Jaundice: Causes, symptoms and Treatments

Jaundice is a condition that occurs when your skin and eyes turn yellow. It can be a sign of some serious problems like liver disease, therefore, you must take medical help. It is caused by the build-up in your body of a yellow substance called bilirubin. Bilirubin is formed in the body when the parts of the red blood cells break down.

The liver takes the bilirubin as waste material from the blood and changes its chemical makeup and it passes through the stools as bile. An inflammation or obstruction of the liver bile duct can lead to excessive bilirubin leading to jaundice. The symptoms of the disease include a yellow colour to the skin and eyes, dark urine and itchiness.

Alt text=Jaundice
Jaundice

Especially the colour of the skin and whites of the eyes will vary depending on levels of bilirubin. Bilirubin is a waste material present in the blood. Moderate levels lead to a yellow colour, while very high levels will appear brown.

About 60 percent of all infants born in the United States have jaundice. However, this can happen to people of all ages and is normally the result of an underlying condition. Especially Jaundice normally indicates a problem with the liver or bile duct.

Fast facts on jaundice

  • Jaundice is a condition when 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.
  • Generally, treatment of this disease is by managing the underlying cause.

Causes of excess bilirubin

Jaundice is a yellowing of the skin and the whites of the eyes that happens when the body does not process bilirubin properly. This may be due to a problem in the liver. Icterus is the other name of this disease.

Likewise, Bilirubin is a yellow-coloured waste material that remains in the bloodstream after iron is removed from the blood.

Especially, the liver filters waste out from the blood. When bilirubin reaches the liver, other chemicals attach to it. A substance called conjugated bilirubin results.

For instance, the liver produces bile, a digestive juice. Conjugated bilirubin enters the bile, then it leaves the body. It is this type of bilirubin that gives feces its brown colour.

Also if there is too much bilirubin, it can leak into the surrounding tissues. As hyperbilirubinemia causes a yellow colour in the skin and eyes.

Risk factors of Excess bilirubin

Jaundice most often happens as a result of an underlying disorder that either causes the production of too much bilirubin or prevents the liver from getting rid of it. Such as both of these result in bilirubin deposition in the tissues.

Therefore underlying conditions that may cause excess bilirubin 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 brokes 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.

Likewise rarer conditions that may cause excess bilirubin 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 the cells of the liver.
  • Pseudojaundice: This is a harmless form of jaundice. Therefore 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.

Symptoms of jaundice

Common symptoms of this disease include: 

  • Fatigue
  • Abdominal pain and some may have pain in upper abdomen due to inflammation of liver.
  • Weight loss
  • Vomiting and nausea
  • Fever
  • Pale stools
  • Dark urine
  • The itchiness due to jaundice is sometimes so severe that patients scratch their own skin or experience insomnia.

If the cause of this disease is something else than any infection the symptoms might also include itchy skin or weight loss. Sometimes the reason behind the occurrence of jaundice is liver disease. In that case, the symptoms might include.

  • Chronic Hepatitis
  • Acute Hepatitis
  • Pyoderma gangrenosum
  • Polyarthralgias

The itching that accompanies jaundice can sometimes be so intense that patients scratch their skin raw, experience insomnia, or, in extreme cases, even have thoughts of suicide.

When complications happen, this is usually because of the underlying problem, not jaundice itself.

For example, if an obstructed bile duct leads to jaundice, uncontrolled bleeding may result. This is because the blockage leads to a shortage of vitamins needed 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 the production of bilirubin.
  • Obstructive jaundice occurs as a result of an obstruction in the bile duct. This prevents bilirubin from leaving the liver

Excess bilirubin in newborns

In particular, Jaundice is a common health issue in newborn infants. Around 60 percent of newborns experience this disease, and this increases to 80 percent of premature infants born before 37 weeks of pregnancy. They normally show signs within 72 hours of birth.

Red blood cells in the body of an infant frequently brokes down and replace. Therefore, this causes the production of more bilirubin. Also, the livers of infants are less developed and, therefore, less effective at filtering bilirubin from the body.

Generally, symptoms will usually resolve without treatment within 2 weeks. However, infants with extremely high bilirubin levels will require treatment with either a blood transfusion or phototherapy.

In these cases, treatment is vital as jaundice in newborns can lead to kernicterus, a very rare type of permanent brain damage.

Levels of bilirubin

In conclusion, the bilirubin test defines the level of bilirubin in the blood. This measures unconjugated, or indirect, bilirubin levels. Particularly these are responsible for the onset of jaundice.

Bilirubin levels are measured in milligrams per decilitre (mg/dL). Adults and older children should have a level of between 0.3 and 0.6 mg/dL. Around 97 percent of infants born after 9 months of pregnancy have levels lower than 13 mg/dl. If they show higher levels then further investigation is essential.

These ranges may differ between laboratories. How far above the normal range a person’s levels are will set out a course of treatment.

Diagnosis

Doctors will most likely use the history of the patient and a physical exam to diagnose this disease and confirm bilirubin levels. They will pay close attention to the abdomen, feel for tumours, and check the firmness of the liver.

A firm liver indicates cirrhosis or scarring of the liver. A rock-hard liver suggests cancer.

Several tests can confirm this disease. The first is a liver function test to find out whether or not the liver is functioning properly.

If a doctor cannot find the cause, a doctor may request blood tests to check bilirubin levels and the composition of the blood. These include:

  • 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.

The doctor will examine the structure of the liver if they suspect an obstruction. In these cases, they will use imaging tests, including MRI, CT, and ultrasound scans.

They may also carry out an endoscopic retrograde cholangiopancreatography (ERCP). This is a procedure combining endoscopy and X-ray imaging.

A liver biopsy can check for inflammation, cirrhosis, cancer, and fatty liver. This test involves inserting a needle into the liver to obtain a tissue sample. The examination of the sample is done under a microscope.

What is the treatment for jaundice?

The medical treatment of jaundice targets the specific cause, rather than jaundice itself. For example:

  • Hepatocellular jaundice is treated with anti-viral medications and steroids
  • Hemolytic jaundice is treated with iron supplements
  • Obstructive jaundice is treated with surgery to remove the obstruction followed by medication
  • There is also medication induced jaundice, in other words, jaundice which occurs as a side effect to consuming certain medicines. In such cases the medicines are discontinued and alternative medicines are prescribed.

What are the side effects of Jaundice treatments?

The methods of jaundice treatments usually include phototherapy in infants, intravenous immunoglobulin therapy, blood transfusion, certain medications, and surgical correction of the blocked bile duct. These methods can create some side effects and complications which generally include constipation, bloating, gas, stomach pain, diarrhoea, nausea and vomiting, upset stomach, and abdominal pain.

What stage of liver disease is jaundice?

Jaundice is the last stage of liver disease. In the earlier stages of liver diseases, the liver feels inflamed. Ignoring this creates problems later and the situations can get worse.

Due to the lack of proper treatment, it turns into cirrhosis, which is not curable. When the liver disease reaches an end-stage then jaundice can occur as a symptom.

Can Jaundice go away on its own?

This disease links to the abnormal condition of the liver, blood, or gallbladder. Doctor’s consultation is essential who diagnose the cause of the disease and decides the treatment plan according to it. However, in some cases such as acute viral hepatitis resolves spontaneously with the self-healing tendency of the liver and treatment is not essential.

Who is not eligible for the treatment?

The symptoms of jaundice are managed and controlled spontaneously in most cases such as Acute viral hepatitis, and need not be treated. In this case, the symptoms fade away gradually due to the self-healing tendency of the liver and certain medications.

While anemia-induced jaundice can be controlled at home by incorporating iron-rich foods in one’s diet, hepatitis-related jaundice can undergo self-treatment by the application of medicines such as antivirals and steroids. In these cases, the symptoms may resolve in a time period of around two weeks and there is no need for medical treatment.

What are the Complications of Jaundice?

The itching in jaundice might get very intense and the patients might suffer from insomnia. The complications of this disease are mostly not due to jaundice itself, but the underlying causes. For example, bile-duct obstruction jaundice might result in continuous bleeding due to vitamin deficiency.

Is jaundice a serious disease?

Jaundice is not particularly a disease in itself. It is more of a symptom of several underlying diseases. The overall seriousness depends on the condition of the person.

Which organ is affected by jaundice?

In most common cases, the organs affected by jaundice are the Liver, Gall bladder or Pancreas. Jaundice is the outcome of an excessive breakdown of bilirubin in the body.

What are the Precautions for Jaundice?

Precautions for jaundice:

  • Ensure safe and healthy eating and drinking habits.
  • During infection avoid fatty and oil rich foods.
  • Consume fluids and water so as to keep well hydrated.
  • Eat foods like carbohydrates, fruits like mango and papaya that are digestive friendly and are causing no harm to liver.

Some preventive measures against jaundice are as follows:

  • Avoid heavy alcohol use .
  • Get vaccines for hepatitis.
  • Take medications to prevent malaria before travelling to high risk areas.
  • Avoid high risk behaviours like intravenous drug use or unprotected sex.
  • Avoid potentially contaminated water/food and maintain good hygiene.
  • It’s important to avoid medications that cause hemolysis in susceptible individuals.
  • Consult the doctor immediately if one faces the symptoms of the jaundice.

What to cure jaundice?

Some of the fastest ways to cure this disease are as follows:

  • Drink at least 8 glasses of water.
  • Consider adding milk to your routine.
  • Opt for fruits like papaya and mango which are high in digestive enzymes.
  • Eat at least 2 and ½ cups of vegetables and 2 cups of fruits daily.
  • Look for high-fibre foods like oatmeal, berries and almonds.

Treatment of adult jaundice is not about treating by itself, rather treating its cause. For example, if you have acute viral hepatitis, jaundice will go away on its own as the liver begins to heal. When there is Blockage in the bile duct then your doctor may suggest surgery to open it.

Should you go to the hospital if you have jaundice?

It is of vital importance that if you see any signs or symptoms of jaundice, you must immediately consult your doctor.

If your doctor is not available you must go into the emergency and get yourself checked. This can be treated with a small consultation from your doctor but in severe cases, the patient might be needed to get admitted to the hospital.

Can jaundice affect kidneys?

If the jaundice is managed in a less severe state, there is no effect on the kidneys. If the disease has reached a higher level of severity, then it can cause intratubular accumulation of bilirubin and bile salts.

This might lead to the impairment of renal functions. The reason behind kidney failure may be nephron obstruction or direct tubular toxicity or both.

Physical exercises for the people suffering from Jaundice:

Lifestyle changes including exercises and yoga and implementing the same in one’s daily routine is a great way of improving the disease. Some of the yoga practices can benefit us a lot.