Jaundice or jaundice is not a disease or condition, but a phenomenon or symptom of an underlying condition of the liver or gallbladder/bile ducts. As such, jaundice may be accompanied by other symptoms depending on the underlying cause. Jaundice refers to yellowing of the skin and whites of the eyes, and dark urine due to too high a bile pigment content in the blood. Bile dye or bilirubin is a breakdown product of red blood dye and is formed in the liver. Possible causes of jaundice include biliary disorders or bile congestion due to bile duct stricture, obstruction or tumors. Icterus or jaundice can also be a symptom of liver disease. The diagnosis of ‘icterus’ or ‘jaundice’ is made on the basis of the clinical picture and blood and urine tests. If necessary, additional research can be conducted. The treatment for icetrus or jaundice depends on the underlying cause.
- What is jaundice?
- What is bilirubin?
- When does jaundice occur?
- Types of jaundice
- Causes of pre-hepatic jaundice
- Causes of per-hepatic jaundice
- Causes of post-hepatic jaundice
- Physiological jaundice – jaundice in babies
- Symptoms of jaundice
- Diagnosis: interview with the doctor
- Diagnosis: physical examination
- Signs of jaundice
- Swelling of the legs, ankles and feet
- Swelling of the abdomen
- Enlarged liver
- Appearance, body and tattoos
- Lymph nodes
- Upper limbs
- Diagnosis: follow-up examination
- Liver function and blood tests
- Visual art investigation
- Liver biopsy
- Treatment of jaundice
- Prevention and prevention
- Forecast and prospects
Jaundice due to pancreatic cancer / Source: James Heilman, MD, Wikimedia Commons (CC BY-3.0)
What is jaundice?
Jaundice refers to yellowing of the skin and/or the whites of the eyes due to an increased amount of bilirubin in the blood. Jaundice is a sign or symptom of an underlying disease process, just as pallor is a syndrome of anemia or shock. Jaundice is therefore not a disease in itself, as many people think.
What is bilirubin?
Bilirubin is the breakdown product of hemoglobin, the red blood dye found in red blood cells. Bilirubin is absorbed from the spleen via the blood to the liver, where it is transformed. The converted bilirubin (bile dye) is then drained with the bile fluid to the gallbladder. Ultimately, this breakdown product leaves the body with the feces.
When does jaundice occur?
When a disturbance occurs in the normal metabolism and/or production of bilirubin, this can lead to jaundice. Because bilirubin has an intense yellow color, an increased concentration of bilirubin in the blood will cause jaundice. In mild cases, this leads to a yellow discoloration of only the whites of the eyes, but in more severe cases the entire skin of the body will turn yellow.
Types of jaundice
Several conditions can cause elevated bilirubin levels in the blood. Three types of jaundice are distinguished:
- Pre-hepatic jaundice (‘before the liver’);
- Per-hepatic jaundice (‘through the liver’);
- Post-hepatic jaundice (‘after the liver’).
Causes of pre-hepatic jaundice
In pre-hepatic jaundice, jaundice is caused by the rapid increase in the breakdown and destruction of red blood cells (hemolysis). There is nothing wrong with the liver itself, but the breakdown of hemoglobin is increased to such an extent that there is too much supply. This often causes a mild form of jaundice. Examples of conditions with increased breakdown of red blood cells:
- Sickle cell anemia;
- Congenital spherocytosis;
- Glucose-6-phosphate dehydrogenase deficiency (G6PD);
- Medicines or other toxic substances;
- Autoimmune diseases.
Excessive alcohol consumption / Source: Istock.com/Csaba Deli
Causes of per-hepatic jaundice
In per-hepatic jaundice, the liver itself is affected by disease and can therefore handle less supply; it can break down (metabolize) less waste. Another possibility is that the liver allows the processed products to leak back into the blood instead of into the bile. A combination is also possible. Examples of conditions that cause this include:
- Hepatitis (usually viral: hepatitis A, hepatitis B and hepatitis C; or alcohol-related or alcoholic hepatitis)
- Alcoholic liver disease (where the liver is damaged by drinking too much alcohol), such as cirrhosis
- Drugs or other toxins (toxic hepatitis)
- Crigler-Najjar syndrome, a rare, hereditary disorder of the liver;
- Gilbert’s syndrome, a hereditary disorder of the liver;
- Liver cancer, a rare and usually incurable cancer that develops in the liver;
- Leptospirosis, a bacterial infection spread by animals, especially rats;
- Glandular fever or mononucleosis, a viral infection caused by the Epstein-Barr virus;
- Drug abuse (the main causes are ecstasy (XTC) and paracetamol overdoses);
- Primary biliary cirrhosis (PBC), a relatively rare chronic liver disease that gradually causes liver damage;
- Exposure to substances harmful to the liver, such as phenol (used in plastic manufacturing) or tetrachloride (historically used in fire extinguishers, although its use is strictly controlled);
- Autoimmune hepatitis (AIH), a rare condition in which the immune system attacks the liver;
- Primary sclerosing cholangitis (PSC), a condition in which the bile ducts inside and outside the liver are inflamed.
- Dubin-Johnson syndrome, a form of jaundice that is harmless. The cause is a change in the DNA (hereditary material).
Gallstones / Source: Blausen.com staff, Wikimedia Commons (CC BY-SA-4.0)
Causes of post-hepatic jaundice
In post-hepatic jaundice, the bile drainage ducts in or after the liver are blocked, usually as a result of a gallstone, sometimes by a tumor (pancreatic cancer or gallbladder cancer). Pancreatitis or pancreatitis is another possible cause of post-hepatic jaundice. This causes a lot of soluble bilirubin to leak into the blood. If there is post-hepatic jaundice, the stool will be light to white and the urine will be very dark to brown.
Physiological jaundice – jaundice in babies
Many newborns experience physiological jaundice. The jaundice is caused by an excess of fetal hemoglobin and immaturity of the liver. It starts about the second or third day and normally disappears by the seventh day. Read more here.
Jaundice in a baby / Source: Anastasiia Ylitko/Shutterstock.com
Symptoms of jaundice
Pre-hepatic jaundice symptoms
Pre-hepatic jaundice has the following symptoms:
- dark urine
- dark color of the stool
- yellow skin color
- the whites of the eyes turn yellow
- itching (probably caused by irritation by bile dye or by bile salts) and scratching effects
- bradycardia (due to the high concentration of bile salts in the blood)
Per-hepatic jaundice symptoms
Per-hepatic jaundice has the following symptoms:
- dark urine
- lighter color of the stool
- yellow skin color
- the whites of the eyes turn yellow
- itching and scratching
With post-hepatic jaundice symptoms
With post-hepatic jaundice the following symptoms may occur:
- putty relief
- jaundice of tissues
- itching and scratching effects
The itching can sometimes be so intense that you scratch your skin completely, causing wounds. The itching can also cause you to sleep poorly. Most complications that arise are due to the underlying cause of jaundice, not from jaundice itself. For example, jaundice caused by bile duct obstruction can lead to uncontrollable bleeding due to a deficiency of vitamins necessary for normal blood clotting.
Stomachache / Source: Andrey Popov/Shutterstock.com
Diagnosis: interview with the doctor
Your GP or hospital doctor will conduct an extensive interview with you about your complaints, during which he will take into account your medical history to find out why you have jaundice. The doctor may ask the following questions, among others:
- Whether you had flu-like symptoms before jaundice set in (this may indicate hepatitis);
- Whether you currently have other symptoms such as stomach pain, itchy skin or weight loss;
- Or you have recently traveled to a country where diseases such as malaria or hepatitis A are widespread;
- Or you have noticed a change in color in your urine and stool (dark urine or white or light stool);
- Whether you are familiar with alcohol abuse;
- Whether you have currently (or previously) used drugs;
- Whether you have a profession where you could be exposed to harmful substances.
- Whether there has been recent consumption of shellfish (which can lead to infection with the hepatitis A virus);
- Whether there has been a recent operation, as a recent surgical procedure on the bile ducts or cancer increases the risk of developing jaundice.
Diagnosis: physical examination
It is likely that the doctor will also perform a physical exam to check for signs of an underlying condition. During a physical examination, the doctor may look for the following, among other things:
Tomatoes / Source: Vlad Teodor/Shutterstock.com
Signs of jaundice
The doctor examines for signs of jaundice in the following places: skin, palms, nail bed, eyes, tip of the nose, lips, underside of the tongue and palate. The white background of the sclera or whites of the eyes makes it easy to detect jaundice in the eye. It is particularly important for a doctor to look at the eye to distinguish between hyperbilirubinemia and hypercarotenemia. Hyperbilirubinemia turns the eyes yellow. With carotenemia, the skin turns yellow, but the eyes do not turn yellow. Hypercarotenemia involves a yellow discoloration of the face, palms and/or soles. However, the discoloration does not affect the eyes. The cause is the excessive consumption of raw carrots and tomatoes.
Swelling of the legs, ankles and feet
Edema or fluid retention and swelling in the ankles, legs and abdomen is a possible sign of cirrhosis.
Fluid retention in the abdomen (ascites) / Source: James Heilman, MD, Wikimedia Commons (CC BY-SA-3.0)
Swelling of the abdomen
Ascites (fluid retention in the abdomen) is a symptom of liver cirrhosis or cancer.
Noticeable swelling of your liver (an enlarged liver) is a possible sign of hepatitis.
Appearance, body and tattoos
Are you ill? With hepatocellular jaundice you are more acutely ill than with an obstruction. Is there cachexia? This is a form of extreme thinness. This may be an indicator of cancer causing jaundice. The doctor also checks for tattoos. If present, the doctor will ask if the jaundice occurred a few months after the tattoo was applied. This may indicate hepatitis that has been transmitted through a dirty needle.
The doctor examines all nodes. Glands above the collarbone (supraclavicular lymph nodes) can swell due to an infection or tumor near the lungs, chest, neck, or abdomen.
Drumstick fingers / Source: Desherinka, Wikimedia Commons (GFDL)
The doctor examines the hands, arms and hands. Chronic liver disease is often associated with leukonychia (white nails), drumstick fingers (your nails look bulbous, the terminal phalanges are thickened), and palmar erythema or palmoplantar erythema (red palms of the hands and sometimes soles of the feet).
Liver failure is associated with asterixis (the inability to maintain a fixed position). Asterixis is also called a ‘flapping tremor’ or ‘negative myoclonias’. Alcoholic cirrhosis may be associated with a cramping of the fingers (Dupuytren’s contracture of the palms). The armpits may show less armpit hair, which indicates cirrhosis.
Xanthelasma around the eyes / Source: Klaus D. Peter, Wikimedia Commons (CC BY-3.0)
A xanthelasma (palpebrarum) is a yellow bump that can appear around the eyes. It consists of an accumulation of cholesterol. This can occur with cholestasis or bile congestion due to narrowing or closure of the bile ducts that carry bile from the liver to the intestine.
The doctor checks your chest for small star-shaped veins in the skin (spidernaevi), breast development in men (gynaecomastia). Spidernaevi usually occur on the chest and upper abdomen. Gynecomastia can occur with chronic liver disease.
With most causes of jaundice, tenderness of the abdominal region usually does not occur. Tenderness indicates a complication. For example, ascites in cirrhosis can be complicated by peritonitis, causing tenderness and pain. People with obstructive jaundice may develop bile duct inflammation (cholangitis). They are likely to experience tenderness or pain in the upper abdomen.
Mass or swelling
The presence of a swelling or mass in the abdominal region may be a tumor, associated with extensive liver metastases (spreads in the liver) and jaundice.
Location of the gallbladder in the body / Source: Decade3d – anatomy online/Shutterstock.com
The gallbladder is usually not palpable in cases of obstructive jaundice caused by choledocholithiasis (the presence of gallstones in the hepatocholedochus duct). However, the gallbladder becomes enlarged in cases of obstructive jaundice caused by certain cancers, such as pancreatic cancer and cholangiocarcinoma (a primary malignant tumor of the liver arising from the bile duct cells). The gallbladder does not enlarge when cholangiocarcinoma occurs in the hepatic duct.
Hepatomegaly is the medical term for an abnormally enlarged liver. Hepatitis is associated with a mild form of hepatomegaly. In cirrhosis, the liver is shrunken and not palpable. Exceptions are patients with very early chronic liver disease, in which case the liver may be palpable and firm.
Splenomegaly is the medical term for an enlarged spleen. Splenomegaly occurs due to portal hypertension and, together with jaundice, typically indicates cirrhosis.
Collection of blood for research / Source: Istock.com/Jovanmandic
Diagnosis: follow-up examination
The diagnosis is made on the basis of the clinical picture and blood and urine tests. If necessary, additional research can be conducted.
Urinalysis can be used to measure levels of a substance called urobilinogen. It is produced when bacteria break down bilirubin in the digestive system.
Liver function and blood tests
A liver function test is a type of blood test used to diagnose certain liver diseases, including hepatitis and cirrhosis. When the liver is damaged, it releases enzymes into the blood. At the same time, proteins that the liver produces to keep the body healthy begin to break down. By measuring the levels of these enzymes and proteins, it is possible to get a picture of how well the liver is functioning. Additionally, your blood may be tested for infections known to cause jaundice, such as malaria and hepatitis C.
Visual art investigation
Imaging research can also be useful, such as:
MRI scan / Source: Istock.com/© james steidl
- MRI scan;
- endoscopic retrograde cholangiopancreatography (ERCP): a diagnostic procedure used to detect stones or other abnormalities in the gallbladder, bile ducts, and pancreatic ducts.
A biopsy is a medical procedure in which a piece of tissue is removed from the body to be examined under a microscope. A biopsy may be recommended to assess the condition of the liver tissue if it may be damaged by a condition such as cirrhosis or liver cancer. During a liver biopsy, your abdomen is numbed with a local anesthetic, after which a fine needle is inserted so that a small sample of liver cells can be taken and sent to a laboratory for examination under a microscope.
Medication for jaundice / Source: Stevepb, Pixabay
Treatment of jaundice
The treatment for jaundice depends on the underlying condition. Pre-hepatic jaundice and per-hepatic jaundice
are usually treated with medication. Post-hepatic jaundice will often require surgical intervention.
When treating pre-hepatic jaundice, the aim is to prevent the rapid breakdown of red blood cells. A too high bilirubin level indicates increased blood breakdown, damage to the liver or a problem with the gallbladder. In cases where pre-hepatic jaundice is caused by an infection, such as malaria, medication is usually recommended to treat the underlying infection. Genetic blood disorders, such as sickle cell disease or thalassemia, may require blood transfusions to replace red blood cells.
In the case of per-hepatic jaundice, little can be done to repair any liver damage, although the liver often repairs itself over time. The goal of treatment is to prevent further liver damage. In cases of viral hepatitis, antiviral medications may be prescribed to prevent further damage. If the damage is caused by alcohol or exposure to harmful substances, it is recommended to stop using alcohol or avoid further exposure to harmful substances. In severe cases of liver disease, a liver transplant is warranted. There is no treatment for Gilbert’s syndrome.
If pain persists due to gallstones, it is considered whether the gallbladder needs to be surgically removed, preferably via keyhole surgery.
Prevent excessive alcohol consumption / Source: Marian Weyo/Shutterstock.com
Prevention and prevention
The underlying medical condition that causes jaundice can be prevented in some cases. Preventive measures include the following:
- Avoid excessive alcohol consumption (alcoholic hepatitis, cirrhosis and pancreatitis).
- Vaccines for hepatitis (hepatitis A, hepatitis B).
- Take medicines that prevent malaria when traveling to risk areas.
- Avoid high risk behavior such as intravenous drug use or unprotected sexual intercourse (hepatitis B).
- Avoid potentially contaminated food or water, and practice good hygiene (hepatitis A) when preparing food.
- Avoid medications that can cause hemolysis (the release of hemoglobin from red blood cells) in susceptible individuals (such as individuals with glucose-6-phosphate dehydrogenase (G6PD)).
- Avoid medications and toxins that can cause hemolysis or directly damage the liver.
- Try to maintain a healthy weight and prevent overweight/obesity.
- Maintain a healthy lifestyle: eat a balanced diet, exercise regularly and limit alcohol consumption.
Forecast and prospects
The prognosis of jaundice depends on the underlying cause. Some conditions can be treated quite easily and have an excellent prognosis, while others can become chronic and require lifelong treatment and follow-up. Some causes of jaundice can be fatal despite medical or surgical intervention. Discuss the prognosis with your doctor once the diagnosis has been established.
- Liver diseases: symptoms, causes and treatment
- Icterus (jaundice): symptoms, cause and treatment
- Yellow eyes and yellow skin: causes, symptoms and treatment
- Yellow skin: causes of yellow skin discoloration (xanthoderma)
- Jaundice in a baby: symptoms, cause and treatment