Jaundice, also known as icterus, is a term used to describe a yellowish tinge to the skin and sclerae (the white part of the eye) that is caused by an excess of bilirubin in the blood (hyperbilirubinemia). Body fluids may also be yellow.
The color of the skin and sclerae varies depending on levels of bilirubin; mildly elevated levels display yellow skin and sclerae, while highly elevated levels display brown.
In this article, we will discuss what jaundice is, why it happens, and how it is diagnosed and treated.
Contents of this article:
Fast facts on jaundice
Here are some key points about jaundice. More detail and supporting information is in the main article.
- Jaundice is caused by a build up of bilirubin
- Jaundice can be caused by a number of conditions, including an inflamed liver and an obstructed bile duct
- Symptoms include a yellow tinge to the skin and whites of the eyes, dark urine, and itchiness
- Diagnosis of jaundice can involve a range of tests
What is jaundice?
A yellow tinge to the whites of the eyes is a common symptom of jaundice
Bilirubin (bil-ih-ROO-bin) is a yellow-colored substance that is responsible for the yellowing of the skin and sclerae in jaundice.
Bilirubin is a waste product that remains in the bloodstream after iron is removed from hemoglobin in red blood cells. When there is an excess of bilirubin, it can leak out into surrounding tissues, saturating them with this yellow substance. Bilirubin that is circulating freely in the blood is called unconjugated bilirubin.
One of the liver's functions is to filter out waste, such as bilirubin, from the blood.
Once bilirubin is in the liver, other chemicals are latched on to it, creating a substance called conjugated bilirubin, which is secreted in bile (a digestive juice released by the liver) and then excreted. A product of bilirubin is what gives feces its brown color.
Causes of jaundice
Jaundice most often occurs as a result of an underlying disorder that either causes overproduction of bilirubin or prevents the liver from disposing of it, both of which result in bilirubin being deposited in tissues.
Some underlying conditions that may cause jaundice are:
- Acute inflammation of the liver - may impair the ability of the liver to conjugate and secrete bilirubin, resulting in a buildup.
- Inflammation of the bile duct - may prevent the secretion of bile and removal of bilirubin, causing jaundice.
- Obstruction of the bile duct - prevents the liver from disposing of bilirubin.
- Hemolytic anemia - production of bilirubin increases when large quantities of red blood cells are broken down.
- Gilbert's syndrome - an inherited condition that impairs the ability of enzymes to process the excretion of bile.
- Cholestasis - a condition where the flow of bile from the liver is interrupted. The bile containing conjugated bilirubin remains in the liver instead of being excreted.
More rare conditions that may cause jaundice include:
- Crigler-Najjar syndrome - an inherited condition that impairs the specific enzyme responsible for processing bilirubin
- Dubin-Johnson syndrome - an inherited form of chronic jaundice that prevents conjugated bilirubin from being secreted out of the liver's cells
- Pseudojaundice - a harmless form of jaundice in which the yellowing of the skin results from an excess of beta-carotene, not from an excess of bilirubin; usually from eating lots of carrots, pumpkin, or melon
Symptoms of jaundice
Symptoms of jaundice include:
- Yellow tinge to the skin and the whites of the eyes, normally starting at the head and spreading down the body
- Pruritis (itchiness)
- Abdominal pain - typically indicates a blockage of the bile duct
- Weight loss
- Paler than usual stools
- Dark urine
Types of jaundice
There are three main types of jaundice:
- Hepatocellular jaundice - occurs as a result of liver disease or injury
- Hemolytic jaundice - occurs as a result of hemolysis (an accelerated breakdown of red blood cells) leading to an increase in production of bilirubin
- Obstructive jaundice - occurs as a result of an obstruction in the bile duct (a system of tubes that carries bile from the liver to the gallbladder and small intestine), which prevents bilirubin from leaving the liver
Jaundice, not to be confused with infant jaundice, is usually a sign of an underlying disorder.
Treatments for jaundice
Treatment of jaundice typically requires a diagnosis of the specific cause in order to select suitable treatment options. Treatment would then target the cause, rather than the jaundice itself.
Anemia-induced jaundice may be treated by increasing the amount of iron in the blood; either by taking iron supplements or eating more iron-rich foods.
Hepatitis-induced jaundice may be treated with anti-viral or steroid medications.
Obstruction-induced jaundice may be treated via surgery to remove the obstruction.
Medication-induced jaundice is treated by selecting an alternative medication and by discontinuing medications that caused jaundice.
Diagnosis of jaundice
Doctors will most likely diagnose jaundice based on the patient's history and a physical exam, paying close attention to the abdomen. Doctors will be feeling for masses (tumors) in the abdomen and/or checking the firmness of the liver; a firm liver indicates cirrhosis, while a rock-hard liver indicates cancer.
The severity of jaundice is determined by several tests, the first of which is a liver function test to find out whether or not the liver is functioning properly.
If the cause of the symptoms cannot be identified, a doctor may require blood tests to check levels of bilirubin and evaluate the composition of the blood. Some of these tests include:
- Bilirubin tests - a high level of unconjugated bilirubin relative to levels of conjugated bilirubin indicates hemolysis (accelerated breakdown of red blood cells)
- Full blood count (FBC), or complete blood count (CBC) - measures levels of red blood cells, leukocytes (white blood cells), and thrombocytes (platelets)
- Hepatitis A, B, and C tests
If an obstruction of the liver is suspected, the liver's structure will be looked at with the help of imaging tests. Some of these tests include:
- MRI scan - uses magnetic signals to create image "slices" of the soft tissues of the human body.
- Abdominal ultrasonography (ultrasound) - uses high-frequency sound waves to create a two-dimensional image of the soft tissues inside the human body
- CT or CAT scan - uses a thin X-ray beam to create image "slices" of soft tissues in the body
- Endoscopic retrograde cholangiopancreatography (ERCP) - a procedure that combines an endoscopy and X-ray imaging
A liver biopsy is particularly useful in checking for inflammation, cirrhosis, cancer, and fatty liver. This test involves injecting a needle through the skin and into the liver to obtain a sample of the tissue, which is examined under a microscope.
Complications from jaundice
The symptom pruritis (itching) can sometimes be so intense that patients scratch their skin raw, have insomnia, or even commit suicide.
Most complications that arise are a result of the underlying cause of jaundice, not from jaundice itself. For example, jaundice caused by a bile duct obstruction may lead to uncontrolled bleeding due to a deficiency of vitamins needed for normal blood clotting.
Prevention of jaundice
Jaundice is related to the function of the liver, so it is essential that individuals maintain this vital organ's health by eating a balanced diet, exercising regularly, and refraining from exceeding recommended amounts of alcohol.