From the archives
post by GK

Posted - 01/27/2004 : 1:49:28 PM
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Jaundice and Pruritus

Jaundice (also called Incterus) is a yellow discoloration of the
skin and eyes. It is caused by excessive amounts of bilirubin in
the blood. When liver cells are sick or damaged, the liver cannot
convert the bilirubin into the form necessary to allow it to be
excreted from the body. Jaundice may be transient, and can begin
when total blood levels of bilirubin concentrations exceed 2.5
mg/dl (milligrams per deciliter). The color of urine may become
darker, while stools may become lighter-colored. In cases of viral
hepatitis, fever, chills, pain, loss of appetite and fatigue may
accompany the onset of jaundice.

Pruritus (itching) often occurs with jaundice, and results from
bile salts being deposited in the skin. This is not common in
patients with hepatitis C, but when it occurs, it may be very
difficult to treat. If the itching is due to bile salts, the
condition will not respond to creams, lotion, or other "home
remedies." Only medications which improve the flow and excretion of
bile will decrease the symptoms.

Kidney Damage

When the body is attacked by a virus, it creates substances called
antibodies which attack viruses, bacteria, parasites and other
foreign invaders, collectively referred to as antigens. When
antibodies are produced as a result of a foreign invasion, they
attach themselves to the antigen, rendering the antigen incapable
of infecting cells. The combined antigen and antibody is referred
to as an "antigen-antibody (AgAb) complex."

These AgAb complexes are fairly large, as microscopic things go.
When they pass through the kidney, they can "clog" the filtering
membrane, resulting in a condition called Membranoproliferative
Glomerulonephritis. This condition allows protein to be lost in the
urine, which can eventually contribute to muscle wasting and
ascites, and in rare cases, causes renal failure.

Thyroid Disease

Thyroid disease is common is the general population, but even more
common among hepatitis patients. Both hypothyroid (too little) and
hyperthyroid (too much) can occur, and can be medically managed
quite easily. In some cases, thyroid disorders can develop during
HCV therapy, and may persist after the conclusion of therapy.

Varices

Varices are veins which have been stretched and distorted by
increased pressure resulting from impaired blood flow through the
liver. Common sites for varices are the esophagus, stomach and
rectum. Varices are thin-walled veins under high blood pressure,
and bleeding is a common problem. In some instances, esophageal
varices can rupture and massive bleeding can ensue, resulting in
vomiting and ingestion of large amounts of blood. If uncontrolled,
bleeding varices can result in death.

The picture is further complicated by the fact that hepatitis
patients may have greater difficulty with clotting, prolonging the
bleeding period.

Wasting (Muscle Loss)

The liver plays a central role in the metabolism of protein.
Protein is the building-block of body tissues, so when protein
metabolism is impaired by a sick liver, the body can begin to break
down muscle tissue to obtain the protein necessary for other
metabolic processes. Protein is also necessary for the liver to
synthesize albumin, so decreased protein synthesis can contribute
to the development of ascites and edema.

If you have hepatitis, you should consume an adequate amount of
protein to avoid muscle wasting. However, a by-product of protein
metabolism is ammonia, which the liver has to metabolize in order
to excrete. A sick liver may not be able to remove the increased
amounts of ammonia produced by a high protein diet. This can cause
abnormally high levels of ammonia to accumulate in the blood, which
can cause severe neurological impairment, a condition called
hepatic encephalopathy.

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