Jaundice: A Complication of NASH

Jaundice is a yellowing of the eye sclera (the white part) and skin because there’s too much bilirubin in the blood. There are many causes of jaundice. However, for people living with liver disease, jaundice is a common nonalcoholic steatohepatitis (NASH) complication.

Bilirubin, the Liver, and Jaundice

Bilirubin is formed while recycling old or damaged red blood cells. The bilirubin travels through the bloodstream to the liver. Then, it binds with bile and moves through the bile ducts into the digestive tract for removal from the body. Jaundice can develop when bilirubin levels build up in the blood and deposit in the skin. Any disease or other factor that prevents bilirubin from being eliminated from the body can lead to jaundice. The most common causes are:

• Liver infections, like hepatitis
• Excessive alcohol consumption
• Gallstone disease
• Some medicines and herbal supplements
• Cirrhosis
• Cancer of the gallbladder or pancreas

In addition, high bilirubin levels can cause an accumulation of substances the body forms when it breaks bile down. This can lead to itching all over the body.

Hepatitis and Jaundice

The word hepatitis means liver inflammation and is a crucial part of the damage to the liver NASH causes. NASH is a more severe form of fatty liver disease where there is an excessive accumulation of fat in the liver. While a simple fatty liver isn’t necessarily harmful, it can progress to NASH which is marked by chronic inflammation.

In some individuals, the accumulation of fat in the liver triggers the body’s healing response. The immune response includes:

• Inflammation (increases oxygen-rich blood and other nutrients to damaged areas)
• Liver cell repair
• Application of collagen to protect healing areas

Normally, this is a self-limiting reaction, which means that once repairs and healing are complete, the body sends a signal to the immune system to switch off the healing response. With NASH and other liver diseases, most people are unaware they have a condition because there are no noticeable symptoms at first. If you don’t know something is wrong, you also don’t seek treatment or make healthier lifestyle changes to reduce the amount of fat in the liver.

This means that the liver continues accumulating fat and, therefore, continues the healing response. Eventually, chronic liver inflammation begins to scar and damage the liver replacing healthy liver cells with stiff, fibrous, non-functioning scar tissue. Over time, the liver can progress into cirrhosis, liver cancer, and liver failure. Without enough healthy cells, the liver cannot perform its vital functions, including moving the bilirubin through the bile ducts.

Reducing the Prevalence of NASH

The prevalence of NASH is growing at an alarming rate in America. There are no FDA-approved treatments available currently for NASH, but potential new options are being evaluated in clinical trials. Arizona Liver Health offers a FREE fibroscan to adults at risk of liver disease to check the health of their liver. To schedule your FREE fibroscan appointment or explore our enrolling NASH studies, contact us today at (480) 470-4000!

Sources:

https://www.merckmanuals.com/home/liver-and-gallbladder-disorders/manifestations-of-liver-disease/jaundice-in-adults

https://www.aafp.org/pubs/afp/issues/2017/0201/p164-s1.html

https://my.clevelandclinic.org/health/diseases/15367-adult-jaundice