Jaundice (icterus) is often a serious symptom

With jaundice, the skin is yellowish in color. The whites of the eyes are especially sensitive to this discoloration. It is sometimes also seen in newborns. Is it dangerous? What causes could underlie this? To begin with, jaundice is always a symptom of too much bilirubin circulating in the blood. Bilirubin is formed during the breakdown of red blood cells. The liver links bilirubin to glucagon acid and releases it into the bile. A lot of things can go wrong during that process. With jaundice there is usually something wrong with the liver or gallbladder. But there may also be an infection, such as hepatitis A.

Contents

  • What is jaundice (icterus)?
  • Dynamic and mechanical jaundice
  • Main causes of jaundice
  • Icterus gravis (jaundice in newborns)
  • Three main forms of jaundice
  • Prehepatic or hemolytic jaundice
  • Posthepatic jaundice
  • Intrahepatic jaundice
  • To the doctor…

 

What is jaundice (icterus)?

Jaundice is a yellow discoloration of the skin and mucous membranes. The bilirubin level in the blood is then too high. The discoloration of the whites of the eyes is the most striking. Normally, bilirubin is excreted as bile in the feces via the spleen and liver. Bilirubin is a breakdown product of hemoglobin, or the iron-containing red pigment in red blood cells.

Liver and bile ducts / Source: Henry Vandyke Carter, Wikimedia Commons (Public domain)

Bilirubin
This dye is transported to the liver through a chemical conversion process, where it is ultimately excreted into the intestines via the bile. If this process falters somewhere along the way, too much bilirubin will enter the blood and the skin will turn yellow. This is called jaundice or jaundice. It is a symptom of an underlying condition.

Dynamic and mechanical jaundice

With dynamic jaundice, jaundice occurs due to increased breakdown of red blood cells. The healthy liver cannot handle the influx of bilirubin. In mechanical jaundice, bilirubin buildup occurs because the defective or affected liver cells cannot process the supply from the blood. The congestion can also occur because the bilirubin cannot be drained to the bile ducts, for example due to a blockage.

Main causes of jaundice

Jaundice can be caused by an obstruction of the bile ducts. But increased breakdown of hemoglobin can also be the cause. Hepatitis A is also notorious.
Obstructive jaundice
The cause is a partial or complete blockage of the bile ducts. For example, due to a gallstone, gallbladder cancer or congenital abnormalities of the bile ducts. This is called post-hepatic jaundice. The (soluble) bilirubin is then pushed back into the blood, resulting in jaundice. The stool is very light in color, the urine, on the other hand, is dark. Worms and pancreatic cancer can also cause a blockage of the bile ducts. In the case of obstructive jaundice, colic can occur due to, for example, gallstones.
Hemolytic jaundice
This form of jaundice is due to an increased breakdown of red blood cells in the spleen. The healthy liver cannot handle the processing of bilirubin, for example after a hemorrhage. The urine is then colored brown.

Gastrointestinal tract / Source: Mariana Ruiz Villarreal (LadyofHats), Wikimedia Commons (Public domain)

Hepatic jaundice
The cause is liver cell damage, for example due to hepatitis A or liver cirrhosis.
Weil’s disease (infectious jaundice)
In addition to high fever and flu-like symptoms, jaundice also occurs.
Medicines, alcohol, nutrition
Long-term alcohol abuse causes liver cirrhosis and liver insufficiency. The liver cells are then destroyed and connective tissue occurs, as a result of which the liver is no longer up to its task. Certain medications can also have jaundice as a side effect.
Hereditary disorders
Such as Gilbert’s syndrome and Crigler-Najjar syndrome. These conditions reduce the processing capacity of the liver cells, which can cause jaundice.

Icterus gravis (jaundice in newborns)

This form of jaundice occurs in the first hours after birth. The cause is usually a difference in blood type, or antagonism, between the mother and the baby. The mother has then produced antibodies against the fetal blood (rhesus antagonism). There is an increased breakdown of red blood cells, resulting in too much bilirubin in the blood (jaundice). There is also the danger that so-called kernicterus will develop, because bilirubin is very toxic to the newborn’s brain. Damage then occurs in the nervous system.
Light therapy
In newborns, the liver is sometimes not yet mature enough to process the bilirubin. Jaundice also occurs then, because the fetal hemoglobin is first broken down and there is therefore an increased supply of bilirubin. Light therapy is often given to newborns with high bilirubin levels. Exposure to light accelerates the conversion of bilirubin into a soluble form. These babies are put ‘under the blue lamp’.

Three main forms of jaundice

From the above, three main forms of jaundice can be deduced:

Prehepatic or hemolytic jaundice

The cause of the yellow discoloration can be found before the liver, such as after increased breakdown of red blood cells. The liver cannot process the influx of bilirubin.

Source: FotoshopTofs, Pixabay

Posthepatic jaundice

We must look for the cause of this jaundice behind the liver, for example as a result of gallstones that obstruct bile drainage in the gallbladder, also called occlusive jaundice.

Intrahepatic jaundice

The liver may be damaged (liver cirrhosis), such as after long-term alcohol abuse. Or there may be inflammation (hepatitis).

To the doctor…

There are other causes of jaundice, such as viral jaundice. Breastfed babies also have symptoms of jaundice more often than bottle-fed babies. The phenomenon is usually harmless if the baby shows no symptoms of other conditions. However, if jaundice persists, it is always wise to visit the doctor. Jaundice is a symptom. So something is wrong if the whites of the eyes look yellow, or if the stool has a putty color. Discoloration of the stool almost always indicates a bile duct or liver problem. The GP is the best person to determine whether the jaundice is serious. He can refer someone to the specialist or give other advice.

read more

  • Digestion under the microscope – the liver
  • Liver failure or hepatic insufficiency – acute and chronic
  • Anatomy & physiology in 10 steps – liver and bile ducts
  • This is how jaundice (icterus) occurs
  • Causes of pain – gallstone, kidney stone and ileus (colic)
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