What is jaundice?

Jaundice, also known as icterus, is a disorder that causes the skin and white parts of the eyes to turn a yellowish colour. It is not a disease in itself, but rather a symptom of something happening. Jaundice occurs when there is an excess of bilirubin, a yellow compound which is formed by red blood cells breaking down in the body.

What are the symptoms?

The main symptom of jaundice is yellow discolouration of the skin and mucous membranes. In some cases, other symptoms such as coluria (very dark urine) and acolia (very light stools due to the absence of pigments derived from bilirubin) may occur.

Further symptoms of jaundice include:

What are the causes of jaundice?

Jaundice occurs when there is an excess of bilirubin. Bilirubin is a waste product of haemoglobin, which is the main content of red blood cells. This bilirubin is processed in the liver and transported through the bile duct into the small intestine, and eliminated in the faeces. Jaundice occurs when there is an increase in the rate of destruction of red blood cells, for example in certain liver diseases and in diseases where there is a blockage of the bile duct.

What are the different types of jaundice?

Types of jaundice are categorised by the area where the liver processes bilirubin that cannot be filtered into your digestive system for removal, and builds up to high levels in your blood. The types are:

Pre-hepatic - this is before the liver
Hepatic - this occurs in the liver
Post-hepatic - this is after the liver

Pre-hepatic jaundice

This type of jaundice is caused by conditions that heighten your blood's rate of haemolysis. Haemolysis is the process where red blood cells are broken down, releasing haemoglobin and converting into bilirubin. The liver can only process so much bilirubin, so this means this excess overflows into bodily tissues.

There are several common causes of pre-hepatic jaundice, which are:

T halassemia - a condition that is genetic, which causes the body to create an irregular type of haemoglobin. This haemoglobin limits the number of healthy red blood cells in your blood stream.
S ickle cell anaemia - where red blood cells become crescent-shaped rather than disc-shaped
Spherocytosis - instead of disc-shaped red blood cells, the genetic condition causes them to be sphere-shaped
Malaria - an infected mosquito bite that causes a blood infection

Symptoms of pre-hepatic jaundice include:

Dark urine or pale stool
Feeling itchy
Abnormal weight loss
Fever and cold sweats
Abdominal pain

You are more at risk of developing pre-hepatic jaundice if you:

Use drugs
Have a family member with a blood disorder
Travel to malaria-endemic regions

To make a diagnosis, there are different types of tests for pre-hepatic jaundice:

A HIDA scan, which helps to find blockages or other problems in the liver, gallbladder, bile ducts alongside the small intestine
MRI or ultrasound imaging tests, which examine your liver, gallbladder and bile ducts. These tests can rule out other forms of jaundice
B lood tests, which measure bilirubin and other substances in the blood
Urinalysis, which measures the amount of certain substances in your urine

Hepatic jaundice

When you have cirrhosis, which means your liver tissue is scarred, damaged or functioning incorrectly, it makes it less effective at filtering bilirubin from your blood.

As well as cirrhosis, hepatic jaundice can be caused by:

Viral hepatitis, which is an inflammation of the liver caused by viruses from infected food, water or blood, alongside stool or sexual contact
Liver cancer, where cancerous cells develop and multiply within liver tissues
Alcoholic hepatitis, where liver tissues are scarred by the heavy, long-term drinking of alcohol
Leptospirosis, a bacterial infection which can spread by infected animals, or infected urine or faeces.
Primary biliary cirrhosis, which occurs when bile ducts are damaged and can't process bile. This causes it to build up in your liver and damage liver tissue.

The symptoms of hepatic jaundice can include:

Vomiting
Feeling sick
Fever
Darkening skin
Muscle or joint pain
Dark urine or pale stool
Abdomen or leg swelling
Abnormal weight loss
Weakness
Itchy skin
Nose bleeding
Loss of appetite

You are more at risk at developing hepatic jaundice if you:

Have had previous liver infections
Use medications that can cause liver damage, such as some heart medications and Acetaminophen
Have drunk alcohol or used drugs for a long period of time

A diagnosis of hepatic jaundice can be made with the following tests:

Endoscopy, which can be used to look at your liver and take a tissue sample, or biopsy, if analysis is necessary for cancer or other conditions.
Imaging tests like MRIs or ultrasounds. They examine your liver for damage or presence of cancerous cells.
Complete blood count (CBC) and antibody tests
Liver function tests. Liver function tests measure bilirubin in the blood and levels of substances which indicate that your liver may not be processing bilirubin properly.
Urinalysis, which measures substance levels in your urine related to your liver function.

Post-hepatic jaundice

Post-hepatic jaundice, also known as obstructive jaundice, is when bilirubin can't be drained properly into the bile ducts or digestive tract because of a blockage.

Common causes of obstructive jaundice are:

Biliary atresia - This is a genetic condition where you have narrow or missing bile ducts.
Bile duct cancer
Pancreatitis
Pancreatic cancer
Gallstones

Post-hepatic symptoms include:

Fever
Abdominal swelling
Weight loss that's abnormal
Skin itching
Diarrhoea
Vomiting
Dark urine or pale stool
Feeling sick

Obstructive jaundice risk factors are:

Having a family history of gallstones
Smoking
Drinking
Pancreas inflammation or infection in the past
Being overweight
Having a diet that's high in fat and low in fibre
Diabetes

Tests you can undertake to diagnose post-hepatic jaundice:

Endoscopy
Imaging tests
Urinalysis
Blood tests

How is jaundice treated?

In adults and young children, jaundice should be considered only as a symptom of a disease. Therefore, the treatment should not be for jaundice, but for the disease causing it. For example, if you have gallstones that are blocking your bile duct, which is one cause of jaundice, you might need medication or surgery.

IV fluids used to treat liver disease, which can cause jaundice

How do I know if I have jaundice in my eye?

The whites of your eyes (sclera) can turn yellow when you have jaundice, as well as your skin. It's caused by the build up of too much bilirubin, a yellow substance that forms when red blood cells break down, in your blood, or due to the fact your liver can't get rid of it fast enough.

Causes of jaundice which may lead to yellowing of your eyes can be:

Hepatitis
Gallstones
Drinking too much alcohol
Medications such as steroids, Penicillin and Acetaminophen (taking too much), alongside birth control pills and Chlorpromazine, which is used to treat some mood disorders
Liver infection
Reaction to a blood transfusion
Sickle cell anaemia
Malaria
Cirrhosis
Non-alcoholic fatty liver disease
Haemolytic anaemia
Liver, pancreatic and gallbladder cancer
Bile duct diseases such as biliary atresia, primary biliary cholangitis and primary sclerosing cholangitis
Ulcerative colitis
Sarcoidosis, where collections of inflammatory cells called granulomas
Amyloidosis, a rare disease where there's a build up of abnormal amyloid deposits in parts of the body such as the heart, brain, kidneys or spleen
Pancreatitis
Gilbert's syndrome, a genetic liver disorder which affects the body's ability to process bilirubin

Treatment for the cause of jaundice will help to get rid of yellow eyes.

Can jaundice occur in newborns?

In newborns, jaundice can occur, but it usually goes away on its own. If the jaundice is mild, then parents should ensure the baby is feeding properly and is kept hydrated. If the jaundice is severe, then certain treatments may be indicated. Blood transfusion can be performed to clear the bilirubin from the blood, or light therapy (phototherapy) may be used in order to promote excretion of bilirubin.

Newborn baby with possible jaundice

Can jaundice be prevented?

There are some measures which can be taken to prevent jaundice such as:

Avoiding excessive consumption of alcohol
Receiving the hepatitis vaccine
Avoiding certain medications (consult your doctor)

Which specialist treats jaundice?

There are a variety of specialists that treat jaundice. Gastroenterologists, hepatologists and general surgeons all treat conditions linked to jaundice.

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