What is it?
Jaundice is not actually a disease itself. Rather, it is a
manifestation of an underlying problem.
The word jaundice is derived from the French word for yellow:
"jaune" and refers to a yellowish colour of the skin and eyes. It is
caused by a build-up of bilirubin in the body tissues.
Bilirubin is a pigment which is formed as a natural process when
haemoglobin (the oxygen-carrying component of blood) is metabolised.
Any disease affecting the liver, the bile ducts or the breakdown of
red blood cells, can cause an accumulation of bilirubin and lead to
What are the causes?
There is a multitude of possible causes of jaundice. In all cases,
a person with jaundice should be seen by a doctor who will need to
take a history of the illness, examine the patient and request some
tests in order to make an accurate diagnosis.
Some of the more common and more important causes of jaundice are
1. Neonatal Jaundice
Jaundice in newborn babies is very common and is mostly a normal
event. It can occur for two reasons:
- Newborn babies have too many red blood cells which contain
haemoglobin. It is normal for the baby's body to break down these
excess red blood cells and thus form a large amount of
- A newborn's liver is underdeveloped or immature and therefore
cannot process the bilirubin as quickly as an adult.
In most cases, an infant's jaundice will resolve within a few
days, often without the need for any treatment.
Occasionally, jaundice in an infant is caused by blood group
incompatibility (ABO or Rhesus Incompatibility) which causes a very
fast breakdown of red blood cells. If it is not the mother's first
pregnancy, the possibility of this problem is usually picked up in
the antenatal period.
A rare cause of neonatal jaundice is a physical defect in the
liver or bile duct system.
Treatment of jaundice in a newborn may be required if the blood
level of bilirubin is very high. This will usually entail placing the
infant under fluorescent lights for a few days, which speeds up the
metabolism of the excess bilirubin.
2. Viral Hepatitis
Hepatitis means inflammation of the liver and is often associated
with jaundice. Hepatitis can be caused by several viruses, but the
most common ones are: hepatitis A, hepatitis B and hepatitis C. More
recently, other viruses causing hepatitis have been discovered, but
less is known about them.
The severity of symptoms of viral hepatitis varies widely, but the
symptoms in each of the different viruses are similar. Apart from
jaundice, viral hepatitis can cause flu-like symptoms: fever,
headache, aching limbs, tiredness, loss of appetite, nausea and
vomiting. Skin rashes and joint pains can also occur in hepatitis B.
A tender and enlarged liver is also commonly present.
Hepatitis A is transmitted through contaminated food or water. The
virus is excreted in the faeces of an infected person and can survive
for 3-4 hours outside of the body. Transmission of the virus is thus
enhanced in conditions of poor hygiene and overcrowding. Generally,
hepatitis A is a self-limiting illness and does not persist in the
bloodstream nor in the stools after the illness has resolved. A
vaccine against hep A is available and will prevent 90% of people
from getting the disease.
Hepatitis B and C are transmitted in blood and other body fluids
(e.g. semen, breast milk). Hepatitis B is particularly infectious and
is frequently spread by sexual contact. It can also be transmitted by
hep B positive mothers to their infants at the time of delivery, in
which case the risk of chronic hepatitis in the baby is as high as
90%. Other groups at high risk of getting hepatitis B include
intravenous drug abusers, homosexuals and health care workers.
Most people who get hepatitis B will become ill and their immune
system will fight off the infection. However, 5-10% of people will go
on to develop chronic hepatitis. Another 5-10% will become carriers,
in which case they will be asymptomatic but able to infect
The hep B vaccine consists of 3 separate injections over a period
of 7 months and is also 90% effective.
Hepatitis C is less likely to be transmitted by sexual contact or
from mother-to-neonate, and is more likely to be transmitted in blood
(e.g. intravenous drug use or blood transfusion). Both hepatitis B
and C are now screened for in blood donors and the risk of getting
these viruses from blood transfusions is nowadays negligible.
Treatment of viral hepatitis
There is no specific medication to treat viral hepatitis.
Treatment during the acute illness is generally "supportive" e.g. bed
rest, avoidance of alcohol.
As is the case in all viruses, prevention is a more effective way
of controlling the disease.
If a person knows they have been in contact with someone with
hepatitis B, they should see a doctor quickly, as immune globulin can
be given to lower the risk of getting hepatitis B themselves.
Gallstones are a common problem in adults. Although they more
commonly cause intermittent abdominal pain, they can sometimes cause
jaundice. This occurs when gallstones get stuck in gallbladder or
bile duct system, blocking bilirubin from being excreted via the
intestine. Usually, the acute problem will resolve spontaneously and
the gallbladder can be taken out non-urgently. However, sometimes,
gallstones can lead to infection of the gallbladder or bile duct
and/or septicaemia, which also may be associated with jaundice. This
can be a serious condition and requires urgent treatment with
4. Alcoholic Hepatitis
Alcoholic hepatitis can be an acute or chronic illness that occurs
as a result of liver cell damage caused by excessive alcohol. It is
usually a reversible disease, but can go on to cause cirrhosis.
It usually occurs after a recent binge of heavy drinking. The
symptoms can include jaundice, nausea, loss of appetite, abdominal
pain, an enlarged tender liver, fever and mental confusion. It can be
a mild illness which resolves after stopping alcohol, or it can lead
to serious complications, causing critical illness and even
Cancer is a possible cause of jaundice, particularly in older
people and in cases where there are few other symptoms besides the
In these cases the jaundice is usually caused by a blockage in the
excretion of bilirubin. A tumour causing the blockage may be in the
liver, in the bile duct system or in the pancreas and pressing on the
In cases where the jaundice is caused by excessive breakdown of
red blood cells, there might be a malignancy of the blood, or
involving the spleen. (The spleen is largely responsible for the
breakdown of 'old' blood cells).
Several medications can cause hepatitis as a possible side effect.
This may or may not result in a visible jaundice and sometimes it
only causes a blood test abnormality. The jaundice is usually mild
and the illness nearly always resolves once the drug has been
A rare cause of jaundice is pregnancy. Sometimes, this is
associated with excessive 'morning sickness' (hyperemesis
gravidarum). The reason why some women get jaundice with pregnancy
and the mechanism behind it are unclear, but it is usually a mild
illness with an excellent prognosis.
What tests might the doctor order to diagnose the cause of
1. Blood tests
Blood tests are very useful in a case of jaundice. These will
usually show raised 'liver enzymes' as well as a high bilirubin
level. Depending on exactly which enzymes are raised, further tests
may be necessary to make an accurate diagnosis.
A 'full blood count" is also useful to look for infection or any
blood cell abnormality.
A doctor may request an ultrasound scan or a CT scan of the
abdomen to check for gallstones or other structural abnormalities of
the liver, gallbladder or bile ducts.
ERCP (endoscopic retrograde cholangiopancreatography) is an
invasive test requiring sedation or anaesthetic. It involves passing
a 'scope' into the bile and pancreatic ducts via the small intestine
and can be useful to demonstrate a site of blockage or to perform
delicate surgery, including gallstone removal.
4. Liver Biopsy
Sometimes, a sample of liver tissue is required to make a
definitive diagnosis. Liver biopsy is usually done under local
anaesthetic and involves a long biopsy needle being passed through
the skin to get a small sample of liver. Sometimes, it is done under
ultrasound or CT guidance.
Treatment of jaundice
Treatment, if possible, would be of the underlying cause. As
mentioned above, not all of the causes of jaundice are treatable.
In cases where there is a very high level of bilirubin, usually
from a bile outflow obstruction, a patient may experience severe
generalised itching. There are drugs which can help the itching (e.g.
cholestyramine), and topical treatments (e.g. calamine lotion) may
help, but this problem can be very difficult to treat.
Anyone experiencing a yellow change in skin colour should see a
doctor for a diagnosis to be made as a specific treatment might be
Dr Ali Goldkorn
- Medical Researcher
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