Jaundice, Skin Problems and Fluid Build-Up
For information on Jaundice, Skin Problems and Fluid Build-Up, please see the list of topics below.
Jaundice can occur if your bile duct becomes blocked. The bile duct drains bile from the liver and gall bladder into the bowel. You can also become jaundiced if there’s an infection in your liver. Symptoms of jaundice include:
- Yellowing of the skin and the whites of the eyes
- Itchy skin
- Dark-coloured urine
- Pale bowel motions
- Feeling tired
Dealing with Jaundice
If jaundice is caused by an infection, antibiotics may help. If it’s caused by a tumour, treatment to remove or shrink the cancer may be recommended. Your doctors may suggest putting in a stent – a small tube that holds the bile duct open. The stent can be put in using a procedure known as an ERCP (endoscopic retrograde cholangio-pancreatography). A thin, flexible tube called an endoscope is passed down your throat into your stomach and then into the first part of the small bowel – the duodenum. Once it’s in position, the doctor can see through the endoscope into the opening of the bile duct. A stent is then put inside the duct to keep it open. Another procedure called PTC (percutaneous transhepatic cholangiography) may also be used to place a stent into the bile duct. It involves inserting a needle through the skin just below the ribcage. A fine guide wire is passed through the liver into the blockage. The stent is passed along this wire. Sometimes a stent can become dislodged or blocked. The first sign of this is often the jaundice returning. If this happens, the stent can be replaced. An alternative treatment to relieve the blockage is surgery to bypass the bile duct but this is only suitable for some people. In this procedure, the surgeon joins the gall bladder or bile duct to the bowel in an operation called a cholecystoenterostomy. If it’s possible to unblock the bile duct, your symptoms should begin to improve. Sometimes, however, it’s not possible and symptoms will continue. Itchy skin can often be the most troublesome symptom of jaundice. Medicines used to treat an itch caused by jaundice include prochlorperazine, colestyramine and antihistamine tablets.
Itching is a common symptom and can affect any area of your body. It may affect all of your body or only one particular area. Itching may be due to:
- Dry skin
- Chemicals released by your body in response to your illness
- Medication (particularly the painkillers morphine and diamorphine)
- Kidney and liver problems.
Tips for dealing with itchy skin
- If your skin is dry use a simple moisturiser, such as aqueous cream, twice a day. A combination of aqueous cream and menthol can be helpful. If you store the cream in the fridge it will feel cool and soothing when applied.
- If hot water makes the itching worse, take cool or lukewarm baths or showers. Try adding an emollient (moisturising solution) such as Oilatum® to bath water, and use aqueous cream instead of soap. A little baking soda added to bath water can also help. After bathing, apply emollients or aqueous cream while your skin is still damp.
- Protect your skin from the damage caused by scratching. Keep your nails clean and short, and rub rather than scratch the itchy area.
- Avoid things that may irritate the skin or make itching worse, such as biological washing powders, scented soaps, bubble baths and products containing lanolin.
- Keep cool by wearing light, natural fibres such as cotton, and by keeping the atmosphere around you cool but not too dry. Avoid alcohol and hot spicy foods and drinks.
- Use other activities to try to distract you from the itching. Relaxation techniques may help you cope.
- Sometimes acupuncture or transcutaneous electrical nerve stimulation (TENS) can reduce itching. The aim of TENS is to stimulate the nerves reaching the brain, and so block out the sensation of itching. Acupuncture and TENS treatments are given at some NHS hospitals.
Itching can be difficult to control, but there are medicines that may help. If a particular medicine is the cause, an alternative drug may be prescribed. For some liver problems there are specific medicines that can control itching. Your doctor can discuss these with you.
Some drugs that may be helpful include:
- Antihistamine tablets or lotion
- A short course of steroid cream or tablets
- Anti-inflammatory drugs, cimetidine, aspirin and thalidomide
- Drugs that affect blood pressure, such as propranolol
- Drugs that act on the nervous system, including anaesthetics, antidepressants, anti-epileptic drugs, sedatives and some types of painkiller
- An anti-sickness drug called ondansetron.
A pressure sore (also called a bedsore or pressure ulcer) is damage to the skin and the tissue underneath. It can be caused by the weight of the body pressing down on the skin. Friction from clothing or skin being dragged when you’re moved by others can also cause sores. If your mobility has been restricted by your illness or its treatment, you’re at a higher risk of developing a pressure sore. You’re also at a higher risk if you’ve lost a lot of weight or aren’t managing to eat and drink well. Some drugs can also increase your risk, including chemotherapy drugs, steroids and anti-inflammatory drugs. Inspect your skin, particularly bony areas like elbows and ankles. For areas that are difficult to see, like shoulder blades or the base of your spine, use a mirror or ask a friend to help. Look out for reddened or dark patches on these areas, or any blisters or breaks in the skin. Let your nurse know about them straight away.
Preventing pressure sores
- If you spend a lot of time sitting or lying in bed, change your position regularly – preferably every half an hour. Wear loose, cotton bedclothes and use pillows to support yourself in comfortable positions.
- When possible, standing up for a short time or taking a short walk is the best way to relieve pressure. A physiotherapist can supply you with a walking aid to help with this, if needed.
- Your district nurse will be able to assess whether you need a pressure-relieving mattress or cushion and arrange these for you. It’s still important to change position regularly when using these. A bed cradle can help keep the weight of bedclothes off your legs and feet.
- Tell your doctor or a district nurse if you think you have early signs of a pressure sore. They can give you help and advice to make sure that your skin heals properly and to prevent infection from developing. There are also organisations that can provide equipment to keep you comfortable.
- Treat dry skin using the tips given above.
Sweating is one of the ways our body keeps our temperature normal, but when people are unwell they can have episodes of increased sweating. When this is severe it can be very uncomfortable and affect activities like sleeping. There are different causes, including certain medicines. Your doctor will be able to advise you on the best treatment, depending on the cause. There are also things you can do to help:
- Wear layers of light cotton clothing that can be taken off or put on easily.
- Keep rooms cool and well-aired – a fan can be helpful.
- Keep a sponge or flannel and some cool water by your bed for night sweats.
- Use light cotton bedding and put a large cotton towel on the bed underneath you. This will absorb any sweat and can be removed easily, rather than having to change all the bedclothes.
- Avoid things that may trigger sweats – for example, some people find sweats are made worse by alcohol or spicy food.
- Your body loses fluid through sweating, so try to drink a bit more to prevent dehydration.
Some people will have night sweats caused by the menopause or as a side effect of hormonal treatment.
Sometimes fluid can build up in the ankles and legs, which can cause swelling. There can be several reasons for this, including being unable to move about as much as usual. Using a footstool to keep your feet up when sitting can help. It’s also helpful to gently exercise your legs while you’re sitting. A nurse or physiotherapist can show you some exercises to do. Water tablets (diuretics) may also be prescribed by your doctor to help reduce the swelling. In some situations, your doctor or nurse can supply pressure stockings to help the circulation in your legs. If the swelling is only in one leg or ankle and is painful, red and hot, this may be a sign of a blood clot (thrombosis). People with cancer particularly have a higher risk of getting a blood clot and some cancer treatments can also increase your risk. Let your doctor know if you develop any of these symptoms, as treatment needs to be given as soon as possible.
Lymphoedema is swelling caused by a build-up of a fluid called lymph in the body tissues. It usually affects an arm or leg, but can affect other parts of the body. It can be present from birth (primary lymphoedema) or it can happen if lymph nodes (sometimes called glands) have been removed by surgery or damaged by radiotherapy, or if a cancer is blocking them. Lymph nodes are part of the lymphatic system, which is part of the body’s immune system that helps us fight infections and other illnesses. If lymphoedema is diagnosed, you’re likely to be referred to a specialist for a full assessment.
- Lymphoedema specialists are usually based in hospitals, hospices or specialist lymphoedema centres. They can offer advice on self-care and treatments, including:
- Skincare to prevent injury and infection
- Positioning the limb and movement to help drain fluid
- Compressing the limb or area using compression garments such as sleeves, stockings, special bras or compression bandages
- Exercises and keeping active to improve the flow of lymph
- Self-massage or specialised massage called manual lymphatic drainage (MLD) to help move fluid that’s built up.
Some illnesses can cause a build-up of fluid in the tummy (abdomen). This is more common with illnesses that affect the liver or cancers that are present within the abdomen. This fluid is called ascites. The abdomen becomes swollen and distended, which can be uncomfortable or painful. Other symptoms include a tightness across the abdomen, unexplained weight gain, feeling breathless, feeling sick (nausea) and a reduced appetite. Your doctors may treat ascites by inserting a small tube into your abdomen to drain off the fluid. This is usually done in hospital or the Hospice under a local anaesthetic. The fluid can be drained as often as necessary. Water tablets (diuretics) may be used to try to stop or slow down fluid build-up. Sometimes radiotherapy or chemotherapy treatment can prevent the fluid from coming back.