Jaundice is the yellowish discolouration of the sclera of eyes, nail beds, and skin due to either excessive production of bilirubin or decreased clearance. The patient with jaundice also notices passing high coloured urine.

For easy understanding, we divide causes into three broad headings. Namely ⮚ Pre-hepatic causes
Hemolytic anaemia – malaria, sickle cell anaemia, immune and non-immune causes ⮚ Hepatic causes
Acute hepatitis – HAV, HBV, HCV infections
Sepsis
Hepatotoxicity secondary to drug overdose
Hepatocellular carcinoma
⮚ Post-hepatic causes
o Acute cholangitis o Acute cholecystitis o Blockage of the bile duct due to stone or mass o Duodenal, pancreatic, or biliary duct cancers

These are cysts, non-cancerous and cancerous tumours, inflammatory swellings or abscesses, vascular malformations like hemangiomas, and metastatic lesions. The benign or non-cancerous lesions are very common as compared to cancerous lesions.

✔ Bacterial infections o Secondary to cholecystitis, appendicitis, diverticulitis o Sepsis ✔ Amoebic infections o Amoebic colitis can cause a liver abscess.

The patient usually presents with right upper abdomen pain, fever, and loss of appetite. The patient may also have generalised body ache and weight loss. The patient will be hospitalised, routine blood tests will be done to look for increased WBC counts, IV fluids, antibiotics will be started, USG abdomen done to see the location and size of the abscess, if possible, scan guided aspiration of pus will be done and if needed a tube will be placed in abscess cavity which will be draining the pus. Occasionally the liver abscess ruptures inside the abdomen, then will need emergency laparoscopic drainage.

Hydatid cyst is a parasitic disease that affects the liver predominantly, other parts like skeletal muscles, and brain occasionally. It is caused by a parasite called Echinococcus granulosus. It is mainly present in the sheep rearing areas, and man is an intermediate host. The cyst enters the human body by eating contaminated food, settling in the liver, and growing in size by forming a cyst. The cyst contains hydatid fluid and daughter cysts. The patient usually presents with pain in the right upper abdomen and jaundice. The cyst ruptures and a severe allergic reaction called anaphylaxis occurs, which is detrimental to life. Diagnostic laparoscopy, installation of scolicidal solution to kill the daughter cysts, suctioning all the contents without spilling inside the abdomen, and excision of the cystic wall are recommended.

Hepatocellular cancer is a primary malignancy that develops from hepatic cells. The causes of HCC are heavy alcohol consumption, cirrhosis of the liver, hepatitis-C virus, hepatitis-B virus infection, aflatoxin, anabolic steroid usage, diabetes, and obesity. Patients usually present with upper abdominal fullness, pain, jaundice, weight loss, loss of appetite, nausea, vomiting, and deep fatigue. The patient will be thoroughly examined for abdominal mass, jaundice, and metastasis features. Blood tests, imaging, and biopsy are done to confirm the lesion, and depending on the staging of the tumour patient will need surgical excision, chemoradiotherapy, cryoablation, and liver transplantation.

Chronic calcific pancreatitis is a long-standing inflammation of the pancreas resulting in scarring, loss of parenchymal tissue, and deposition of calcific stones in the duct and parenchyma. It causes recurrent abdominal pain, fatty bulky stools, and also leads to diabetes mellitus. The most common causes of chronic pancreatitis are alcohol abuse, smoking, idiopathic, tropical, and other reasons are congenital abnormalities, cystic fibrosis, increased calcium levels, increased triglyceride levels in the blood. Many factors contribute to pain in chronic pancreatitis mainly, the increased pressure in the pancreatic duct by strictures or stones blocking the duct, decreased blood supply to pancreatic parenchyma, and inflammation of nerves. Chronic pancreatitis is often difficult to manage. Treatment is mainly cornered to relieve the pain and halt the progression. The initial therapy is the management of pain with pain-relieving medications. Alcohol and smoking cessation will help to stop further damage to the pancreas. Supplementing with pancreatic enzymes help with the digestion of proteins, fat, and carbohydrates. These are also used in a few patients to reduce the pain associated with chronic pancreatitis. Surgical therapy is indicated in obstructed ducts because of stones or strictures. Surgery is usually reserved for patients with failed medical and endoscopic treatments. One procedure, called the modified Puestow or lateral pancreaticojejunostomy, opens the pancreas at the pancreatic duct and attaches a loop of the bowel to the open pancreatic duct.

Following are the causes of pancreatic cancer ● Smoking ● Long term diabetes ● Chronic pancreatitis ● Specific familial genetic syndromes like Lynch syndrome, BRCA2 gene mutation, and familial atypical mole-malignant melanoma (FAMMM) syndrome ● Family history of pancreatic cancer ● Obesity ● Older age, as most people are diagnosed after age 65 The patient will be thoroughly examined for signs of disease progression like the presence of jaundice, abdominal mass, and enlargement of the liver. If the tumour is operable, then surgery is the ideal treatment. Usually, most of the patients present to physician/surgeon with an advanced stage where the surgery will be inadequate; these patients will require chemotherapy and pain-relieving medications.