~ by Jo Jordan
Jaundice is not a disease, but rather a symptom that can occur as a result of a variety of diseases.
Also referred to as icterus and cholestasis, jaundice appears as a yellowish discoloration of the skin and whites of the eyes (sclerae) caused by the abnormal buildup of bilirubin in the blood.
An orange-yellow pigment, bilirubin is part of bile; it forms in the liver as a byproduct of old blood cells. Each day our red blood cells die, and are replaced by new ones. The liver processes the old ones, and the resulting bilirubin exits the body via the stool.
When there are too many red blood cells dying for the liver to cope with, yellow pigment builds up in the body resulting in jaundice. The body’s inability to transport processed bilirubin from the liver through the biliary tract and into the gut can also cause jaundice.
What does jaundice look like?
Yellowing is from accumulated bilirubin in the skin, often caused by liver or gallbladder disorders.
Try to recall the last time you had a bruise. As it healed, the skin in the affected area would have gone through a series of color changes. During the yellow stage, you were seeing bilirubin in your skin. This is the result of the die-off of red blood cells.
With jaundice, the degree of yellowing to the skin and whites of the eyes varies depending on the level of bilirubin present. The higher the level of bilirubin, the more the skin and sclerae tend to deepen into brown, rather than yellow. Typically, jaundice first appears in the face, and progresses downward toward the feet.
Bilirubin gives stool its brown color. An absence of bilirubin can result in light-colored stool. Too much bilirubin can turn stools dark brown. Likewise, urine may darken when a buildup of bilirubin occurs.
In addition to skin, eye whites, stool and urine discoloration, the symptom associated most frequently with jaundice is itching (pruritus), which can become severe, and in some cases cause sleep disruption and emotional distress.
What diseases cause adult jaundice?
The presence of jaundice is an indicator that a person is suffering from one of a variety of diseases including,
- Alcoholic liver disease (alcoholic cirrhosis)
- Autoimmune hepatitis
- Biliary stricture (an abnormal narrowing of the biliary duct)
- Bilirubin processing disorders present at birth (Crigler-Najjar, Dubin-Johnson, Gilbert’s, or Rotor’s syndromes)
- Blocked bile ducts (caused by gallstones, infection, or tumors)
- Chronic active hepatitis
- Drug-induced cholestasis (bile pools in the gallbladder as a result of certain drugs)
- Drug-induced hepatitis
- Hemolytic anemia
- Intrahepatic cholestasis of pregnancy (bile pools in the gallbladder because of the pressure in the abdomen during pregnancy)
- Ischemic hepatocellular jaundice (jaundice caused by inadequate oxygen or blood flow to the liver)
- Pancreatic cancer
- Primary biliary cirrhosis or sclerosing cholangitis
- Viral hepatitis (A, B, C, D, and E)
Jaundice in infancy
Babies often experience jaundice during their first week of life, especially if they are premature. During birth, an abundance of red blood cells can end up dying prematurely, causing a heavy workload on baby’s inexperienced liver. Until newborns begin to produce stool, bilirubin accumulates more easily.
In more than one in ten breastfed infants, breastfeeding jaundice may occur in the first week of life. The cause is thought to be inadequate milk intake, leading to dehydration or low caloric intake.1
Less common is breast milk jaundice, which occurs in about one in two hundred babies.2 Caused by substances in mother’s milk that decrease the ability of a baby’s liver to deal with bilirubin, breast milk jaundice rarely causes any problems whether it is treated or not.
Diagnosing the cause of jaundice
In addition to a personal history and physical examination, numerous testing methods are employed to determine the underlying cause of jaundice:
- Blood tests (measuring bilirubin levels)
- Computerized tomography (CT or CAT scans use X-rays to examine the soft tissues of the abdomen)
- Elevated liver enzymes
- Endoscopic retrograde cholangiopancreatography (ERCP combines the use of X-rays and an endoscope [a long, flexible, lighted tube] to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas)
- Endoscopic ultrasound (EUS combines endoscopy [a procedure using a long, flexible, lighted tube] and ultrasound [see below] to obtain diagnostic images about the digestive tract and the surrounding tissue and organs)
- Liver biopsy
- Magnetic resonance imaging (MRI scans use magnetization of the body to examine the soft tissues of the abdomen)
- Ultrasonography (high-frequency sound waves are bounced off internal tissue, and their echoes converted into soft tissue images)
Generally, the treatment of jaundice, or cholestasis requires diagnosing and treating the specific cause. For more information on caring for the liver, please review the liver health links to the left, the liver cleansing overview article, or search for related articles by using the search box.