Travel Reference
In-Depth Information
DISEASES OF THE LIVER
Jaundice
Jaundiceisproducedbydiseasesoftheliver.Oneofthenumerousfunctionsoftheliver
is to remove from the blood the pigment (bilirubin) resulting from the normal destruction
of old red blood cells. When disease severely damages the liver, the bilirubin not removed
from the blood accumulates in the body and imparts a yellow or bronze color to the whites
of the eyes and later the skin.
Bilirubin is excreted into the intestine through the bile ducts and, following further
changes in the intestinal tract, imparts the normal brown color to stools. If the pigment is
excreted into the intestine in small amounts or not at all, the stools become pale or clay
colored.
Excess bilirubin is partially excreted by the kidneys, imparting a brown color to the ur-
ineandcausing thefoamproducedbyshakingtohaveayellow colorinstead ofthenormal
white appearance.
When jaundice is suspected, the person should be examined in daylight. Flashlights and
other artificial lights usually produce a yellowish color that can simulate jaundice. Any
treatment administered should be for the underlying disease causing jaundice.
Hepatitis
Acute hepatitis, an inflammatory disorder of the liver, is predominantly caused by in-
fection with viruses that selectively involve that organ. It is the most important cause of
painless jaundice likely to occur for the first time in wilderness conditions. (Jaundice as-
sociated with pain is discussed in
Chapter 20: Acute Abdominal Pain
.
) Untreated malaria
and other conditions cause jaundice occasionally by the excessive destruction of red blood
cells. However, such disorders can usually be recognized from other findings. Individuals
with previous attacks of jaundice should be evaluated by a physician and instructed in the
treatment for their condition prior to undertaking an outing.
A number of distinct hepatitis viruses are now recognized: hepatitis A, B, C, the delta
agent (hepatitis D), and hepatitis E, F, and G. Hepatitis A is an RNA virus that is spread
principally by fecal contamination of water and food, particularly shellfish. Infections are
common but almost never fatal; well over 90 percent of infected individuals have such
minor symptoms they do not realize they are ill. If jaundice does develop, it rarely lasts
over a month. However, such individuals are usually unable to continue a wilderness out-
ing. Chronic liver disease does not follow hepatitis A infections. Effective vaccines are
available.Individualsnotknowntohavebeenpreviouslyinfectedshouldbevaccinatedbe-
foretravelingtodevelopingnations,particularlyiftheyvisitsuchareasfrequently(
Chapter
5: Immunizations
). Gamma globulin may be advisable for unvaccinated individuals who
cannot defer travel for the time needed for vaccination to be effective.
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