Jaundice (medically known as icterus) refers to the yellowing of the skin, mucous membranes, and sclera (the white part of the eyes). This characteristic yellowing is caused by elevated levels of bilirubin in the body. Bilirubin is a yellowish bile pigment produced during the natural breakdown of hemoglobin.
Jaundice is not a disease in itself, but rather a sign of an underlying condition. The causes should always be evaluated by a doctor. Jaundice itself often causes few symptoms, but it can indicate a disease of the liver, the bile ducts, or other organs.
Here you will find further information as well as a selection of jaundice specialists.
Definition: What is jaundice?
Jaundice, or icterus, refers to the yellowish discoloration of the skin, eyes, and mucous membranes resulting from an elevated concentration of bilirubin in the body.
The yellowing of the skin, mucous membranes, and the sclera (the white part of the eyes) is particularly noticeable.
Bilirubin is produced during the breakdown of old red blood cells; more specifically, it is formed from the red blood pigment hemoglobin. This breakdown product is normally absorbed by the liver, processed, and released into the intestines via bile. There, it is ultimately excreted in the stool.
If this metabolic pathway is disrupted, bilirubin can accumulate in the body. If the concentration exceeds certain levels—such as 2 milligrams per deciliter—jaundice becomes visible.
Depending on the underlying mechanism, different forms are distinguished; each form of jaundice has its own causes and requires individualized evaluation.
Symptoms of the Disease
The most important symptom of jaundice is the visible yellowing of the skin and eyes; this change is initially most noticeable in the sclera of the eyes. As the condition progresses, the skin and mucous membranes may also become noticeably discolored.
Typical symptoms of jaundice include:
- Yellowing of the skin and eyes
- dark-colored urine
- Light-colored stools
- Fatigue and reduced energy
- Upper abdominal discomfort
- Itching
- Nausea and loss of appetite
The yellowing is caused by a buildup of bilirubin in the body. Bilirubin is a yellowish bile pigment that is produced when the body breaks down hemoglobin, the red blood pigment. The body normally excretes bilirubin via the liver and the bile ducts.
If this does not happen, the bilirubin remains in the body and leads to jaundice.
Pain may also occur. Painless jaundice can be a sign of a malignant tumor (e.g., pancreatic cancer).
If jaundice goes untreated, bilirubin can enter the bloodstream. This can lead to sepsis (blood poisoning).
Other symptoms depend on the underlying cause. In cases of infection or inflammation, fever and a general feeling of illness may occur. Liver diseases are often accompanied by tenderness in the upper right abdomen.
Painless jaundice may indicate a tumor of the pancreas or the bile ducts. Therefore, any new discoloration of the skin should be evaluated by a doctor.
Other symptoms may also include weight loss or digestive problems.
Jaundice is noticeable, among other things, by yellowing of the whites of the eyes © blackday | AdobeStock
Causes of Jaundice
The cause of jaundice can lie at various points in the bilirubin metabolism. As the central organ, the liver plays a crucial role in this process.
Hemolytic jaundice results from the increased breakdown of the red blood pigment hemoglobin. This process, known as hemolysis, leads to an excess of bilirubin that the liver cannot process quickly enough. Causes may include medications, certain blood disorders, or congenital abnormalities.
Hepatic jaundice, on the other hand, results from damage to liver cells. Common causes include hepatitis, alcohol abuse, or other forms of liver disease. Hepatitis A and B can impair liver function and cause permanent damage to the organ. Hepatitis and cirrhosis are among the most common causes.
Another form of jaundice is cholestatic jaundice, also known as obstructive jaundice. In this condition, bile can no longer flow freely. This is often caused by gallstones, inflammation of the bile ducts, gallbladder disease, or a tumor of the pancreas. The buildup of bile causes the amount of bilirubin in the body to rise.
In addition, there are rare metabolic disorders, such as Gilbert’s syndrome; this condition, which is usually congenital, leads to reduced processing of bilirubin in the liver.
Overall, therefore, a wide variety of causes can lead to the development or onset of jaundice.
- Prehepatic (hemolytic) jaundice: Increased breakdown of red blood cells (e.g., due to medications) leads to increased release and breakdown of hemoglobin. This results in elevated levels of bilirubin.
- Hepatocellular (parenchymal) jaundice: the inability of liver cells to excrete the accumulated bilirubin to a sufficient extent, e.g., in hepatitis or liver cirrhosis
- Cholestatic (obstructive) jaundice: Impaired bile flow due to, for example, bile duct stones, liver tumors, or pancreatic tumors
Diagnosis of Suspected Jaundice
Diagnosis begins with a detailed medical history and a physical examination. The doctor pays particular attention to the severity of the yellowing, any accompanying symptoms, and known pre-existing conditions.
Laboratory tests provide important clues as to the cause. Among other things, the following are measured: bilirubin in the blood, liver function tests, markers of inflammation, complete blood count, and coagulation tests.
These tests help determine whether bilirubin levels are elevated and whether there is liver damage.
Additional diagnostic methods of choice include
- ultrasound,
- computed tomography (CT) and magnetic resonance imaging (MRI), as well as
- ERCP (endoscopic retrograde cholangiopancreatography): This procedure visualizes the bile ducts and the pancreatic duct.
How is jaundice treated?
Treatment for jaundice generally depends on the underlying cause.
The goal of any treatment for jaundice is to resolve the underlying condition.
In cases of hemolytic jaundice, the underlying cause is treated; if necessary, medications must be discontinued or underlying conditions treated.
In cases of liver inflammation or hepatitis, treatment depends on the specific cause. Viral infections, alcohol abuse, or metabolic disorders require different treatment approaches.
If cirrhosis of the liver is the cause of jaundice, complete abstinence from alcohol is the treatment of choice. In the end stage, a liver transplant is the only chance for a permanent cure.
Interventional and surgical methods are used to treat cholestatic jaundice.
ERCP is the treatment of choice for bile duct stones; in a few cases, surgical correction of the bile duct is necessary. Tumors of the liver or pancreas can be surgically removed (depending on their size and extent).
Jaundice in newborns (neonatal jaundice) is a common, usually temporary yellowing of the skin and eyes caused by elevated bilirubin levels in the blood. Depending on the severity, treatment usually involves observation or light therapy (phototherapy), and in the vast majority of cases, neonatal jaundice resolves completely within a few days to weeks.
Course
The course depends on the underlying condition; in many affected individuals, the jaundice disappears as soon as the cause has been successfully treated.
Jaundice in adults can have causes ranging from harmless to serious.
Untreated diseases of the liver or bile ducts, on the other hand, can lead to permanent damage. Early diagnosis significantly improves the prognosis.
FAQ - Frequently Asked Questions
Is jaundice dangerous?
Jaundice itself is not a disease in its own right, but rather a sign of an underlying condition. Whether it is dangerous depends on the specific cause.
How does jaundice develop?
Jaundice occurs due to an increased accumulation of bilirubin in the body. The cause is usually a disorder in the processing or excretion of the bile pigment.
What causes jaundice?
The most common causes of jaundice are hepatitis, liver cirrhosis, gallstones, diseases of the bile ducts, and increased breakdown of blood cells.
How is jaundice treated?
Treatment for jaundice always depends on the underlying cause. Jaundice can only be treated once the underlying condition has been addressed.
What is jaundice in newborns?
Jaundice in newborns is relatively common after birth. Many infants develop elevated bilirubin levels within the first few days of life. This type of jaundice usually resolves on its own within ten to 14 days. Therefore, jaundice is relatively common as a newborn’s metabolism adjusts to conditions outside the womb.
Can jaundice be prevented?
Jaundice can sometimes be prevented by avoiding risk factors for liver disease. These include moderate alcohol consumption, vaccinations against certain forms of hepatitis, and a healthy lifestyle.
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