Jaundice: Causes, Symptoms and Treatment

What Is Jaundice?

Jaundice (medically known as icterus) is a yellow discoloration of the skin, the whites of the eyes (sclerae), and mucous membranes. It results from an elevated concentration of bilirubin in the blood. Bilirubin is a yellow breakdown product of hemoglobin, the oxygen-carrying protein in red blood cells. Under normal circumstances, the liver processes bilirubin and excretes it through bile. When bilirubin levels exceed approximately 2 mg/dL, the characteristic yellow coloration becomes visible.

Causes

Jaundice is classified into three main types based on where the problem originates:

Pre-hepatic Jaundice

The problem occurs before the liver. Excessive destruction of red blood cells (hemolysis) floods the liver with more bilirubin than it can process.

• Hemolytic anemia
• Sickle cell disease
• Malaria
• Autoimmune conditions

Hepatic Jaundice

The liver itself is damaged or diseased and cannot properly process bilirubin.

• Hepatitis (viral, alcoholic, or drug-induced liver inflammation)
• Liver cirrhosis
• Liver cancer
• Wilson disease

Post-hepatic (Cholestatic) Jaundice

A blockage in the bile ducts prevents bilirubin from being excreted.

• Gallstones
• Cholangitis (inflammation of the bile ducts)
• Pancreatic cancer
• Bile duct strictures

Symptoms

The hallmark symptom is the yellow discoloration of the skin and eyes. Additional symptoms may include:

• Dark (brown) urine
• Pale, clay-colored stools
• Itching (pruritus)
• Fatigue and weakness
• Nausea and loss of appetite
• Pain in the upper right abdomen
• Fever (in cases of infection or inflammation)

Diagnosis

A range of investigations is used to determine the underlying cause of jaundice:

• Blood tests: Total, direct, and indirect bilirubin levels; liver function tests (ALT, AST, GGT, ALP); full blood count
• Urine and stool analysis: Detection of bilirubin or urobilinogen
• Ultrasound: Evaluation of the liver, gallbladder, and bile ducts
• CT or MRI scan: More detailed imaging for complex cases
• ERCP (Endoscopic Retrograde Cholangiopancreatography): Visualization and potential treatment of bile duct obstructions
• Liver biopsy: Tissue sampling for histological analysis when liver disease is suspected

Treatment

Treatment always targets the underlying cause of jaundice:

• Hepatitis: Antiviral medications, cessation of alcohol, discontinuation of causative drugs
• Gallstones: Endoscopic removal or surgical intervention
• Hemolysis: Treatment of the underlying condition; blood transfusions if necessary
• Liver cirrhosis: Supportive care, management of complications, possible liver transplantation
• Tumors: Surgery, chemotherapy, radiation therapy, or palliative care

Neonatal Jaundice

Neonatal jaundice (icterus neonatorum) is a special case that affects many newborns within the first days of life. It is usually physiological (normal) and results from the transition from fetal to adult hemoglobin. In more severe cases, phototherapy (treatment with blue light) is used to convert bilirubin into a water-soluble form that can be more easily excreted by the body.

References

1. Herold, G. et al. - Internal Medicine. Herold Publishing, 2023.
2. European Association for the Study of the Liver (EASL) - Clinical Practice Guidelines on the management of hepatic encephalopathy. Journal of Hepatology, 2022.
3. World Health Organization (WHO) - Hepatitis: Global health sector strategy, 2022-2030. WHO Press, 2022.