Jaundice, also known as icterus, is a yellowing of the skin, whites of the eyes, and body fluids due to an increase in the amount of bilirubin in the blood. Bilirubin is a yellowish pigment and byproduct of the natural daily breakdown of red blood cells (RBCs). Red blood cells typically survive for about 120 days before the body breaks them down, forming bilirubin in the process. The blood transports bilirubin to the liver, where bilirubin is metabolized and excreted in the bile. Bile is a thick, yellow-green-brown fluid that is secreted into the upper small intestine (duodenum) to eliminate waste products (such as bilirubin and excess cholesterol) and to aid in the digestion of fats. Disruption of this normal metabolism and/or the overproduction of bilirubin may cause jaundice.
Jaundice
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Causes
Jaundice is not an illness but a medical condition or sign of an underlying problem with the liver, pancreas, or gallbladder. Infections, use of certain drugs, cancer, blood disorders, gallstones, birth defects, inherited conditions, and a number of other medical conditions can cause jaundice. In general, the causes of jaundice may fall into one of three main categories:
- Conditions caused by the liver's inability to properly metabolize and eliminate bilirubin
- Conditions that result in shortened survival of red blood cells, which in turn increases the level of bilirubin
- Conditions that prevent elimination of bilirubin from the body
Examples of common causes of jaundice
- Acute hepatitis: liver inflammation due to a variety of causes, including hepatitis A, B, C, D, and E viral infections, alcohol abuse, and some medications (e.g., acetaminophen) and toxins
- Obstruction of the bile ducts; causes may include:
- Damage and scarring
- Biliary atresia, a congenital condition associated with abnormal development of the bile ducts that leads to the backup and pooling of the bile and to the increase of bilirubin in the blood
- Gallstones
- Pancreatic cancer, can sometimes lead to a blockage in the bile ducts
- Conditions that lead to a significant increase in the destruction of red blood cells, thereby causing an increase in the production of bilirubin, such as hemolytic anemia, due to an abnormal hemoglobin variant, malaria, autoimmune disorder, or hemolytic disease of the newborn (HDN)
- Gilbert syndrome: a mild inherited condition associated with decreased bilirubin metabolism due to a decrease in enzyme activity; those affected may have temporary jaundice during times of illness or stress and increases in their unconjugated bilirubin levels.
- Cirrhosis: in its late stages, can cause jaundice
- Physiologic jaundice of the newborn: the liver of a newborn infant has not yet developed its ability to metabolize bilirubin, so newborns frequently go through a brief period of jaundice right after they are born. Newborns with jaundice are carefully monitored and generally improve within 48 to 72 hours. If the jaundice persists or is severe, however, the infant may be treated and evaluated for other and more severe conditions, such as hemolytic disease of the newborn.
Examples of more rare conditions that may cause jaundice
- Crigler-Najjar syndrome: an inherited condition that may lead to severe unconjugated hyperbilirubinemia (high bilirubin concentrations); a gene mutation leads to a deficiency in an enzyme necessary for bilirubin conjugation.
- Dubin-Johnson syndrome: an inherited disorder that causes the retention of conjugated bilirubin (and other compounds that turn the liver black) in liver cells; those affected may have intermittent jaundice.
- Rotor syndrome: an inherited conjugated hyperbilirubinemia that causes intermittent jaundice; similar to Dubin-Johnson without the retention of other compounds or a black liver.
- The drug atazanavir (sometimes used to treat HIV infection) causes the same block in bilirubin metabolism as Gilbert syndrome and can cause mild jaundice that can worsen at times of illness or stress.
- Pseudojaundice: someone's skin may turn yellowish when the person eats large quantities of carrots, squash, or cantaloupe due to the presence of beta-carotene; this is a temporary and benign condition that is not related to bilirubin or bile.
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Tests
The goals of testing are to determine the cause of jaundice and to evaluate the severity of the underlying condition. Initial testing, usually a physical exam conducted by a healthcare practitioner, is generally focused on the liver. Specific additional tests, such as viral hepatitis testing and/or testing to evaluate increased red blood cell destruction, may be ordered along with or following the initial tests based on the clinical findings and the healthcare practitioner's suspicions of the cause of the jaundice.
Laboratory tests
Some tests are used to detect liver damage and evaluate liver function and may include:
- Liver panel, often comprised of:
- Prothrombin time (PT): the liver produces proteins involved in the clotting (coagulation) of blood; the PT measures clotting function and, if abnormal, may indicate liver damage.
- Urine bilirubin (often as part of a urinalysis)
Some tests may be used to detect infections that affect the liver, such as:
Tests used to detect decreased red blood cell survival may include:
- Complete blood count (CBC)
- Reticulocyte count (if CBC is abnormal)
- Blood smear: to visualize RBCs under a microscope
- Haptoglobin
Non-laboratory tests
Imaging tests and liver biopsies may be used to help evaluate the status and structure of the liver, gallbladder, and bile ducts. Testing may include:
- Abdominal ultrasound
- CT (computed tomography) scan
- MRI (magnetic resonance imaging) scan, often including MRCP (magnetic resonance cholangiopancreatogram, to visualize the pancreas and bile ducts)
- Endoscopic retrograde cholangiopancreatography (ERCP, a direct imaging of the pancreas and bile ducts)
- Liver biopsy
Visit RadiologyInfo.org for more details about imaging tests.
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Treatment
Treatment depends on the underlying cause of the jaundice:
- In newborns, phototherapy (special light therapy), blood exchange transfusion in severe cases, and certain drugs may reduce the bilirubin level.
- In Gilbert, Rotor, and Dubin-Johnson syndromes, no treatment is usually necessary.
- Crigler-Najjar syndrome may respond to certain enzyme drug therapies or may require a liver transplant or blood transfusion.
- Jaundice caused by obstruction of the bile ducts is often resolved by surgery to remove the blockage.
- Cirrhosis-caused jaundice is a result of long-term liver damage and does not respond well to any type of therapy other than a liver transplant.
