Jaundice

Jaundice occurs when bilirubin, a yellow pigment produced during the normal breakdown of red blood cells, accumulates in the blood and tissues. Normally, the liver processes bilirubin and releases it into bile, which is then eliminated through stool. When this process is disrupted, bilirubin builds up, causing the characteristic yellowing.

The yellowing typically appears first in the whites of the eyes (scleral icterus) because the white background makes even small amounts of yellow pigment visible. As bilirubin levels rise, the yellowing spreads to the skin, starting with the face and progressing downward. The deeper the yellow color, the higher the bilirubin level.

Jaundice itself isn't a disease but rather a sign of an underlying problem. The location of the problem - before the liver (pre-hepatic), in the liver (hepatic), or after the liver (post-hepatic) - determines the type of jaundice and guides treatment. Understanding these distinctions is crucial for proper diagnosis and management.

Liver Diseases

• Hepatitis: Viral (A, B, C, D, E), alcoholic, autoimmune
• Cirrhosis: End-stage liver scarring from various causes
• Fatty liver disease: Alcoholic or non-alcoholic
• Drug-induced liver injury: Acetaminophen overdose, antibiotics
• Liver cancer: Primary or metastatic
• Genetic disorders: Wilson's disease, hemochromatosis
• Primary biliary cholangitis: Autoimmune bile duct disease

Bile Duct Obstruction

• Gallstones: Most common cause of obstruction
• Pancreatic cancer: Compressing bile duct
• Cholangiocarcinoma: Bile duct cancer
• Pancreatitis: Swelling blocking duct
• Biliary strictures: Narrowing from surgery or injury
• Parasites: In endemic areas
• Primary sclerosing cholangitis: Inflammatory scarring

Blood Disorders

• Hemolytic anemia: Rapid red cell destruction
• Sickle cell disease: Abnormal hemoglobin
• Thalassemia: Inherited blood disorder
• G6PD deficiency: Enzyme deficiency
• Transfusion reactions: Blood incompatibility
• Malaria: Parasite destroying red cells

Other Causes

• Gilbert's syndrome: Benign genetic condition
• Pregnancy: Cholestasis of pregnancy
• Sepsis: Severe infection affecting liver
• Heart failure: Liver congestion
• Thyroid disorders: Affecting metabolism
• Fasting or starvation: Mild jaundice

Jaundice rarely occurs alone and is typically accompanied by other symptoms that help identify the underlying cause:

• Dark urine: Tea or cola-colored from bilirubin
• Pale stools: Clay-colored from lack of bile
• Itching (pruritus): Often severe, from bile salt deposits
• Abdominal pain: Right upper quadrant with gallstones or liver disease
• Fatigue: Common with liver disease
• Nausea and vomiting: Liver dysfunction or obstruction
• Fever: Suggests infection or inflammation
• Weight loss: May indicate cancer
• Swelling: Abdomen (ascites) or legs (edema)
• Easy bruising: Poor liver function affecting clotting
• Confusion: Hepatic encephalopathy
• Spider veins: On skin with chronic liver disease

Medical History

• Duration and progression of jaundice
• Associated symptoms
• Alcohol consumption
• Medication history
• Travel history
• Family history of liver disease
• Blood transfusions
• IV drug use
• Sexual history

Physical Examination

• Extent of jaundice
• Liver size and tenderness
• Spleen enlargement
• Abdominal fluid (ascites)
• Signs of chronic liver disease
• Lymph node enlargement
• Neurological assessment

Laboratory Tests

• Bilirubin levels: Total, direct, and indirect
• Liver function tests: ALT, AST, alkaline phosphatase
• Complete blood count: Check for hemolysis
• Prothrombin time: Clotting function
• Viral hepatitis panel: A, B, C viruses
• Autoimmune markers: If suspected
• Tumor markers: If cancer suspected

Imaging Studies

• Ultrasound: First-line for gallstones, liver
• CT scan: Detailed liver and pancreas imaging
• MRCP: Bile duct visualization
• ERCP: Diagnostic and therapeutic
• Liver biopsy: If cause unclear

Acute Complications

• Acute liver failure
• Cholangitis (bile duct infection)
• Pancreatitis
• Hepatic encephalopathy
• Coagulopathy (bleeding disorders)
• Kidney failure
• Sepsis

Chronic Complications

• Cirrhosis
• Portal hypertension
• Liver cancer
• Chronic itching
• Malnutrition
• Osteoporosis
• Recurrent infections

Neonatal Complications

• Kernicterus (brain damage)
• Hearing loss
• Developmental delays
• Cerebral palsy
• Death (if severe and untreated)

• Hepatitis vaccination: Hepatitis A and B vaccines
• Safe practices: Protected sex, no needle sharing
• Limit alcohol: Prevent alcoholic liver disease
• Medication safety: Follow dosing, avoid mixing with alcohol
• Maintain healthy weight: Prevent fatty liver disease
• Food safety: Prevent hepatitis A
• Regular check-ups: Early detection of liver problems
• Genetic counseling: If family history
• Travel precautions: Vaccinations, safe water
• Blood screening: For transfusions
• Newborn screening: Early detection and treatment
• Avoid toxins: Industrial chemicals, certain herbs

See a Doctor Immediately For:

• Any yellowing of skin or eyes
• Dark urine with pale stools
• Persistent itching
• Abdominal pain with jaundice
• Unexplained fatigue with yellowing
• Jaundice after starting new medication
• History of liver disease with new jaundice
• Jaundice with any other symptoms

Emergency Symptoms:

• Severe abdominal pain
• High fever with jaundice
• Confusion or mental changes
• Vomiting blood
• Black, tarry stools
• Severe weakness
• Difficulty breathing