue coated thickly yellow, with red edges, showing
imprint of teeth

38. China
Ailments: from loss of vital fluids, especially
hemorrhages, fever of malarial origin, with marked
periodicity; return every other day.
Face pale, Hippocratic; eyes sunken and surrounded by
blue margins; pale, sickly expression.
Excessive flatulence of stomach and bowels, belching
gives no relief (belching relieves, Carbo v.); < after eating
fruit (Puls.). Colic: at a certain hour each day; periodical,
form gall-stones (Card.m.); worse at night and after eating;
better bending double.

39. Crotalus Horridus
Haemorrhagic diathesis, Yellow color of conjunctiva;
Malignant jaundice; haematic rather than hepatic. Purpura
haemorrhagica; comes on suddenly from all orifices, skin,
nails, gums.
Tongue fiery red, smooth and polished.
Instantly producing dark, green vomiting; black or coffee
grounds, of yellow fever. Diarrhoea; stools black, thin; like
coffee-grounds; offense; from noxious effluvia or septic
matters in food or drinks; during yellow fever, cholera,
typhoid, typhus.

40. Lachesis
There is Fever annually returning; paroxysm every spring
(Carbo v., Sulph.), after suppression by quinine the previous
autumn. Fever: typhoid, typhus; stupor or muttering
delirium, sunken countenance.
conjunctiva yellow or orange color; perspiration cold, stains
yellow, bloody (Lyc.).
Tongue dry, black, trembles, is protruded

41. LEPTANDRA
VIRGINICA
Tongue coated yellow. Great distress in stomach and
intestines, with desire for stool. Aching in region of
liver extending to spine, which feels chilly.
Stool.--Profuse black, fetid stools, with pain at
umbilicus. Stools turn black and look like tar. Clay
colored stools with jaundice.

42. Lycopodium
Gastric affections; excessive accumulation of
flatulence; constant sensation of satiety; good
appetite, but a few mouthfuls fill up to the throat, and
he feels bloated; fermentation in abdomen, with loud
grumbling, croaking, especially lower abdomen (upper
abdomen, Carbo v. - entire abdomen, Cinch.); fulness
not relieved by belching (Cinch.).
Constipation: since puberty; since last confinement;
when away from home; of infants; with ineffectual
urging.

43. Mag Mureaticum
Pressing pain in liver, when walking and touching it,
liver hard, enlarged, < lying on right side (Mer., Kali
c.).
Constipation: stool hard, scanty, large, knotty, like
sheep's dung; difficult to pass; crumbling at verge of
anus (Am. m., Nat. m.); of infants during dentition.
Urine; pale, yellow, can only be passed by bearing
down with abdominal muscles.

44. MYRICA CERIFERA
Taste bitter with offensive breath. Complete loss appetite,
but with a feeling of fullness in the stomach after a meal.
Strong desire for acids. Weak, sinking feeling in the
epigastrium, approaching nausea; increased after eating;
relieved by rapid walking.
Stool.--Constant discharge of flatus when walking. Urging
to stool, with no other results than the expulsion of a great
amount of flatus. Loose, light-colored stool; ash-colored
and destitute of bile.
Urinary.--Dark, frothy, scanty, high-colored, biliary.
Skin.--Yellow and itching. Jaundice. Creeping sensation, as
of insects.

45. Nux Vomica
Jaundice from anger (Cham.), high living. Nausea:
constant; after eating; in morning; from smoking; and
feels "If I could only vomit I would be so much better.".
Stomach: pressure an hour or two after eating as from a
stone. Constipation; with frequent unsuccessful desire,
passing small quantities of faeces sensation as if not
finished.

46. Phosphorus
Constipation: faeces slender, long, dry, tough, and hard
(Stap.); voided with great straining and difficulty
(Caust.).
Diarrhoea: as soon as anything enters the rectum;
profuse, pouring away as from a hydrant; watery, with
sago-like particles.

47. 47