Jaundice is a term used to describe skin and eye whites with a yellowish tinge. Body fluids can be yellow too.
The skin color and eye whites can differ based on bilirubin levels. Bilirubin is a waste substance that has been detected in blood. Moderate levels result in a yellow colour, while very high levels appear brown.
Around 60 percent of all American-born babies have jaundice. However, jaundice can happen to people of all ages and is normally the result of an underlying condition. Jaundice normally points to a liver or bile duct problem.
We’ll discuss in this article what jaundice is, why it happens, and how it’s diagnosed and treated.
Important facts about jaundice
- Jaundice is caused by a buildup of bilirubin, a waste material, in the blood.
- An inflamed liver or obstructed bile duct can lead to jaundice, as well as other underlying conditions.
- Symptoms include a yellow tinge to the skin and whites of the eyes, dark urine, and itchiness.
- Diagnosis of jaundice can involve a range of tests.
- Jaundice is treated by managing the underlying cause.
Causes
Jaundice is a yellowing of skin and eye whites that occurs when bilirubin isn’t handled properly by the body. That may be because of a liver condition.
It is also known as icterus.
Bilirubin is a yellow-colored waste material which remains in the bloodstream after removing iron from the bloodstream.
The liver filters waste out from the blood. Once bilirubin enters the liver it is bound to by other chemicals. A substance called conjugated bilirubin results.
The liver yields bile, a digestive juice. Conjugated bilirubin goes into the bile, and then leaves the body. It is this type of bilirubin that gives feces its brown color.
When too much bilirubin is present, it can leak into surrounding tissues. This is known as hyperbilirubinemia, and causes skin and eyes to have yellow colour.
Risk factors
Jaundice is most commonly caused by an underlying disorder that either causes too much bilirubin to be produced, or prevents the liver from getting rid of it. Any of these results in the secretion of bilirubin into tissues.
Underlying conditions that may cause jaundice include:
- Acute inflammation of the liver: This may impair the ability of the liver to conjugate and secrete bilirubin, resulting in a buildup.
- Inflammation of the bile duct: This can prevent the secretion of bile and removal of bilirubin, causing jaundice.
- Obstruction of the bile duct: This prevents the liver from disposing of bilirubin.
- Hemolytic anemia: The production of bilirubin increases when large quantities of red blood cells are broken down.
- Gilbert’s syndrome: This is an inherited condition that impairs the ability of enzymes to process the excretion of bile.
- Cholestasis: This interrupts the flow of bile from the liver. The bile containing conjugated bilirubin remains in the liver instead of being excreted.
Rarer conditions that may cause jaundice include:
- Crigler-Najjar syndrome: This is an inherited condition that impairs the specific enzyme responsible for processing bilirubin.
- Dubin-Johnson syndrome: This is an inherited form of chronic jaundice that prevents conjugated bilirubin from being secreted from of the cells of the liver.
- Pseudojaundice: This is a harmless form of jaundice. The yellowing of the skin results from an excess of beta-carotene, not from an excess of bilirubin. Pseudojaundice usually arises from eating large quantities of carrot, pumpkin, or melon.
Treatment
Treatment depends on the condition behind it.
Jaundice medication does not resolve the signs of the jaundice but the cause.
Treatments used are as follows:
- Anemia-induced jaundice may be treated by boosting the amount of iron in the blood by either taking iron supplements or eating more iron-rich foods.
- Hepatitis-induced jaundice requires antiviral or steroid medications.
- Doctors can treat obstruction-induced jaundice by surgically removing the obstruction.
- If the jaundice has been caused by use of a medication, treatment for involves changing to an alternative medication.
Prevention
Jaundice relates to function of the liver. It is important that people maintain the health of this vital organ by eating a healthy diet, exercising regularly, and consuming no more than the amounts of alcohol they recommend.
Symptoms
Common symptoms of jaundice include:
- a yellow tinge to the skin and the whites of the eyes, normally starting at the head and spreading down the body
- pale stools
- dark urine
- itchiness
Accompanying symptoms of jaundice resulting from low bilirubin levels include:
Complications
Sometimes the itching that accompanies jaundice can be so intense that patients are known to scratch their skin raw, experience insomnia, or, in extreme cases, even have suicide thoughts.
When complications occur, this is usually due to the underlying problem, rather than the jaundice itself.
For example, if an obstructed bile duct leads to jaundice it can result in uncontrolled bleeding. That’s because the blockage leads a shortage of vitamins required for clotting.
Types
There are three main types of jaundice:
- Hepatocellular jaundice occurs as a result of liver disease or injury.
- Hemolytic jaundice occurs as a result of hemolysis, or an accelerated breakdown of red blood cells, leading to an increase in production of bilirubin.
- Obstructive jaundice occurs as a result of an obstruction in the bile duct. This prevents bilirubin from leaving the liver
Newborns
Jaundice is a common health problem in newborn babies. Approximately 60% of newborns develop jaundice, rising to 80% of premature infants born before 37 weeks of pregnancy.
Normally, they’ll show signs within 72 hours of conception.
Red blood cells are often broken down and replaced within an infant’s body. This causes further bilirubin development. In addition, infant livers are less developed and thus less efficient at removing bilirubin from the body.
Symptoms usually improve within 2 weeks without medication. Yet children with very high levels of bilirubin will require treatment with either a blood transfusion or phototherapy.
Treatment is crucial in these cases, as jaundice in newborns can lead to kernicterus, a very rare form of permanent brain damage.
Levels
Bilirubin level is specified in the blood test known as the bilirubin test. This measures unconjugated, or indirect, levels of bilirubin. These are responsible for jaundice start-ups.
The bilirubin levels are measured in mg / dL per decilitre. Adults and older children will be between 0.3 and 0.6 mg / dL, respectively. Around 97 percent of babies who are born after 9 months of pregnancy have rates below 13 mg / dL. If they exhibit higher levels than this, they are usually referred for further research.
Those ranges can vary from one laboratory to another. A recovery plan should also set out how far beyond the normal range a person’s rates are.
Diagnosis
Physicians would most likely use the patient’s history and a physical test to detect jaundice and confirm levels of bilirubin. They will be paying careful attention to the abdomen, looking for tumors and testing for liver firmness.
A firm liver indicates cirrhosis, or scarring of the liver. A rock-hard liver is characteristic of cancer.
Several tests have the potential to confirm jaundice. The first is a test of liver function to find out if the liver is working properly or not.
If a doctor is unable to find the cause, a doctor may ask for blood tests to check the bilirubin levels and blood composition. Including:
- Bilirubin tests: A high level of unconjugated bilirubin compared to levels of conjugated bilirubin suggest hemolytic jaundice.
- Full blood count (FBC), or complete blood count (CBC): This measures levels of red blood cells, white blood cells, and platelets.
- Hepatitis A, B, and C tests: This tests for a range of liver infections.
If they suspect an obstruction, the doctor will investigate the structure of the liver. They will use imaging methods in these cases, including MRI , CT, and ultrasound scans.
They can also perform retrograde endoscopic cholangiopancreatography (ERCP). It is a technique where endoscopy and X-ray imaging are combined.
A biopsy of the liver will test for inflammation, cirrhosis, cancer and liver fat. This examination involves sticking a needle in the liver to get a sample of the tissue. Afterwards the sample is examined under a microscope.
