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Cause Of Jaundice And Surgical Pathology!

MBBS, MS - General Surgery, MCH - Surgical Gastroenterology, Ex assistant professor
Gastroenterologist, Patna
Cause Of Jaundice And Surgical Pathology!

Jaundice is a condition that results in excess of bilirubin in the blood. One of the first signs that become evident is the skin becomes yellowish in color. This article will reflect on the probable causes of jaundice and the way to detect them. While there are a lot of treatment options, the exact course of treatment depends on the underlying cause of the disease.

Causes of Jaundice:
Jaundice is the result of an underlying disorder that either cause overproduction of bilirubin or stops the liver from getting rid of it. In either case, the bilirubin gets deposited in the tissue. Some of the underlying causes of jaundice include the following:

  1. Liver inflammation: An acute inflammation of the liver can restrict the liver to conjugate resulting in accumulation of the bilirubin inside the liver.
  2. Inflammation of the bile duct: This is a serious condition that might result in non-secretion of the bile and failure to remove the bilirubin resulting in jaundice.
  3. Gilbert's syndrome: This is an inherited condition. It restricts the enzymes to excrete bile resulting in jaundice.
  4. Hemolytic anemia: This is a condition where a large amount of RBC is broken down resulting in an increased production of bilirubin. This lead to jaundice.
  5. Cholestasis: This is a condition that leads to an interruption of the flow of bile from the liver. As a result, the bilirubin gets accumulated in the liver resulting in jaundice.
  6. Dubin-Johnson syndrome: This is again an inherited condition that stops the bilirubin from draining out of the liver.
  7. Pseudojaundice: This is a harmless condition that might result in jaundice due to an excess of beta-carotene. People who tend to eat a lot of melon, carrot, and pumpkin have a high possibility of getting this type of jaundice.
  8. Crigler-Najjar syndrome: This is a genetic condition that impairs the ability of the tissue to excrete bilirubin from the liver resulting in jaundice.

Surgical Pathological Cause-

  1. CBD stone 
  2. Periampullary carcinoma of pancreas 
  3. Cholangiocarcinoma 
  4. Choledochal cyst 
  5. Mirrizi syndrome 
  6. Duodenal growth

How is it diagnosed?

  1. Urine Test: A urine test aims to measure the count of urobilinogen. The latter is produced when bacteria inside the body breaks the bile into smaller parts. A Higher count of urobilinogen certainly suggests the indication of Jaundice.
  2. Blood tests and Liver function: A liver function test can help a doctor diagnose certain liver ailment such as the cirrhosis, hepatitis and alcohol led diseases. Apart from these, the protein produced by liver and releases into the body tends to fall. A blood work will capture the reading and indicate towards jaundice.
  3. Imaging tests: Imaging tests are only required when post-hepatic or intra-hepatic jaundice is suspected. Some of the tests that are helpful include MRI, Ultrasound scan and CT scan.
  4. Liver Biopsy: A biopsy is recommended to witness the condition of the liver when the liver is affected by serious condition along with jaundice such as cirrhosis etc.


In surgical pathology(jaundice), laproscopy / open surgery require according to diagnosis and symptoms! If you wish to discuss about any specific problem, you can consult a Gastroenterologist.

1811 people found this helpful

Chemical Peel and the Pathology Behind It

Diploma in Dermatology, MD, MBBS
Dermatologist, Delhi
Chemical Peel and the Pathology Behind It

Chemical peeling is a medical procedure which includes application of a chemical agent to the skin, causing controlled destruction of the epidermis, with or without the dermis, leading to exfoliation and removal of superficial lesions, followed by regeneration of new epidermal and dermal tissues. In simple words chemical peeling or chemical rejuvenation is procedure where a chemical agent or combination of agents of defined strength are applied the skin causing a controlled destruction of layers of the skin. This is followed by regeneration and remodeling leading to improvement of texture and surface abnormalities. It is a safe, effective and affordable option for improving skin ageing and imperfections.

Skin is considered the largest organ of the body and has many different functions. The skin is divided in two main regions, the epidermis and the dermis. The dermis is attached to an underlying hypodermis also called subcutaneous connective tissue.

Epidermis: It is the most superficial layer of the skin. The first barrier of protection from the invasion of foreign substances. The epidermis is divided into four layers – stratum corneum, stratum granulosum, stratum spinosum and stratum basalis(basal layer).

Dermis: It is composed of fibroblasts which are responsible for secreting collagen, elastin and ground substance that gives support and elasticity to skin. It supplies the epidermis with nutrients and has its role in thermoregulation. The dermis is subdivided into two zones, upper papillary and lower reticular layer.

Classification of peels according to histological depth

  1. Very superficial peel – Exfoliation of the stratum cormeum, without any epidermal necrosis.
  2. Superficial peel – Destruction of the full epidermis, up to the basal layer
  3. Medium peel – Destruction of the epidermis, papillary dermis and upto the upper one third of the reticular dermis.
  4. Deep peel – Necrosis of the entire epidermis and papillary dermis with inflammation extending to the mid reticular dermis.

Classification of chemical peeling agents

Very superficial Peel:

  • Glycolic Acid 30-50% applied for 1-2 minutes
  • TCA* 10% applied as one coat
  • Jessner’s solution 1-3 coats

Superficial Peel:

  • Glycolic acid 50-70% applied for 2-10 mins (depending on the type and thickness of the skin)
  • TCA 10-30%
  • Jessner’s solution 4-10 coats
  • Very superficial and superficial Peels are the mildest form and often called, “the lunchtime peel.” These peels break down corneocyte adhesion, causing dead skin cells to shed off to reveal the fresh, healthy underlying skin. These peels address minor skin irregularities like discoloration, acne, surface scarring, fine lines, and sun spots.

Medium Peel:

  • Glycolic acid 70% applied for 3-30 mins (depending on the type and thickness of the skin)
  • TCA 35-50%
  • Glycolic Acid 70% plus TCA 35%
  • Jessner’s solution plus TCA 35%

Deep Peel:

  • Phenol 88%
  • Baker Gordon phenol formula
  • Medium and deep peels increase the collagen and glycosaminoglycans content, cause collagen remodeling and increase dermal thickness to improve the clinical appearance of the skin with reduced wrinkles, skin tightening and pigmentary dyschromia.

Reason behind chemical peeling:

  • Wound healing process is an important reason for rejuvenation. The phases of wound healing after chemical exfoliation are apparent:
  • Inflammatory phase (1-5 days) – This phase is evident after peeling as erythma and swelling on the skin
  • Proliferative phase (2-21 days) – In superficial peels, the basement membrane is intact, hence normal epidermis is restored in 2 to 3 days. In medium to deep peels, wound is below basement membrane and re-epithelialization takes time.
  • Remodeling phase (3 weeks to 2 years) – collagen remodeling is the main reason that chemical peels cause rejuvenation and reduce wrinkles.

Indications for peels:

1. Pigmentary disorders

  • Resistant melasma
  • Pigmented cosmetic dermatitis
  • Freckles
  • Lentigines
  • Post inflammatory hyperpigmentation

2. Acne

  • Comedonal acne
  • Post acne scars
  • Acne cosmetic
  • Acne excoriee

3. Cosmetic

  • Photoageing
  • Fine wrinkling
  • Skin glow and rejuvenation
  • Oily to rough skin
  • Actinic keratosis

4. Miscellaneous

  • Keratosis pilaris
  • Macular amyloidosis
  • Dilated pores
  • Seborrheic keratoses


  • Active bacterial, viral and fungal infection and open wounds
  • Oral isotretinoin use within the past three months
  • Pregnancy and breast feeding
  • History of keloid formation
  • History of taking oral contraceptive and photosensitive drugs
  • Unrealistic patient expectation
  • Uncooperative patient, eg. Patient is careless about sun exposure or application of medicine
  • For medium depth and deep peels, history of abnormal scarring, atrophic skin and isotretinoin use in the last six months.

How to choose a patient:

A patient should be chosen depending upon 4P’s:

P – Pathology

P – Point of depth required

P – Patients skin

P – Previous peeling agents

Newer peels:

Many peels like mandelic acid, kojic acid, lactic acid, citric acid and many more have been introduced in the market which are also available in combination. These peels are not only more skin friendly but also more patient friendly. They have buffering agents like licorice extract and willow bark extract to minimize irritation to skin and antioxidants to infuse the skin with restorative nutrients. The change in the skin often occurs at cellular level and are not apparent to the naked hence making it more popular amongst busy patients who are seeking effective treatments quickly with little or no downtime.

Benefits of chemical peels:

The skin becomes noticeably smoother and rejuvenated.

  • It reduces pigmentation, improves dull and uneven skin tone, reduces signs of photoagaeing, acne and enlarged pores.
  • Removes dead and damaged skin cells and improves skin texture
  • Helps in removal of tan
  • Skin becomes brighter and more vivid because chemical peels not only cause re-epithelialization of the epidermis but also collagen remodeling.

Pre peel and post peel precautions:

  • Patient has to be motivated enough to get multiple sittings of the peel ( 4-8, depending on the indication and type of peel) every 2-3 weekly to get the desired result.
  • Patient should not wax, bleach, scrub, shave(the same day) or get any other aesthetic procedure like microdermabrasion, ipl, derma-roller one day before the chemical peel procedure. A gap of at least 7 days before and after the peel should be maintained.
  • Patient should use a mild soap/ non soap cleanser after the peel
  • Broad spectrum sunscreen and moisturizer should be used liberally, at least 2-3 times a day and sun exposure should be avoided.
  • Patient should be strictly prohibited from scratching, picking or scrubbing the skin.

Take home message:

Chemical peeling is a simple office procedure for the treatment of acne, pigmentation, skin rejuvenation and photo ageing. These are not one time procedures but require 6-8 sessions and maintenance peels to achieve maximum improvement and prevent recurrences. The newer peels are safer and effective. If you wish to discuss about any specific problem, you can consult a Dermatologist.

4468 people found this helpful

Pathological Gambling - 5 Ways to Control it

Ph. D - Psychology, Psychology
Psychologist, Delhi
Pathological Gambling - 5 Ways to Control it

Pathological gambling is a situation in which a person is unable to resist the impulse to gamble and this leads to harmful consequences on the personal and social front of an individual. Pathological gambling is repetitive in nature, and a person cannot stop gambling by any means. The person would try to get money anyhow to gamble and he would feel uncomfortable or irritated at the idea of quitting gambling.

In order to control pathological gambling, it is advised that a person should quit gambling totally. Here are some measures which you can follow to control pathological gambling.

  1. Rehabilitation Programs: Both inpatient and outpatient rehabilitation programs can curb pathological gambling in a person. The program of a treatment center, if followed by heart, can cure the gambling problem. Moreover, by staying at a rehab for a period of time, a person will also stay away from gambling and will not get a chance to do so. Outpatient rehabilitation programs like group sessions and classes or one-on-one therapy sessions can also prevent gambling addicts from gambling without staying away from home.
  2. Twelve-step Program: The twelve step program by Gamblers Anonymous or GA may help a person overcome pathological gambling. For people who cannot afford long term rehabilitation programs, the twelve steps are ideal. Based on the same principles of the Alcoholics Anonymous, this program helps you to build a support group comprising of other recovering or recovered gambling addicts. Meetings are held every day, and you must attend these meetings to get help and encouragement.
  3. Cognitive behavioral therapy: Other than group therapies and support groups, psychotherapy also helps in dealing with pathological gambling problems. A one-on-one session with a therapist is very essential as gambling addiction arises from deep emotional issues. Clearing these issues would benefit the affected person. Treating the underlying issues may stop pathological gambling. Opening up to a therapist may be effective.
  4. Medication: In certain cases, medication is required to help get over pathological gambling. Gambling addiction may result on account of other underlying mental health conditions such as bipolar disorder. Treating the underlying causes with proper medication will cure the pathological gambling problem. Your impulse must be taken under control.
  5. Changes in lifestyle: Pathological gambling causes extreme loss of a person’s financial condition. A recovering pathological gambler must hand over all his financial responsibilities to a trusted family member or friend. Places such as casinos or gambling events should be avoided to restrict relapse.

Pathological gambling is a severe situation, which can cause great loss and harm to a person from many perspectives. One must take all necessary measures required to bring pathological gambling under control.

4445 people found this helpful

Vitamin-d Deficiency!

Homeopath, Lucknow
Vitamin-d Deficiency!

10 min exposure of sunlight daily in morning is sufficient to fulfill demand of vitamin-d in your body. Excluding other pathological causes of vitamin-d.

Blood glucose meter accuracy

MD - Internal Medicine, CCMD(Diabetology), PG Course in Diabetology, ADVANCED CERTIFICATE COURSE IN DIABETES
Diabetologist, Dehradun
Blood glucose meter accuracy
Glucometer-Blood glucometer reading results vary within ±20% of blood sugar readings tested in pathology Lab. but still the best means of self monitoring of blood glucose(SMBG).
60 people found this helpful

Homeopath, Delhi
Homoeopathy treatment is not only based on disease, it based on totality of symptoms (abnormal sensation and manifestation during sickness). These are 3 types- physical, pathological, mental symptoms for treatment. Homoeopathy treated individual suffering including human disease.

M.Ch - Paediatric Surgery, MS - General Surgery
Pediatric Surgeon, Kolkata
Phimosis is the adherence of the prepucial skin to the glans. It is not always pathological. This adhesion is usual at birth and spontaneous separation occurs by the age of 5 yrs. Usually it is the wrong advice of stretching the prepucial skin forcefully with or without a lubricant that causes maximal damage. Sometimes the phimosis is pathological and needs surgery. Surgery is done as day care and babies are sent home on the same day. The procedure involves minimal pain and they recover within a week. Circumcision and Preputialplasty are the two procedural options.

Preputialplasty is a cosmetically more acceptable procedure.

Passage of Air From Vagina

MBBS, PGC In Family Welfare & Health Management, DHA, PGD In Medical Laws & Ethics
General Physician, Kolkata

Recently one question was raised.

Known as vart, queefing or fanny fart.

It may happen after intercourse, excercise or squatting or in a pathological condition of a connection betwwn colon & vagina as result of child birth, radiation or cancer.

The main culprit in non-pathological condition is weakness of pelvic floor.

"Kegel" exercise may help as well as vaginal pessary

4 people found this helpful

FRHS, Ph.D Neuro , MPT - Neurology Physiotherapy, D.Sp.Med, DPHM (Health Management ), BPTh/BPT
Physiotherapist, Chennai
Diagnostic ultrasound in sports medicine
Ultrasound enables physicians to reliably visualize soft tissue structures including muscle bellies tendons ligaments arteries and nerves as well as identify any pathologic changes within these structures. It is a repeatable non invasive imaging modality that is capable of providing real time dynamic tissue assessment

white lesions

Dentist, Jaipur
white lesions
Hello everyone,
If you ever see any white patches in your mouth please do visit a dentist for proper check up as it could be an unavoidable disease. It can be scrapable or non scrapable. White patches can be seen due cheek bites if you have any sharp tooth it can hurt your oral mucosa all you can do is do visit your dentist he/she will the round off the sharp point as it is necessary to avoid further development of any pathology.
Keep your diet healthy add more fruits and green vegetables in your diet will do the added benefits.

2 people found this helpful

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