Jaundice, also known as icterus, is a term used to describe a yellowish tinge to the skin and sclerae (the white part of the eye) which is a result of an excess of bilirubin in the blood (hyperbilirubinemia). Body fluids may also be yellow.
The colour of the skin and sclerae varies depending on levels of bilirubin; mildly elevated levels display yellow skin and sclerae, while highly elevated levels display brown.
Bilirubin is a yellow-coloured substance that is responsible for the yellowing of the skin and sclerae in jaundice.
Bilirubin is a waste product that remains in the bloodstream after iron is removed from haemoglobin in red blood cells. When there is an excess of bilirubin, it can leak out into surrounding tissues, saturating them with this yellow substance. Bilirubin that is circulating freely in the blood is called unconjugated bilirubin.
One of the liver's functions is to filter out waste, such as bilirubin, from the blood.
Once bilirubin is in the liver, other chemicals are latched on to it, creating a substance called conjugated bilirubin, which is secreted in bile (a digestive juice released by the liver) and then excreted. A product of bilirubin is what gives faeces its brown colour.
The term jaundice is derived from the French word jaune, which means yellow. Jaundice is not a disease per se, but rather a visible sign of an underlying disease process.
Any adult who develops jaundice needs to undergo a comprehensive medical evaluation in order to determine its cause
Causes of Jaundice
Jaundice most often occurs as a result of an underlying disorder that either causes overproduction of bilirubin or prevents the liver from disposing of it, both of which result in bilirubin being deposited in tissues.
Some underlying conditions that may cause jaundice are:
Acute inflammation of the liver - may impair the ability of the liver to conjugate and secrete bilirubin, resulting in a build-up.
Inflammation of the bile duct - may prevent the secretion of bile and removal of bilirubin, causing jaundice.
Obstruction of the bile duct - prevents the liver from disposing of bilirubin.
Hemolytic anaemia - production of bilirubin increases when large quantities of red blood cells are broken down.
Gilbert's syndrome - an inherited condition that impairs the ability of enzymes to process the excretion of bile.
Cholestasis - a condition where the flow of bile from the liver is interrupted. The bile containing conjugated bilirubin remains in the liver instead of being excreted.
More rare conditions that may cause jaundice include:
Crigler-Najjar syndrome - an inherited condition that impairs the specific enzyme responsible for processing bilirubin.
Dubin-Johnson syndrome - an inherited form of chronic jaundice that prevents conjugated bilirubin from being secreted out of the liver's cells.
Pseudojaundice - a harmless form of jaundice in which the yellowing of the skin results from an excess of beta-carotene, not from an excess of bilirubin; usually from eating lots of carrots, pumpkin, or melon.
Symptoms of Jaundice
Symptoms of jaundice include:
Yellow tinge to the skin and the whites of the eyes, normally starting at the head and spreading down the body
Abdominal pain - typically indicates a blockage of the bile duct
Paler than usual stools
Doctors will most likely diagnose jaundice based on the patient's history and a physical exam, paying close attention to the abdomen. Doctors will be feeling for masses (tumours) in the abdomen and/or checking the firmness of the liver; a firm liver indicates cirrhosis, while a rock-hard liver indicates cancer.
The severity of jaundice is determined by several tests, the first of which is a liver function test to find out whether or not the liver is functioning properly.
If the cause of the symptoms cannot be identified, a doctor may require blood tests to check levels of bilirubin and evaluate the composition of the blood. Some of these tests include:
Bilirubin tests - a high level of unconjugated bilirubin relative to levels of conjugated bilirubin indicates hemolysis (accelerated breakdown of red blood cells)
Full blood count (FBC), or complete blood count (CBC) - measures levels of red blood cells, leukocytes (white blood cells), and thrombocytes (platelets)
Hepatitis A, B, and C tests
If an obstruction of the liver is suspected, the liver's structure will be looked at with the help of imaging tests. Some of these tests include:
MRI scan - uses magnetic signals to create image "slices" of the soft tissues of the human body.
Abdominal ultrasonography (ultrasound) - uses high-frequency sound waves to create a two-dimensional image of the soft tissues inside the human body
CT or CAT scan - uses a thin X-ray beam to create image "slices" of soft tissues in the body
Endoscopic retrograde cholangiopancreatography (ERCP) - a procedure that combines an endoscopy and X-ray imaging
A liver biopsy is particularly useful in checking for inflammation, cirrhosis, cancer, and fatty liver. This test involves injecting a needle through the skin and into the liver to obtain a sample of the tissue, which is examined under a microscope.
When to Seek Medical Care for Jaundice
Call a health care practitioner if you or your baby develops jaundice. Jaundice may be a sign of a serious underlying medical condition.
Treatment for Jaundice
Treatment depends on the cause of the underlying condition leading to jaundice and any potential complications related to it. Once a diagnosis is made, treatment can then be directed to address that particular condition, and it may or may not require hospitalization.
Treatment may consist of expectant management (watchful waiting) at home with rest.
Medical treatment with intravenous fluids, medications, antibiotics, or blood transfusions may be required.
If a drug/toxin is the cause, these must be discontinued.
In certain cases of newborn jaundice, exposing the baby to special coloured lights (phototherapy) or exchange blood transfusions may be required to decrease elevated bilirubin levels.
Surgical treatment may be required.
Self-Care at Home for Jaundice
The objectives of home therapy include symptom relief and managing the medical condition causing the underlying jaundice. The various measures that may be undertaken include:
Maintain adequate hydration by drinking fluids, and rest as needed.
Take medications only as instructed and prescribed by a health care practitioner.
Avoid medications, herbs, or supplements which may cause detrimental side effects. Consult a health care practitioner for advice.
Avoid drinking alcohol until it has been discussed with your healthcare professional.
Certain dietary restrictions may be recommended by a health care practitioner.
In certain cases of newborn jaundice, the parents or caregivers can place the baby next to a well lit window a few times a day to decrease elevated bilirubin levels. In more severe cases, a health care practitioner may need to discharge the baby home from the hospital with home phototherapy.
Provide adequate milk intake for the baby in cases of breastfeeding jaundice.
When infant jaundice isn't severe, your doctor may recommend changes in feeding habits that can lower levels of bilirubin. Talk to your doctor if you have any questions or concerns about how much or how often your baby is feeding or if you're having trouble breast-feeding. The following steps may lessen jaundice:
1 - More-frequent feedings. Feeding more frequently will provide your baby with more milk and cause more bowel movements, increasing the amount of bilirubin eliminated in your baby's stool. Breast-fed infants should have eight to 12 feedings a day for the first several days of life. Formula-fed infants usually should have 1 to 2 ounces (about 30 to 60 millilitres) of formula every two to three hours for the first week.
2 - Supplemental feedings. If your baby is having trouble breast-feeding, is losing weight or is dehydrated, your doctor may suggest giving your baby formula or expressed milk to supplement breast-feeding. In some cases, your doctor may recommend using formula alone for a couple of days and then resuming breast-feeding. Ask your doctor what feeding options are right for your baby.
If symptoms worsen or if any new symptoms arise, consult a health care practitioner.
Complications from Jaundice
The type of complication and the severity of complications vary with the underlying cause leading to jaundice. Certain individuals will not suffer any long-term after effects and will have a full recovery, while for others the appearance of jaundice will be the first indication of a life-threatening condition. A few of the potential complications include:
Hepatic encephalopathy (brain dysfunction)
Jaundice in newborn babies can be caused by several different conditions, although it is often a normal physiological consequence of the newborn's immature liver to get rid of bilirubin in the bloodstream. Infant jaundice is a common condition, particularly in babies born before 38 weeks gestation (preterm babies) and some breast-fed babies.
Treatment of infant jaundice often isn't necessary, and most cases that need treatment respond well to non-invasive therapy. Even though it is usually harmless under these circumstances, newborns with excessively elevated levels of bilirubin from other medical conditions (pathologic jaundice) may suffer devastating brain damage (kernicterus) if the underlying problem is not addressed.
Prevention of Jaundice
Jaundice is related to the function of the liver, so it is essential that individuals maintain this vital organ's health by eating a balanced diet, exercising regularly, and refraining from exceeding recommended amounts of alcohol.