Jaundice is a disorder marked by elevated bilirubin levels that result in the yellowing of the skin and mucous membranes. People can develop jaundice due to a number of conditions that interfere with the normal metabolism or excretion of bilirubin. This article gives you a detailed description of jaundice, its causes, symptoms, complications, and treatment.
What is jaundice？
Jaundice is a condition where there is yellowing of the skin, mucous membranes, and sclera (the whites of the eyes). This occurs due to the build up of bilirubin in the blood. Haemoglobin, the protein that is found in red blood cells responsible for the transport of oxygen, gets broken down to produce bilirubin. This bilirubin is used to make bile by the liver and is primarily expelled through the stools (a minor portion is excreted in the urine). Jaundice develops when bilirubin builds up in the blood and gets deposited in the skin, eyes, and other tissues.
What causes jaundice？
Jaundice may occur if there is an issue with any of the three stages of bilirubin production. This include:
Prehepatic jaundice: Elevated bilirubin levels lead to unconjugated jaundice. It is caused by:
- Resorption of a significant hematoma (a collection of clotted or partially clotted blood under the skin)
- Anaemia with hemolysis (blood cells are destroyed and removed from the bloodstream before their expected lifespan is over)
Hepatic jaundice: Jaundice may develop during bilirubin production as a result of:
- Viral infections such as hepatitis A, B, and C, Epstein-Barr virus, cytomegalovirus
- Excessive alcohol intake
- Autoimmune illnesses like autoimmune hepatitis and primary biliary cholangitis
- Rare metabolic genetic abnormalities like Gilbert syndrome and Dubin Johnson syndrome
- Drugs include paracetamol, penicillin, oral contraceptives, and anabolic or oestrogenic steroids
Post-hepatic jaundice: Jaundice may result from blockage of the bile ducts due to:
- Gallstones
- Gallbladder inflammation
- Gallbladder cancer
- Tumour in the pancreas
What are the symptoms of jaundice？
The main symptoms of jaundice include:
- Yellow appearance of the skin, mucous membranes, and the whites of the eyes
- Pale stools
- Dark coloured urine
- Itchiness of the skin (or ‘pruritis’)
- Fatigue
- Abdominal pain
- Weight loss
- Vomiting
- Fever
How can jaundice be diagnosed？
To diagnose jaundice, your doctor takes a detailed medical history and conducts a physical examination. They also examine your skin, liver, and abdomen to look for any changes or abnormalities.
- Lab tests: These are done to rule out the cause of jaundice and include:
- Liver function testing, including bilirubin levels, gives a general idea about the status of your liver. Haemolytic jaundice is indicated by increased levels of unconjugated bilirubin compared to conjugated bilirubin, while the reverse is true in the case of obstructive jaundice. Viral infections and excessive alcohol consumption cause an increase in liver enzyme levels
- Complete blood count
- Urine examination: Urine analysis that is positive for bilirubin confirms the presence of conjugated jaundice
- Liver function testing, including bilirubin levels, gives a general idea about the status of your liver. Haemolytic jaundice is indicated by increased levels of unconjugated bilirubin compared to conjugated bilirubin, while the reverse is true in the case of obstructive jaundice. Viral infections and excessive alcohol consumption cause an increase in liver enzyme levels
- Complete blood count
- Urine examination: Urine analysis that is positive for bilirubin confirms the presence of conjugated jaundice
- Imaging Tests
- Ultrasound
- CT scanning
- Liver biopsy: To look for cirrhosis, malignancy, fatty liver, and inflammation. A needle is inserted into the liver to collect a tissue sample for this test, which is then examined under a microscope
How is jaundice treated？
In adults, the underlying cause of jaundice is treated (while in newborns, severe jaundice is treated with phototherapy).
- Infections are treated with antibiotics, antiviral, and antifungal agents
- Pre-hepatic jaundice can be treated with blood transfusions, which may be required for individuals with anaemia due to hemolysis or as a result of bleeding
- Post-hepatic jaundice may require surgery or other invasive procedures for the removal of gall stones from the bile duct
Medication-induced jaundice develops as a side effect of taking certain medications like paracetamol, penicillin, and steroids. In such circumstances, these medications are stopped and substitutes are recommended. For example, the antidote N-acetylcysteine may be necessary in cases of intentional or unintentional paracetamol overdose - Jaundice-causing medical illnesses like autoimmune disease may be treated with a variety of drugs, like steroids
- Cirrhosis patients are treated with lactulose, diuretics, albumin infusion, and antibiotics
- A liver transplant is a treatment option for people who have advanced cirrhosis or end-stage liver failure
How can I prevent jaundice？
- Avoid high-risk activities like unprotected sex or intravenous drug use, and take all reasonable safety procedures while handling needles and blood products to lower your risk of contracting hepatitis B or C
- Eat well-cooked, hygienic food to minimise your chances of getting hepatitis A
- Keep your cholesterol levels in check to prevent the development of gallstones and gallbladder disease
- Limit your alcohol intake (Moderate alcohol use for healthy adults is one drink a day for women and up to two drinks a day for men. One drink roughly translates to 30 ml of hard liquor, 150 ml of wine, and 330 ml of beer)
- To avoid potential liver damage and unintended overdose, only take drugs as directed by your healthcare professional
What are the complications of jaundice？
Complications mainly depend on the underlying cause of jaundice. For some people, there won’t be any long-term effects, and they’ll fully recover, but for others, the onset of jaundice will be the first sign of a life-threatening condition. Some complications of jaundice include:
- Electrolyte imbalance
- Bleeding
- Anaemia
- Kidney failure
- Hepatitis
- Liver cirrhosis
- Liver failure
- Cancer
Is jaundice curable?
Jaundice is treatable. While treatment options for babies range from dietary adjustments to blood transfusions in more severe situations, adults need to make lifestyle changes, watch their medications, and in some cases, require surgery (gallbladder surgery).
