In Cantonese, there is a saying “yellow faced women” that describes unattractive middle aged housewives. It probably comes from the fact that pre-modern era makeup contains lead; it is toxic and causes discoloration of the face after long-term usage. Is it also true that yellowish face indicates the suffering of liver diseases?
Yes. But doctors generally do not look at skin color to diagnose patients with liver disease, we look at the conjunctiva (the white of eyes), where the detection of yellowish color could be earlier. The yellow color reflects the accumulation of bilirubin. Every day, aged red blood cells break down into bilirubin, bilirubin is metabolized in the liver and passed out of our body in bile through our gut. Bilirubin is the pigment we see in bile, golden yellow, and also gives the brownish color in our poops. Patients with acute or chronic liver failure will accumulate bilirubin in the body, leading to yellowish discoloration of skin and mucous membranes, particularly apparent on the originally white conjunctiva.
In Hong Kong, the major causes of acute hepatitis are due to viruses, drugs and herbs.
Viral infections are mainly hepatitis A, B, C, and E. Hepatitis (hepatitis A) is a gut infection. Virus comes from the stool of infected persons, and then through unclean food, water, or contaminated hands to other people. Therefore, route of infection is usually eating virus-contaminated water and undercooked food (especially oysters, clams, mussels and scallops, etc.). Every year, there are hundreds of cases in Hong Kong. Hepatitis E is transmitted similarly as hepatitis A, but there is evidence that it can spread through eating raw or undercooked meat. The virus is also found in pig liver, but the importance of this route of transmission remains uncertain. Pregnant women should pay special attention because hepatitis E infection in pregnancy ladies has a mortality rate of approximately 20%! And there is no vaccine or cure against this virus. Acute hepatitis B and C are transmitted through sexual contact or blood, such as needle-sharing.
Drugs, be it modern medicines or traditional Chinese herbs, mostly rely on liver to metabolize. So some drugs can cause acute hepatitis. Hong Kong Chinese like to take herbal medicines, not only for sickness but also for general healthiness, making herbs-induced hepatitis a common condition on Hong Kong. It is important to know that drug related hepatitis has no cure, in the event that the liver cannot recover by itself, the only solution is liver transplant!
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肝病=臉黃？
女士們都會不悦给他人稱為黃臉婆。聞說古代女性所用的化妝品含鉛，有毒性，長期使用會導致臉色變黄。所以年長女士成了黃臉婆。其實肝病是否都會導致臉黄？
是。不過醫生一般不會依賴皮膚顏色去診斷病人有肝病。我們會觀察病人的眼白有否呈現黄色。觀看眼白比起觀看皮膚更容易及早和準確地察覺到變化。眼白越黃，病情可能越嚴重。為什麼會黃？因為膽红素(bilirubin)。血液(紅血球) 每日都會因為新陳代謝而產生膽紅素，膽紅素由肝臟經膽汁排出腸道。膽紅素是膽汁主要的色素，為金黃色，亦是大便的主要色素。急性肝炎或肝硬化病人的膽汁排泄不順，膽紅素累積在血液中，會讓皮膚和黏膜顏色變黃，尤其是原本白色的眼結膜就更加明顯。
在香港，急性肝炎主要由過濾性病毒，藥物和中草藥引起。
過濾性病毒主要分甲，乙，丙，戊。甲型肝炎(hepatitis A)是由腸道傳染的。病毒由病人的大便中排出體外，再經由不潔的食物、食水，或沾染病毒的雙手傳入其他人口中而導致傳染。因此感染途徑通常是進食被病毒污染而未經煮熟的食物(尤其是蠔、蜆、貽貝和扇貝等) 或飲用未經妥善處理的食水。香港每年都有幾百宗病例。戊型肝炎(hepatitis E)的主要傳播途徑跟甲型肝炎一樣。但也有證據顯示，傳播可經進食生或未經煑熟的肉類。在豬肝臟亦曾發現戊型肝炎病毒，但這種傳播途徑的重要性仍未確定。孕婦要特別注意。因為孕婦如感染戊型肝炎，死亡率是大約20%的！而現在還沒有疫苗可預防此病毒。急性的乙型和丙型肝炎是經性接觸或血液傳染，如共用針筒。
藥物，無論是西藥，中成藥，或中草藥，大多依靠肝臟分解，然後排出體外。所以有些藥物是會引發急性肝炎。因香港人服用中藥很普遍，中藥引發的急性肝炎亦多。建議切忌自行用藥，因嚴重者是要靠肝臟移植續命的。
更多資訊: Dr-Ernest.net
