Causes and diagnosis of the most common types of jaundice

Written by: Professor Roger Williams CBE
Published:
Edited by: Emma McLeod

Jaundice is characteristically known for its yellow effect on the skin, but unbeknownst to many, there are different types as well as different causes. Professor Roger Williams CBE explains the symptoms, causes and diagnosis of the most common types of jaundice.

 

A close up of an eye which has the yellow colouring that may be experienced by a person with jaundice

 

What are the symptoms of jaundice and how do I know I have it?

A patient will know he/she has jaundice when in addition to having yellow eyeballs, they also have dark urine and pale stools. The most important decision when choosing treatment is to diagnose which category of jaundice the patient has.


Two common categories are obstructive jaundice and parenchymal jaundice. While obstructive jaundice requires surgical relief, parenchymal may only need medical treatment.

 

What causes obstructive jaundice?

The most common cause of obstructive jaundice occurs in the gallbladder. During the passage of a gallstone from the gallbladder to the bile duct, rather than passing through completely, the gallstone becomes lodged and obstructs the bile flow. To remove the gallstone from the gallbladder, surgical treatment is required.

 

The second most common cause is pancreatic cancer. In this case, the obstruction occurs in the lower end of the common bile duct.

 

How is obstructive jaundice diagnosed?

The patient will need to be referred to a Consultant Hepatobiliary Surgeon who will likely carry out further investigations to discover the exact cause. This can be in the form of:

  • An ultrasound examination
  • An ERCP (Endoscopic retrograde cholangio-pancreatography)
  • A MRCP (Magnetic resonance cholangiopancreatography) examination to define the site of the obstruction

 

Characteristic findings in liver blood tests of a patient with obstructive jaundice are:

  • High alkaline phosphatase, a type of enzyme which if high, can indicate that there is a problem with your liver.
  • Raised bilirubin levels (a slightly yellow substance in your blood)

Often the patient experiences itching as the jaundice worsens, sometimes manifested by an episode of cholangitis or other symptoms which include shivers, rigors and high temperatures. Cholangitis occurs when there is obstruction to bile flow and a secondary bacterial infection.

 

What causes parenchymal jaundice?

Parenchymal jaundice is caused by a viral hepatitis, usually hepatitis A or B. If the patient is from overseas, hepatitis E could be a potential cause.

The patient may have general symptoms of feeling unwell, particularly a poor appetite and nausea.

Hepatitis C is rarely acute, meaning it begins gradually and is treatable with the new antiviral agents available. Patients with an acute viral hepatitis usually require supportive therapy only. Furthermore, it is important that the patient’s nutrition is maintained despite a lack of appetite.

 

In parenchymal (hepatic) jaundice, the cause is a disease of the liver itself, such as

  • Infective hepatitis, also known as viral hepatitis (inflammation of the liver)
  • Drug toxicity (when the liver is poisoned)
  • Cirrhosis (when liver tissue becomes scarred)

 

How is parenchymal jaundice diagnosed?

A more chronic liver disease such as autoimmune hepatitis, where drug treatment with Prednisolone is particularly effective, will require further investigations into serum autoantibodies levels and liver biopsy.

Often, a CT examination will be carried out to show any characteristic changes in cirrhosis, a scarring of the liver.

Patients with possible chronic liver disease as well as those with acute viral hepatitis who do not begin to improve after a few days need to be referred to a consultant hepatologist.

Acute Liver Failure (Fulminant Hepatitis)

A rare but very important diagnosis to make is that of acute liver failure. One particular cause of acute liver failure which must be considered urgently is a paracetamol overdose; the earlier the antidote is given, the better the chances of halting the progression of the liver injury.

 

Haemolytic jaundice

A third category of jaundice is haemolytic jaundice. In this case, it develops in association with an increased breakdown of red blood cells. Haemoglobin is a protein found in red blood cells which carries oxygen and in haemolytic jaundice, blood tests show a falling haemoglobin level and a rising jaundice level.

 

Professor Roger Williams CBE is a highly esteemed Hepatologist in London. Visit his profile for more expertise on hepatology and to book an appointment.

By Professor Roger Williams CBE
Hepatology (liver specialist)

Professor Williams is the Director of the Institute of Hepatology, London and Medical Director of the Foundation of Liver Research, a UK-registered charity. He holds an honorary consultant hepatology position in King's College Hospital.

The Institute of Hepatology is an independent research institute funded and managed by the Foundation for Liver Research, a charity set up by Professor Williams in 1974. It has affiliate status to the King's College London and King's College Hospital. Between 1996 and 2010 Professor Williams established a major research institute at University College London and built a major clinical service in hepatology at University College Hospital. During that time he was also responsible for setting up the liver centre at The London Clinic. In his current position he remains close to the world-renowned Institute of Liver Studies at King's College Hospital which he started from scratch as a liver unit in 1966. For 30 years he was Director, building it to become one of the largest clinical and research liver units worldwide. He was responsible, together with Professor Sir Roy Calne, for the early pioneering start of liver transplants in the UK.

He is a fellow of the Academy of Medical Sciences, London and Royal College of Physicians where he was Clinical Vice President and Director of the International Office. He is a recipient of numerous honorary fellowships, medals and prizes including the American Society of Transplantation Senior Achievement Award in 2004, a Hans Popper Lifetime Achievement in 2008, the Distinguished Service Award of the International Liver Transplant Society in 2011, and in 2013 the Distinguished Achievement Award of the American Association for Study of Liver Disease. Since 2013 he has been Chairman of the Lancet Commission into Liver Disease in the UK which, with its body of experts and its annual reports and Parliamentary meetings, has addressed the main lifestyle causes of liver disease in the country, namely alcohol, viral hepatitis and obesity.

His main clinical and research interests are in acute and chronic liver failure, liver support devices, liver transplantation, complications or cirrhosis and management of viral hepatitis.

Professor Williams has wide experience of providing expert medical legal reports and can be contacted through his office at the Institute of Hepatology.

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