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Jai Ganesh

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Jaundice

Jaundice

Gist

Jaundice is the yellowing of the skin and eyes caused by excess bilirubin in the blood, signaling underlying liver dysfunction, bile duct obstruction, or accelerated red blood cell destruction. Common causes include hepatitis, cirrhosis, gallstones, and, in newborns, immature liver function.

Jaundice is primarily caused by a buildup of bilirubin in the blood, resulting from liver dysfunction, bile duct obstruction, or rapid red blood cell breakdown. Common underlying factors include hepatitis, liver cirrhosis, gallstones, alcohol-related liver disease, and pancreatic cancer, which prevent proper processing or excretion of bilirubin.

Summary

Jaundice, also known as icterus, is a yellowish or, less frequently, greenish pigmentation of the skin and sclera due to high bilirubin levels. Jaundice in adults typically indicates the presence of underlying diseases involving abnormal heme metabolism, liver dysfunction, or biliary-tract obstruction. The prevalence of jaundice in adults is rare, while jaundice in babies is common, with an estimated 80% affected during their first week of life. The most commonly associated symptoms of jaundice are itchiness,[2] pale feces, and dark urine.

Normal levels of bilirubin in blood are below 1.0 mg/dl (17 μmol/L), while levels over 2–3 mg/dl (34–51 μmol/L) typically result in jaundice. High blood bilirubin is divided into two types: unconjugated and conjugated bilirubin.

Causes of jaundice vary from relatively benign to potentially fatal. High unconjugated bilirubin may be due to excess red blood cell breakdown, large bruises, genetic conditions such as Gilbert's syndrome, not eating for a prolonged period of time, newborn jaundice, or thyroid problems. High conjugated bilirubin may be due to liver diseases such as cirrhosis or hepatitis, infections, medications, or blockage of the bile duct, due to factors including gallstones, cancer, or pancreatitis. Other conditions can also cause yellowish skin, but are not jaundice, including carotenemia, which can develop from eating large amounts of foods containing carotene—or medications such as rifampin.

Treatment of jaundice is typically determined by the underlying cause. If a bile duct blockage is present, surgery is typically required; otherwise, management is medical. Medical management may involve treating infectious causes and stopping medication that could be contributing to the jaundice. Jaundice in newborns may be treated with phototherapy or exchanged transfusion depending on age and prematurity when the bilirubin is greater than 4–21 mg/dl (68–365 μmol/L). The itchiness may be helped by draining the gallbladder, ursodeoxycholic acid, or opioid antagonists such as naltrexone. The word jaundice is from the French jaunisse, meaning 'yellow disease'.

Details

Jaundice is a condition where your skin, the whites of your eyes and mucous membranes (like the inside of your nose and mouth) turn yellow. Many medical conditions can cause jaundice, like hepatitis, gallstones and tumors. Jaundice usually clears up once your healthcare provider treats your main medical condition.

Overview:

What is jaundice?

Jaundice (hyperbilirubinemia) is when your skin, sclera (whites of your eyes) and mucous membranes turn yellow. Jaundice occurs when your liver is unable to process bilirubin (a yellow substance made when red blood cells break down) in your blood. This can either be caused by too much red blood cell breakdown or liver injury.

How jaundice develops:

* Red blood cell breakdown: Your body regularly breaks down old red blood cells and replaces them with new ones. This breakdown process makes bilirubin.
* Bilirubin processing: Normally, your liver processes bilirubin, making it a part of bile (a bitter, greenish-brown fluid that helps digest food). Your liver then releases the bile into your digestive system.
* Too much bilirubin: Jaundice happens when your liver can’t process all the bilirubin your body makes, or if your liver has a problem releasing bilirubin.
* Yellow color: When there’s too much bilirubin in your blood, it starts to leak into tissues around your blood vessels. This leaking bilirubin makes your skin and the whites of your eyes yellow. This yellow color is a common sign of jaundice.

Possible Causes:

What causes jaundice?

Jaundice can result from a problem in any of the three phases of bilirubin:

* Before your liver processes bilirubin (prehepatic jaundice). This type of jaundice happens before your body makes bilirubin. Too much red blood cell breakdown takes over your liver’s ability to filter out bilirubin from your blood.
* During the production of bilirubin (hepatic jaundice). This type happens when your liver can’t remove enough bilirubin from your blood. Hepatic jaundice can happen if you have liver failure.
* After production of bilirubin (posthepatic jaundice). Also called obstructive jaundice, this type happens when a blockage stops bilirubin from draining into your bile ducts.

Conditions that cause jaundice include:

Prehepatic jaundice causes

* Breaking down a large hematoma (bruise) and then reabsorbing it back into your bloodstream.
* Hemolytic anemias (when blood cells are destroyed and removed from the bloodstream before their normal lifespan is over).

Hepatic jaundice causes

* Viruses, including hepatitis A, chronic hepatitis B and C, and Epstein-Barr virus infection (infectious mononucleosis).
* Alcohol-induced hepatitis.
* Autoimmune disorders.
* Rare genetic metabolic defects.
* Medicines, including penicillin, oral contraceptives, chlorpromazine (Thorazine R), estrogenic or anabolic steroids and acetaminophen toxicity.

Posthepatic jaundice causes

* Gallstones.
* Inflammation (swelling) of your gallbladder.
* Gallbladder cancer.
* Pancreatic tumor.

How do you know if you have jaundice?

You may not notice the yellow skin and sclera associated with jaundice. Your provider may find the condition when looking for something else. How serious your symptoms are depends on what causes them and how quickly or slowly they develop.

Symptoms that can be associated with jaundice include:

* Yellowish tint to your skin and the whites of your eyes.
* Fever.
* Chills.
* Pain in your belly.
* Flu-like symptoms.
* Dark-colored pee.
* Pale-colored poop.
* Being tired or confused.
* Itchy skin.
* Weight loss.

Care and Treatment:

How can my provider tell I have jaundice?

Your provider can tell if you have jaundice by measuring the bilirubin levels in your blood and seeing whether it’s the type of bilirubin related to red blood cell breakdown (unconjugated) or liver injury (conjugated). They may also check for other signs of liver disease, including:

* Bruising.
* Spider angiomas (abnormal collection of blood vessels near the surface of your skin).
* Palmar erythema (red palms and fingertips).

Your healthcare provider will also examine you to decide your liver’s size and tenderness. They may use imaging (ultrasound and CT scanning) and liver biopsy (taking a tissue sample of your liver) to better understand what’s causing your liver injury.

How is jaundice treated?

There’s no specific treatment for jaundice. But your provider can treat the cause and the jaundice should improve. They can also treat complications the condition causes. For example, if itchy skin is a problem, your provider can prescribe medication.

What are the risks of not treating jaundice?

It depends on what’s causing your jaundice. If it’s a virus, the virus could spread or become chronic. But if you have jaundice because your liver is failing, complications from your liver disease can include coma and death.

Can you prevent jaundice?

Since there are many causes of jaundice, it’s hard to find ways to prevent it. Some general tips include:

* Avoiding hepatitis infection by getting vaccinated, having safe sex, using clean needles and practicing good personal hygiene like thorough hand-washing with soap and water.
* Staying within recommended alcohol limits.
* Maintaining a weight that’s healthy for you.
* Avoiding natural and herbal supplements.
* Managing your cholesterol.

When To Call the Doctor:

When should jaundice be treated by a doctor or healthcare provider?

A healthcare provider should evaluate jaundice. It’s a sign that something’s not right with your liver. If you notice signs of jaundice, call your healthcare provider.

Additional Common Questions:

Do children get jaundice?

Jaundice is common in newborn babies. Like with adults, a buildup of bilirubin in your baby’s blood can cause jaundice. Since your baby’s liver is still developing, it can’t remove (or break down) all the bilirubin. Jaundice usually goes away on its own or providers treat it with phototherapy.

Additional Information:

What Is Jaundice?

When red blood cells die, they leave behind bilirubin, a yellow-orange pigment in the blood. The liver filters bilirubin from the bloodstream to be removed in your stool. If too much is in your system or your liver is overloaded, it causes a buildup known as hyperbilirubinemia. This causes jaundice, where your skin and the whites of your eyes look yellow.

Newborn babies often get it. About 60% have jaundice, also known as icterus, within the first couple of days after birth. Adults can get it, too, although it's less common. See a doctor right away if you think you have jaundice. It could be a symptom of a liver, blood, or gallbladder problem.

Types of Jaundice

There are four main types of jaundice, which are grouped by where the bilirubin collects in your body. A blood test can determine which type you have.

Prehepatic

If bilirubin builds up before blood enters the liver, it's known as prehepatic jaundice. This means you're breaking down red blood cells and creating more bilirubin than your liver can process.

Hepatic

If your liver isn't able to process bilirubin well, it's called hepatic jaundice.

Posthepatic

Posthepatic jaundice is when bilirubin builds up after passing through the liver and your body can't clear it quickly enough.

Obstructive jaundice

This condition is when bile isn't able to drain into your intestines because of a blocked or narrow bile or pancreatic duct. This type of jaundice has a high death rate, so it's important to catch and treat it early.

Jaundice Symptoms

Jaundice may have no symptoms. Any signs you have may depend on how quickly the condition is getting worse. Well-known symptoms are yellowing of the skin and jaundice eyes (also called scleral icterus). But there are others to watch for, including:

* Fever
* Stomach pain
* Chills
* Dark urine
* Tar- or clay-colored stools
* Flu-like symptoms
* Itchy skin
* Weight loss
* Feeling unusually irritated
* Confusion
* Abnormal drowsiness
* Bruising or bleeding easily
* Bloody vomit

How long does jaundice last in adults?

How long jaundice lasts depends on what's causing it and the treatment you need. If a medication is causing it, jaundice will fade after you stop taking it. If hepatitis is causing it, medications can be taken to treat the condition. If there is a blocked bile duct or gallstones, surgery may be required.

Jaundice Causes

Jaundice in adults is rare, but you can get it for many reasons. These include:

* Hepatitis: Liver inflammation can be caused by a virus, autoimmune disorder, alcohol or drug use, or chemical exposure. It may be short-lived (acute) or chronic, which means it lasts for at least 6 months. Long-term inflammation can damage the liver, causing jaundice.
* Alcohol-related liver disease: If you drink heavily over a long period of time – typically 8 to 10 years – you could seriously damage your liver. Two diseases in particular, alcoholic hepatitis and alcoholic cirrhosis, harm the liver.
* Other liver disease: Cirrhosis can also be caused by autoimmune diseases, genetic conditions that are passed down in your family, and hepatitis. A severe condition known as nonalcoholic steatohepatitis can cause nonalcoholic fatty liver disease. With this kind of liver disease, fat builds up in your liver along with inflammation, which damages it over time.
* Blocked bile ducts: These are thin tubes that carry a fluid called bile from your liver and gallbladder to your small intestine. If the tubes are blocked by gallstones, cancer, inflammation, or rare liver diseases, you could get jaundice.
* Pancreatic cancer: This is the 10th most common cancer in men and the ninth in women. It can block the bile duct, causing jaundice.
* Certain medicines: Drugs like acetaminophen, penicillin, birth control pills, and steroids have been linked to liver disease.
* Blood clots: If your body reabsorbs a large blot clot (hematoma) under the skin, it can increase bilirubin levels.
* Hemolytic anemias: Destroyed blood cells are sometimes removed from the bloodstream too quickly, increasing bilirubin levels.

Diagnosing Jaundice

Your doctor will ask you about your symptoms and medical history. They'll then give you a physical exam to see if there's swelling in your liver.

To get more information, your doctor will likely order blood tests to measure bilirubin and cholesterol levels and get a complete blood count (CBC). If you have jaundice, your level of bilirubin will be high. Your doctor may order other tests to find the cause of your jaundice and how severe it is, including:

* A hepatitis panel, which is a blood test that shows if you have, or have had, hepatitis. It tests for hepatitis A, hepatitis B, and hepatitis C. If there are no hepatitis antibodies in your blood, it means you don't have the condition, or you had it in the past, but your body has cleared it.
* Tests to check enzyme levels in the liver to see how well it is functioning. If enzyme levels are higher or lower than normal, it can mean you have disease or damage to the liver or bile ducts.
* Imaging, like a CT scan, ultrasound, or magnetic resonance cholangiopancreatography, a type of MRI that checks for blocked ducts near the gallbladder
* A liver biopsy, to show if you have damage to, or disease in, your liver. During the test, a small piece of your liver is removed either with a needle inserted into the belly to the liver, through a vein in your neck, or through a cut in your belly.
* Prothrombin time, which measures how long it takes for blood plasma to clot. Your blood will be taken, and a laboratory will test it to see if it clots faster or slower than the normal range (which is between 10 and 13 seconds). If it clots too slowly, that may mean there are problems with your liver.

Jaundice Treatment

In adults, jaundice itself usually isn’t treated. But your doctor will treat the condition that’s causing it.

If you have acute viral hepatitis, jaundice will go away on its own as your liver heals. If a blocked bile duct is to blame, your doctor may suggest surgery to open it. If your skin is itching, your doctor can prescribe cholestyramine to be taken by mouth. This medication is used to remove bile acids from your body, which cause itching.

Phototherapy for jaundice

Phototherapy uses a fluorescent white or blue-spectrum light that breaks down bilirubin so it can be released from the body. This treatment is used for newborns, but phototherapy has not been shown to be effective for treating jaundice in adults.

Preventing Jaundice
You may have a higher risk for jaundice if you drink too much alcohol or have hepatitis. It is also more common in people during middle age.

You can reduce your risk of jaundice through lifestyle changes like:

* Avoid herbal supplements (which can be toxic to the liver) unless recommended by your doctor
* Stop smoking
* Reduce or cut out all alcohol (the CDC recommends no more than two alcoholic drinks per day for men and one daily for women)
* Don't use intravenous drugs (drugs that go into your vein)
* Don't take more prescription medication than you are prescribed
* Get all recommended vaccines before traveling overseas
* Use safe sex practices
* Maintain a healthy weight
* Keep your cholesterol in a healthy range

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