Jaundice

What is Jaundice?

Jaundice is not actually a disease itself, but a symptom 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 that 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 jaundice.

What are the causes of jaundice?

There are a great many possible causes of jaundice so in every case a person with jaundice should be seen by a doctor who will need to take a history of 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:

Neonatal Jaundice

Jaundice in newborn babies is very common and is mostly a normal event. It can occur for two reasons – firstly, newborn babies have more red blood cell,s which contain haemoglobin, than is essential. It is normal for the baby's body to break down these excess red blood cells and thus form a large amount of bilirubin. Secondly, 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.

Treatment of jaundice in a newborn may be required if the blood level of bilirubin is very high. This will usually involve placing the infant under fluorescent lights for a few days, which speeds up the metabolism of the excess bilirubin.

Viral Hepatitis

The term ‘hepatitis’ simply 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. 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 (solid waste or stools) of an infected person and can survive for 3 to 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 stay in the bloodstream nor in the stools after the illness has gone. A vaccine against hepatitis 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 (such as semen and breast milk). Hepatitis B is particularly infectious and is frequently spread by sexual contact. It can also be transmitted by hepatitis 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, men who have sex with men, people who change sexual partners frequently, and health care workers.

Most people who get hepatitis B will become ill and their immune system will fight off the infection. However, 5 to 10% of people will go on to develop chronic hepatitis. Another 5 to 10% will become carriers, in which case they will be asymptomatic (not showing any symptoms) but able to infect others.

Hepatitis C is less likely to be transmitted by sexual contact or from mother-to-baby, and is more likely to be transmitted in blood (such as 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.

There is no specific medication to treat viral hepatitis so treatment during the acute illness is generally "supportive" - for example, by getting sufficient bed rest and avoiding alcohol.

Gallstones

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 the gallbladder or bile duct system, blocking bilirubin from being excreted via the intestine.

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 death.

Malignancy (cancerous cells)

Cancer is a possible cause of jaundice, particularly in older people and in cases where there are few other symptoms besides the jaundice. 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 bile duct.

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).

Medication

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 stopped.

Pregnancy

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 that causes no long-term problems.

What tests might be needed in cases of jaundice?

Blood tests are very useful in a case of jaundice as 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 find infection or any blood cell abnormality.

A doctor may request an ultrasound scan or a CT (computerised tomography) scan of the abdomen to check for gallstones or other structural abnormalities of the liver, gallbladder or bile ducts.

Less commonly used, ERCP (endoscopic retrograde cholangiopancreatography) is an invasive test using sedation or anaesthetic. It involves passing a 'scope' into the bile and pancreatic ducts via the small intestine and can be useful to look at a site of blockage or to perform delicate surgery, including gallstone removal.

Sometimes, a sample of liver tissue is required to make a definitive diagnosis. A 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.

How is jaundice treated?

Jaundice is usually treated by treating the underlying cause although not all causes of jaundice are treatable. Anyone experiencing a yellow change in skin colour should see a doctor for a diagnosis to be made as a specific treatment might be needed.