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Jaundice: Causes, Symptoms and Treatment

Jaundice is a yellowing of the skin, eyes, and mucous membranes caused by elevated bilirubin levels in the blood. It is an important warning sign of various medical conditions.

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Things worth knowing about "Jaundice"

Jaundice is a yellowing of the skin, eyes, and mucous membranes caused by elevated bilirubin levels in the blood. It is an important warning sign of various medical conditions.

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

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

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