dental implications of an adult jaundice patient: a rare case report

What are the unusual causes of persistent jaundice?

Mucobilia: an unusual cause of persistent jaundice. Cureus 2019; 11 :e4565. [ PMC free article] [ PubMed] [ Google Scholar] [ Ref list] [7] Kiriyama M, Ebata T, Yokoyama Y, et al. . Occult mucin-producing cholangiocarcinoma in situ: a rare clinical case with difficult tumour staging. Surg Case Rep 2017; 3 :06.

What is included in the evaluation of jaundice?

The evaluation of jaundice relies on the history and physical examination. The initial laboratory evaluation should include fractionated bilirubin, a complete blood count, alanine transaminase, aspartate transaminase, alkaline phosphatase, ?-glutamyltransferase, prothrombin time and/or international normalized ratio, albumin, and protein.

What is the pathophysiology of obstructive jaundice?

The pathogenesis of obstructive jaundice ranges from malignant to benign. Malignant causes include cholangiocarcinoma and pancreatic adenocarcinoma, while benign obstructive jaundice mainly originates from choledocholithiasis and chronic pancreatitis. [ 1]

Can cholangiocarcinoma cause obstructive jaundice?

Cholangiocarcinoma is a common cause of obstructive jaundice but is mainly associated with solid mass and not semisolid secretion. In this report, the patient was admitted to the hospital with obstructive jaundice; however, no solid mass was found to lead to jaundice.

Does jaundice affect the teeth?

Jaundice occurs when the liver fails to eliminate bilirubin produced by the body [6]. Severe neonatal hyperbilirubinemia carries a potential for permanent neurological impairment [7]. Furthermore, hyperbilirubinemia is associated with the development of changes in color of the teeth, known as green teeth [8].

Can jaundice cause yellow teeth?

Jaundice is a condition that can cause yellow or green discolouration of teeth due to an alteration of the dentin as teeth are forming.

Can jaundice affect baby teeth?

Newborn jaundice resulting from hyperbilirubinemia Too much bilirubin can affect the color of baby teeth while they're forming; though it's rare, they may come in green. Green baby teeth caused by too much bilirubin will remain that color until they fall out and permanent teeth grow in their place.

Does Alagille syndrome affect teeth?

Dental manifestations are not a primary feature of the syndrome, but they invariably occur as a complication of the long-lasting cholestasis and are linked to hyperbilirubinemia. As a consequence of cholestasis during odontogenesis, enamel opacities, hypomineralization, and hypoplasia of tooth enamel can appear.

What causes yellow teeth in adults?

Wear. Teeth ultimately turn yellow as you get older, when enamel wears away from chewing and exposure to acids from food and drink. Most teeth turn yellow as this enamel thins with age, but some take on a grayish shade when mixed with a lasting food stain.

What are the reasons for yellow teeth?

What causes yellow teeth?certain foods or drinks, such as blueberries, red wine, coffee, or tea.a diet high in sugar and simple carbohydrates.smoking or chewing tobacco.side effects of certain medications and mouthwashes.age, as older adults are more likely to have yellow teeth.genetics.mouth trauma.More items...

Is jaundice in adults serious?

Jaundice is when your skin or the whites of your eyes turn yellow. It can be a sign of something serious, such as liver disease, so you need to get urgent medical help.

Can bile affect teeth?

When you do vomit, the bile, acids and contents of your stomach coming up through your mouth can cause damage to your teeth, gums and throat.

What are the complications of jaundice?

What are the complications of jaundice?bleeding.anemia.infections.abdominal bloating.swelling of legs.liver failure.kidney failure.constipation.More items...

What is Alagille syndrome?

Alagille syndrome — also known as Alagille-Watson syndrome, syndromic bile duct paucity and arteriohepatic dysplasia — is an inherited liver disorder that also affects the heart, eyes, bones, kidneys, vasculature and other organs.

What age is Alagille syndrome diagnosed?

In these cases, the disease is caused by a new gene mutation link that is not inherited from a parent. The liver signs and symptoms of Alagille syndrome usually appear shortly after birth or in early infancy. For this reason, Alagille syndrome is often diagnosed in children younger than age 1.

How rare is Alagille?

The incidence of Alagille syndrome has been estimated to be approximately 1 in 30,000-45,000 individuals in the general population.

What deficiency causes yellow teeth?

A 2007 study found that vitamin C deficiency may worsen peridontitis, which is a buildup of bacteria on the teeth and gums. This buildup contributes to discoloration.

Why is one of my teeth more yellow than the rest?

Sometimes, a tooth may appear more discolored than the surrounding teeth because it has become stained. Tooth staining can occur due to the foods and drinks we consume and certain medications we take. If one tooth is slightly discolored, it may simply mean the tooth has a stain.

Why are my teeth yellow near the gums?

Many people notice that their teeth are more yellow near the gum line than the tips of their teeth. While a yellow hue near the gum line can be an early sign of tooth decay, gum disease, and other dental problems—it is usually an indication of dental plaque or tartar.

How can I get whiter teeth?

11 Tips on How to Get Perfectly White TeethGo For Regular Dental Cleanings. Tartar, also known as calculus, can give your teeth a yellowish appearance. ... Be Careful With Stain-Causing Drinks. ... Quit Smoking. ... Practice Good Dental Hygiene. ... Use Whitening Toothpaste. ... Eat Natural Teeth-Whitening Foods. ... Use Mouthwash. ... Brush Your Tongue.More items...•

What is the cause of jaundice in adults?

Evaluation of Jaundice in Adults. Jaundice in adults can be an indicator of significant underlying disease. It is caused by elevated serum bilirubin levels in the unconjugated or conjugated form.

What causes unconjugated hyperbilirubinemia?

Unconjugated hyperbilirubinemia occurs with increased bilirubin production caused by red blood cell destruction, such as hemolytic disorders, and disorders of impaired bilirubin conjugation, such as Gilbert syndrome.

How many types of viruses are there in hepatitis?

Hepatitis of viral origin comprises a heterogeneous group of diseases caused by at least 6 different types of viruses: A, B, C, D, E and G (2).

What is the fifth most common cancer in the world?

Hepatocellular carcinoma is the fifth most frequent can-cer worldwide (16). As such, it constitutes an important public health problem, and is one of the most common and life-threatening malignancies in the world – with a survival rate after two years of only about 2% (3).It has been estimated that HBV and HCV are responsible for over 80% of all hepatocarcinomas. The other cau-ses are alcoholic and non-alcoholic steatohepatitis. Most patients with hepatocellular carcinoma have a history of cirrhosis, which in itself constitutes a preneoplastic con-dition (12, 16).

How much alcohol is harmful to the liver?

The epidemiological data indicate a threshold of 80 g of alcohol in males and 20 g in females, consumed on a daily basis during 10-12 years, in order to cause the corresponding liver damage. Ten grams of pure ethanol are equivalent to a glass of wine or a beer, while a glass of whiskey doubles that amount. Factors such as chronic hepatitis C infection, obesity and genetic factors can accelerate the develop-ment of alcoholic liver disease even with smaller doses of alcohol.

What is non-alcoholic fatty liver?

Non-alcoholic fatty liver is defined as the accumulation of fat (mainly triglycerides) in the liver, representing over 5% of the weight of the organ (5), in the absence of alcohol consumption in excess of 10 g a day (15).The observed liver damage ranges greatly from simple steatosis (accumulation of fat in the liver) to steatohepa-titis (fat accumulation with added inflammation), advan-ced fibrosis and cirrhosis (16).

How long does chronic hepatitis last?

Chronic hepatitis is a diffuse inflammatory disorder of the liver with a duration of over 6 months in which the underlying cause can be infectious (mainly hepatitis C virus and, to a lesser extent, hepatitis B and D viruses), pharmacological or immunological.

What are the causes of liver disease?

Introduction: Liver diseases are very common, and the main underlying causes are viral infections, alcohol abuse and lipid and carbohydrate metabolic disorders. The liver has a broad range of functions in maintaining homeos-tasis and health, and moreover metabolizes many drug substances. Objective: An update is provided on the oral manifestations seen in patients with viral hepatitis, alcoholic and non-alcoholic liver disease, cirrhosis and hepa-tocellular carcinoma, and on the dental management of such patients. Material and methods: A Medline-PubMed search was conducted of the literature over the last 15 years using the keywords: “hepatitis”, “alcoholic hepatitis”, “fatty liver”, “cirrhosis” and “hepatocellular carcinoma”. A total of 28 articles were reviewed, comprising 20 lite-rature reviews, a clinical guide, three clinical trials and four case series. Results: Oral clinical manifestations can be observed reflecting liver dysfunction, such as bleeding disorders, jaundice, foetor hepaticus, cheilitis, smooth tongue, xerostomia, bruxism and crusted perioral rash. In the case of infection caused by hepatitis C virus (HCV), the most frequent extrahepatic manifestations mostly affect the oral region in the form of lichen planus, xerostomia, Sjögren’s syndrome and sialadenitis. The main complications of the patient with liver disease are risk of contagion (for healthcare personnel and other patients), the risk of bleeding and the risk of toxicity due to alteration of the metabolism of certain drugs.

Is liver disease a chronic disease?

Liver diseases are very common and can be classified as acute (characterized by rapid resolution and complete restitution of organ structure and function once the un-derlying cause has been eliminated) or chronic (charac-terized by persistent damage, with progressively impai-red organ function secondary to the increase in liver cell damage). Based on the extent and origin of the damage, chronic liver disease ranges from steatosis or fatty liver to hepatocellular carcinoma, and includes hepatitis, fi-brosis and cirrhosis. Liver diseases can also be classified as infectious (hepatitis A, B, C, D and E viruses, infec-tious mononucleosis, or secondary syphilis and tubercu-losis) or non-infectious (substance abuse such as alcohol and drugs, e.g., paracetamol, halothane, ketoconazole, methyldopa and methotrexate) (1).

What is eosinophilic cholangiopathy?

Eosinophilic cholangiopathy is a rare benign disorder of the biliary system presenting as eosinophilic cholecystitis, eosinophilic cholangitis, eosinophilic pancreatitis. It is characterised by diffuse eosinophilic infiltration of the gallbladder wall, bile ducts, and pancreas respectively. Clinically children can present with benign biliary ...

What are the symptoms of an 11 year old boy?

11 years old male child born of non consanguinous parents presented with abdominal pain, fever, jaundice, high coloured urine of 5 days duration. There was no family history of jaundice, allergy. Clinical examination showed scleral icterus, tender hepatomegaly with midline surgical scar. On perusal of his past medical records at seven years of age, from a different hospital he was investigated for generalized lymphadenopathy, hepatosplenomegaly, prolonged fever and distended gall bladder. During the first admission, bone marrow examination was done which was followed by diagnostic laparotomy with cholecystectomy and lymph nodal biopsy. Marrow showed increased eosinophilic precursors and nodal biopsy was inconclusive. Reevaluation of histology of resected gall bladder specimen, showed xanthogranulomatous changes with numerous eosinophils and marked fibrosis suggestive of eosinophilic cholecystitis (Figure 1). As per the history he was not on any drugs. Investigations during this admission showed total count 7300×103/µL, polymorphs P 53%/L 34%/E 13%. Ultrasonography of abdomen showed hepatomegaly with biliary dilatation, Serum bilirubin 4.5 mg/dl, direct 2.9mg/dl, SGOT 165 IU/L, SGPT 125 IU/L, SAP 2875 IU/L,GGT 445IU/L, serum albumin 3.9gm/dl, amylase 48 IU/l, lipase 26 IU/l. Blood sugar, renal function tests were within normal limits. Serum IgE level above 1000 IU, absolute eosinophil count 920 cells/cumm. A diagnosis of Eosinophilic Cholangiopathy was considered. Autoimmune markers, screening for viral hepatitis, retroviral screening were negative. Due to financial constrains IgG subgroup was not done. MRI abdomen with MRCP showed biliary dilatation with pancreatic head mass (Figure 2). Based on the above clinical picture and earlier biopsy findings from gall bladder on reevaluation, diagnosis of Eosinophilic Cholangiopathy with pancreatitis was considered and hence repeat biopsy from pancreas was not done. He was started on oral prednisolone 1mg/kg for 6 months till now. As there are literature evidence in support of medical management, ERCP was not contemplated He responded well to treatment with decline in liver function tests, serum IgE level to 124 IU, eosinophil count to 7% and resolution of symptoms. The boy is on regular follow up.

Can eosinophilic cholecystitis be clinically distinguished from other forms of

Though the exact cause is not known, it has been reported with cholelithiasis, parasitic infestation, hypereosinophilic syndromes and allergic disorders [1,2]. Eosinophilic cholecystitis cannot be clinically distinguished from other forms of cholecystitis and the confirmation is often made by tissue histology [3].

Can a child have biliary obstruction?

Clinically children can present with benign biliary obstruction, with or without pancreatic mass lesion often being misdiagnosed as malignancy. This entity was first described by Leegard in 1980 and since then cases are being reported worldwide.

What is TTF-1 used for?

TTF-1 is also used to differentiate adenocarcinomas from squamous cell lung cancers since its present in 76% of adenocarcinomas [ 6 ]. In addition, the absence of p63 also confirms its glandular origin since positive staining is indicative of squamous cell lung cancers. Furthermore, the presence of Cytokeratin (CK) has been useful in ...

Where do adenocarcinomas spread?

Some studies looking at metastatic patterns noted that lung adenocarcinomas commonly spread to the liver, adrenal glands, bones, and kidneys.

Is lung cancer a life threatening disease?

Lung cancer metastases to the pancreas are rare but potentially life-threatening. Oftentimes, the presence of symptoms is indicative of extensive disease burden. This report describes a case of primary lung adenocarcinoma metastasizing to the head of the pancreas presenting as obstructive jaundice. The patient was a 61-year-old female veteran who presented with a chronic dyspnea, weight loss, and 3-weeks of nausea and vomiting found to have jaundice, elevated alkaline phosphatase levels, hyperbilirubinemia, and transaminitis. Imaging of her chest revealed large pulmonary parenchymal nodules throughout both lungs with a large left lower lobe mass and consolidation. Abdominal imaging showed a large heterogeneous mass in the pancreatic head, a grossly dilated common bile duct, and enlarged retroperitoneal lymph nodes contiguous with the mass. Pancreatic head biopsies revealed metastatic cancer cells from her lung adenocarcinoma which was confirmed via cytology and the presence of thyroid transcription factor − 1 and cytokeritin-7 expression and the absence of tumor protein 63 staining. Lung adenocarcinomas commonly metastasize to the bones, liver, and central nervous system but very rarely to the pancreas. There have been only a few reported cases of pancreatic tumors that manifested clinically as a result of primary lung cancer metastases however, even though uncommon, hematogenous spread of cancerous tissue should be considered on the differential as a cause for obstructive jaundice in the setting of lung adenocarcinoma.

What is the most common cause of lung cancer death in the United States?

1. Introduction. Lung adenocarcinoma, a non-small cell lung cancer, represents approximately 40% of all lung cancer diagnoses [ 1 ]. Due to its aggressive nature, it remains one of the most common causes of cancer death in the United States for both men and women. Although it has a high affiliation with smokers;

Can pancreatic cancer cause jaundice?

There have been only a few reported cases of pancreatic tumors that manifested clinically as a result of primary lung cancer metastases however, even though uncommon, hemat ogenous spread of cancerous tissue should be considered on the differential as a cause for obstructive jaundice in the setting of lung adenocarcinoma. Previous article.

Can adenocarcinoma spread to the pancreas?

It is known that lung adenocarcinomas have the ability to spread to the bones, liver, and central nervous system (CNS), however, metastasis to the pancreas was only found in approximately 2% –5% of cases [ 3 ]. Most tumors usually asymptomatic and only found on autopsy [ 4 ].

Is prompt recognition necessary for lung cancer?

However, prompt recognition is imperative in order to prevent poor outcomes . Our case demonstrates that even though uncommon, metastatic spread should be considered on the differential as a cause for obstructive jaundice in the setting of suspected lung cancer.