Jaundice Dr Rob Hicks Yellowing of the skin and eyes may be a sign of serious underlying disease.

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What is Jaundice? Causes and risk factors

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Jaundice is a yellow discolouration of the skin and membranes, often most visible in the eye where the white conjunctiva becomes yellow, due to a pigment called bilirubin which is made in the liver. It‘s normally excreted in the bile, which mixes with the contents of the intestines and is passed out through the gut. In certain instances, levels of bilirubin in the blood rise or the normal passage of bilirubin is blocked and it accumulates in the body, causing jaundice.

Jaundice is common in newborn babies - more than 60 per cent are affected. It’s usually a temporary problem, known as physiological jaundice, which develops a couple of days after birth as a result of immaturity of the body’s system for dealing with bilirubin. Jaundice is much rarer in older children in the UK. In adults it's usually the sign of an underlying problem, such as liver damage.

Jaundice is most easily seen if you blanch the skin with pressure - the nose is a good spot. It can be confirmed using a simple blood test.

The main symptom of jaundice is yellowing of the skin and eyes. It tends to start on the head and face and spread down the body. The skin may be itchy.

Very severe jaundice, due to very high levels of bilirubin in the blood, can cause brain damage in small babies, causing signs such as sleepiness and poor feeding.

In some types of jaundice, where the passage of bilirubin into the gut is blocked (for example due to a blockage of the bile duct which drains bile from the liver) the urine may be very dark (due to high levels of bilirubin passing out this way from the blood) and the faeces may be very pale (bilirubin is the pigment which usually makes faeces brown). This picture of what is known as “obstructive jaundice” can occur in children and adults for several different reasons.

There may be other symptoms which relate to the underlying cause of jaundice. For example, bilirubin is normally made from the regular break down of blood cells. If abnormally large amounts of blood are being broken down, levels of bilirubin may rise causing jaundice but there may also be signs of anaemia (as levels of blood fall) such as pallor or tiredness.

There are many different causes for jaundice, the build-up of bilirubin, produced when the body breaks down red blood cells at the end of their lifespan, incorporating it into bile. If more red blood cells than normal are being broken down - for example, in a condition called haemolytic anaemia, where red blood cells have a shorter lifespan - or if the liver is not functioning properly, then an excess of bilirubin will accumulate in the blood.

In adults, jaundice is often a sign that the liver is not functioning properly. Infections such as hepatitis may be responsible, as may the effects of some drugs. Another common cause of liver cell damage is alcohol abuse.

If nothing is causing excessive production supply of bilirubin and the liver isn’t damaged, then a problem with excretion (removal) of the bile is likely to be responsible. If the bile can't get out of the liver because of an obstruction, then it collects there and bilirubin is forced back into the blood, causing jaundice.

Jaundice may occur in the very first day of a baby's life as a result of the breakdown of blood cells, for example because of rhesus incompatibility or inherited deficiencies in enzymes.

More commonly, however, it develops after two to three days as a result of immaturity of the body's system for dealing with bilirubin (known as physiological jaundice). As with adults, jaundice can also occur because of infections such as hepatitis or blockages to the bowel or bile duct. Another cause is an underactive thyroid gland.

Treatment depends on the cause. In children, physiological jaundice may settle without treatment but a few days of light therapy (phototherapy) may be needed. This exposes the baby to blue band light, which breaks the pigment down into a harmless form. Side-effects are minor but include rash and diarrhoea. If bilirubin reaches dangerous levels, a type of blood transfusion called an exchange transfusion may be needed.

In adults, it's important to identify where the source of the problem lies. The pattern of symptoms may point to obstructive jaundice while blood tests can check for infection, liver function or excessive breakdown of red blood cells. Scans may also be used to identify gallstones or other obstructions to the passage of bile or whether the liver is inflamed. Sometimes a liver biopsy is performed to check for disease.

Treatment will then be directed at the cause, for example stopping a medicine which is causing haemolytic jaundice, surgery to remove a gallstone or antibiotics for infection or antiviral drugs for hepatitis.

This article was last medically reviewed by Dr Trisha Macnair in March 2009.

British Liver Trust

Helpline: 0800 652 7330
Email: info@britishlivertrust.org.uk
Website: www.britishlivertrust.org.uk

This article was last medically reviewed by Dr Trisha Macnair in March 2009.