Jaundice

What is jaundice?

Jaundice is the yellowing of the skin or whites of the eyes caused by excess bilirubin.  Bilirubin is produced in the gallbladder and is found in hemoglobin, the substance that carries oxygen in your red blood cells. As red blood cells break down, your body builds new cells to replace them, and the old ones are processed by the liver.  If the liver cannot process the blood cells as they break down, bilirubin builds up in the body and your skin may look yellow.

Many healthy babies will have some jaundice during the first week of life, which usually goes away. However, jaundice can happen at any age and may be a sign of a significant medical problem.

What are the symptoms of jaundice in adults?

Jaundice is not a disease, but rather a visible sign of an underlying disease process. Individuals with jaundice will have a yellow discoloration of the skin to varying degrees and may also exhibit yellowing of the mucous membranes and of the whites of their eyes.

Depending on the underlying cause of the jaundice, individuals may experience different symptoms. Some individuals may have very few, if any, symptoms at all, while others may experience more severe and pronounced symptoms. Individuals with jaundice may experience any of the following signs and symptoms often as a result of the underlying condition resulting in jaundice:

  • Itchy skin
  • Pale colored stools
  • Dark colored urine
  • Nausea and vomiting
  • Diarrhea
  • Fever and chills
  • Weakness
  • Anorexia (loss of appetite)
  • Abdominal pain
  • Headache
  • Swelling of the abdomen

What are the Causes of Jaundice?

Jaundice occurs when there is a breakdown of the normal processing of bilirubin at various stages. The causes of jaundice are generally classified according to where the breakdown occurs: either before, within or after the liver.

Pre-hepatic causes of jaundice occur due to the excessive destruction of red blood cells from various conditions, which results in the rapid increase in bilirubin levels in the bloodstream. When this occurs, the liver's capability to properly metabolize the bilirubin is diminished.  Some of the diseases and conditions that may cause prehapatic jaundice include:

  • Sickle cell disease
  • Thalassemia
  • Malaria and other infections
  • Autoimmune disease
  • Hereditary spherocytosis
  • Glucose-6-phosphate dehydrogenase deficiency

Hepatic causes of jaundice arise from abnormalities in the metabolism and/or excretion of bilirubin in the liver. These include:

  • Hepatitis
  • Cirrhosis
  • Liver Cancer
  • Drugs or other toxins
  • Crigler-Najjar syndrome
  • Autoimmune disorders,
  • Gilbert's syndrome

Post-hepatic causes arise from an obstruction in the normal drainage and elimination of bilirubin in the form of bile from the liver into the intestine. These include:

  • Gallstones
  • Bile duct stricture
  • Cholangitis
  • Cancer
  • Pancreatitis
  • Parasites (for example, liver flukes).

Neonatal Jaundice:  Many babies develop jaundice in the first few days of life; the condition is typically  most severe at 2 to 4 days of age. This is known as physiological jaundice, and the condition typically goes away within two weeks. Mild jaundice can also result from breastfeeding. Severe jaundice in newborns results from medical conditions that cause an excessive turnover of red blood cells, including abnormal blood cell shapes and mismatch between maternal and fetal blood types. Certain medications and medical conditions can also slow down the process of removing bilirubin from the body and lead to jaundice.

Jaundice of prematurity occurs frequently in premature babies since they are even less ready to excrete bilirubin effectively. Jaundice in premature babies needs to be treated at a lower bilirubin level than in full term babies in order to avoid complications.

Breastfeeding jaundice can occur when a baby is not getting enough breast milk because of difficulty with breastfeeding or because the mother's milk isn’t in yet. This is not caused by a problem with the breast milk itself, but by the baby not getting enough to drink.

Breast milk jaundice results when substances produced in a mother's breast milk cause the bilirubin level to rise; these substances can prevent the excretion of bilirubin through the intestines.

Blood group incompatibility (Rh or ABO problems) can result if a baby has a different blood type than the mother, which can cause the mother to produce antibodies that destroy the infant's red blood cells. As the blood cells are destroyed, bilirubin can build up suddently in the baby's blood. Rh problems can be prevented with an injection of Rh immune globulin to the mother within 72 hours after delivery.

How is jaundice evaluated?

Individuals with jaundice require a comprehensive medical evaluation in order to determine its cause. This will initially consist of a detailed medical history, a physical exam, and some blood tests.  Depending on the results of the initial evaluation, further studies may be needed to help diagnose the condition causing the jaundice. If hepatic or post hepatic causes are suspected a liver biopsy and imaging studies respectively may be required in order to evaluate the liver, gallbladder, and pancreas. Imaging studies may include ultrasound, CT, or MRI scans or an endoscopic retrograde cholangiopancreatography (ERCP).

CONDITIONS OF THE GI TRACT