Jaundice

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Overview

Jaundice, also known as hyperbilirubinemia, is a yellow discoloration of the body tissue resulting from the accumulation of an excess of bilirubin. Deposition of bilirubin happens only when there is an excess of bilirubin, a sign of increased production or impaired excretion. The normal serum levels of bilirubin are less than 1mg/dl; however, the clinical presentation of jaundice as scleral icterus (peripheral yellowing of the eye sclera), is best appreciated only when the levels reach more than 3 mg/dl. Sclerae have a high affinity for bilirubin due to their high elastin content. With further increase in serum bilirubin levels, the skin will progressively discolor ranging from lemon yellow to apple green, especially if the process is long-standing; the green color is due to biliverdin.

Bilirubin has two components: unconjugated(indirect) and conjugated(direct), and hence elevation of any of these can result in jaundice. Icterus acts as an essential clinical indicator for liver disease, apart from various other insults.

Yellowing of skin sparing the sclerae is indicative of carotenoderma which occurs in healthy individuals who consume excessive carotene-rich foods.

Symptoms

Sometimes, the person may not have symptoms of jaundice, and the condition may be found accidentally. The severity of symptoms depends on the underlying causes and how quickly or slowly the disease develops.

If you have a short-term case of jaundice (usually caused by infection), you may have the following symptoms and signs:

Fever.

Chills.

Abdominal pain.

Flu-like symptoms.

Change in skin color.

Dark-colored urine and/or clay-colored stool.

If jaundice isn't caused by an infection, you may have symptoms such as weight loss or itchy skin (pruritus). If the jaundice is caused by pancreatic or biliary tract cancers, the most common symptom is abdominal pain. Sometimes, you may have jaundice occurring with liver disease if you have:

Chronic hepatitis or inflammation of the liver.

Pyoderma gangrenosum (a type of skin disease).

Acute hepatitis A, B or C.

Polyarthralgias (inflammation of the joints).


Causes

Jaundice can be caused by a problem in any of the three phases in bilirubin production.


Before the production of bilirubin, you may have what's called unconjugated jaundice due to increased levels of bilirubin caused by:


Reabsorption of a large hematoma (a collection of clotted or partially clotted blood under the skin).

Hemolytic anemias (blood cells are destroyed and removed from the bloodstream before their normal lifespan is over).

During production of bilirubin, jaundice can be caused by:


Viruses, including Hepatitis A, chronic Hepatitis B and C, and Epstein-Barr virus infection (infectious mononucleosis).

Alcohol.

Autoimmune disorders.

Rare genetic metabolic defects.

Medicines, including acetaminophen toxicity, penicillins, oral contraceptives, chlorpromazine (ThorazineĀ®) and estrogenic or anabolic steroids.

After bilirubin is produced, jaundice may be caused by obstruction (blockage) of the bile ducts from:


Gallstones.

Inflammation (swelling) of the gallbladder.

Gallbladder cancer.

Pancreatic tumor.


Risk factors

Premature birth. A baby born before 38 weeks of gestation may not be able to process bilirubin as quickly as full-term babies do. ...

Significant bruising during birth. ...

Blood type. ...

Breast-feeding. ...

Race.

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Complications

Constipation.

Bloating.

Stomach pain.

Gas.

Upset stomach.

Vomiting.

Diarrhea.

Prevention

Since there are many causes of jaundice, it's hard to provide specific prevention measures. Some general tips include:


Avoid hepatitis infection.

Stay within recommended alcohol limits.

Maintain a healthy weight.

Manage your cholesterol.


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