Jaundice

Jaundice is a term used to describe the yellowing of the skin and the whites of the eyes.

Introduction

Jaundice is a term used to describe the yellowing of the skin and the whites of the eyes.

It's caused by a build-up of a substance called bilirubin in the blood and tissues of the body.

Signs of jaundice

The most common signs of jaundice are:

  • yellowing of the skin, eyes and mucus membrane (the lining of the body’s passageways and cavities, such as the mouth and nose)
  • pale coloured stools (faeces)
  • dark coloured urine

When to seek medical advice

Always seek immediate medical advice if you develop the above signs of jaundice. They are an important warning sign that something is wrong with the normal processes of your body.

Speak to your doctor as soon as possible. If this isn't possible, contact your local out-of-hours service.

Types of jaundice

There are three types of jaundice, depending on what is causing disruption to the normal removal of bilirubin from the body.

The three main types of jaundice are described below.

  • Pre-hepatic jaundice – the disruption occurs before the bilirubin has been transported from the blood to the liver. This is caused by conditions such as sickle cell anaemia and haemolytic anaemia.
  • Intra-hepatic jaundice (also known as hepatocellular jaundice) – the disruption occurs inside the liver. This is caused by conditions such as Gilbert’s syndrome, cirrhosis or other liver damage.
  • Post-hepatic jaundice (also known as obstructive jaundice) – the disruption prevents the bile (and the bilirubin inside it) from draining out of the gallbladder and into the digestive system. This is caused by conditions such as gallstones or tumours.

Read more about the causes of jaundice.

Who's at risk

Intra-hepatic and post-hepatic jaundice are more common in middle-aged and elderly people than in the young. Pre-hepatic jaundice can affect people of all ages, including children.

Certain lifestyle changes may help to prevent jaundice. For example, maintaining a healthy weight, managing how much alcohol you drink and minimising your risk of hepatitis.

Read more about preventing jaundice.

Treating jaundice

Treatment for jaundice in adults and older children depends on the underlying condition that's causing it.

Following tests to determine the cause of jaundice, the appropriate treatment will be recommended.

Read more about diagnosing jaundice.

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Causes

Jaundice is caused by a build-up of a substance called bilirubin in the blood and tissues of the body.

Any condition that disrupts the movement of bilirubin from the blood to the liver and then out of the body (see below) can cause jaundice.

What is bilirubin?

Bilirubin is a waste product that's produced when red blood cells break down.

The bilirubin is transported in the bloodstream to the liver where specialised cells help to combine it with digestive fluid called bile.

The bile (and bilirubin) is converted by bacteria inside the digestive system into a substance called urobilinogen, which is passed out of the body in urine or in stools. It is bilirubin that gives urine its light yellow colour and stools their dark brown colour.

Types of jaundice

There are three types of jaundice, depending on what is affecting the movement of bilirubin out of the body.

  • Pre-hepatic jaundice occurs when a condition or infection speeds up the breakdown of red blood cells. This results in an increase in bilirubin levels in the blood and triggers the symptoms of jaundice.
  • Intra-hepatic jaundice occurs when damage to the liver, either as the result of infection or exposure to a harmful substance, such as alcohol, disrupts the liver’s ability to process bilirubin.
  • Post-hepatic jaundice is triggered when the bile duct system is damaged, inflamed or obstructed, which results in the gallbladder being unable to move bile into the digestive system.

The causes of each type of jaundice are described below.

Pre-hepatic jaundice

Causes of pre-hepatic jaundice include:

  • malaria – a blood-borne infection spread by mosquitoes and common in tropical areas of the world
  • sickle cell anaemia – a genetic condition that causes red blood cells to develop abnormally; sickle cell anaemia is most common among black Caribbean, black African and black British people
  • thalassaemia – a similar genetic condition to sickle cell anaemia in that it affects the production of red blood cells; thalassaemia is most common in people of Mediterranean, Middle Eastern and, in particular, South Asian, descent
  • Gilbert's syndrome – a common genetic condition where the transportation of bilirubin from the blood to the liver is slower than it should be, leading to a build-up of bilirubin in the blood
  • Crigler-Najjar syndrome – a rare genetic condition where an enzyme that's need to help move bilirubin out of the blood and into the liver is missing
  • hereditary spherocytosis – an uncommon genetic condition that causes red blood cells to have a much shorter life-span than normal

Intra-hepatic jaundice

Causes of intra-hepatic jaundice include:

  • the viral hepatitis group of infections – hepatitis A, hepatitis B and hepatitis C
  • alcoholic liver disease – where the liver is damaged as a result of alcohol misuse
  • leptospirosis – a bacterial infection that's spread by animals, particularly rats; it's common in tropical areas of the world
  • glandular fever – a viral infection that's caused by the Epstein-Barr virus
  • drug misuse – two leading causes are the recreational drug, ecstasy, and overdoses of the painkiller, paracetamol
  • primary biliary cirrhosis – a rare and poorly understood condition that causes progressive liver damage
  • liver cancer – a rare and usually incurable cancer that develops inside the liver
  • exposure to substances that are known to be harmful to the liver, such as phenol (used in the manufacture of plastic) or carbon tetrachloride (widely used in the past in processes such as refrigeration, although now its use is strictly controlled)
  • autoimmune hepatitis – a rare condition where the immune system (the body’s natural defence against infection and illness) starts to attack the liver
  • primary sclerosing cholangitis – a rare type of liver disease that causes chronic (long-lasting) inflammation of the liver
  • Dubin-Johnson syndrome – a rare genetic condition where the liver is unable to combine bilirubin with bile and move it out of the liver

Post-hepatic jaundice

Causes of post-hepatic jaundice include:

  • gallstones obstructing the bile duct system pancreatic cancer – an uncommon type of cancer that develops inside the pancreas (a gland that helps with the digestion of food)
  • gallbladder cancer or bile duct cancer, which are both relatively rare types of cancer
  • pancreatitis – inflammation of the pancreas, which can either be acute pancreatitis (the inflammation only lasts for a few days) or chronic pancreatitis (the inflammation lasts for many years)

Diagnosis

If you have jaundice, you'll have a number of initial tests to find out how severe it is and to determine the underlying cause.

These tests are described below.

Medical history and examination

It's likely that your doctor or the clinician in charge of your hospital care will want to take a detailed medical history in case it could provide clues as to why you have jaundice.

You may be asked whether:

  • you had any flu-like symptoms before your jaundice (this would point towards a diagnosis of hepatitis)
  • you're currently experiencing any other symptoms, such as abdominal pain, itchy skin or weight loss
  • you've recently travelled to a country where conditions such as malaria or hepatitis A are widespread
  • you've noticed a change of colour in your urine and stools
  • you have a history of prolonged alcohol misuse
  • you're currently taking recreational drugs or have taken them in the past
  • your occupation could have exposed you to any harmful substances

It's likely that you'll also be given a physical examination to check for signs of an underlying condition, such as:

  • swelling of the legs, ankles and feet (a possible sign of cirrhosis)
  • a noticeable swelling of your liver (a possible sign of hepatitis)

Urine test

A urine test can be used to measure levels of a substance called urobilinogen. Urobilinogen is produced when bacteria break down bilirubin inside the digestive system.

Higher-than-expected levels of urobilinogen in your urine may suggest a diagnosis of pre-hepatic jaundice or intra-hepatic jaundice. Lower levels could suggest post-hepatic jaundice.

Liver function and blood tests

A liver function test is a type of blood test that can be used to help diagnose certain liver conditions, including:

  • hepatitis
  • cirrhosis
  • alcoholic liver disease

When the liver is damaged it releases enzymes into the blood. At the same time, levels of proteins that the liver produces to keep the body healthy begin to drop.

By measuring the levels of these enzymes and proteins, it's possible to build up a reasonably accurate picture of how well the liver is functioning.

In addition, your blood can be tested for infections known to trigger the symptoms of jaundice, such as malaria and hepatitis C.

Imaging tests

If intra-hepatic jaundice or post-hepatic jaundice is suspected, it's often possible to confirm the diagnosis using imaging tests to check for abnormalities inside the liver or bile duct systems.

These include:

  • ultrasound scan – high-frequency sound waves produce an image of the inside of your body
  • computerised tomography (CT) scan – a series of X-rays build up a more detailed, three-dimensional image of your body
  • magnetic resonance imaging (MRI) scan - uses strong magnetic fields and radio waves to produce a detailed image of the inside of your body
  • endoscopic retrograde cholangiopancreatography (ERCP) – a small flexible, fibre-optic camera (endoscope) is used to inject a special dye into the bile ducts; the dye shows up on X-ray and is useful in helping to confirm a diagnosis of pre-hepatic jaundice

Liver biopsy

If it's suspected that your liver has been damaged by a condition such as cirrhosis or liver cancer, a liver biopsy may be recommended to assess the condition of the liver tissue.

During a liver biopsy, your abdomen (tummy) is numbed with a local anaesthetic (painkilling medication) and a fine needle is inserted so that a small sample of liver cells can be taken and sent to a laboratory for examination under a microscope.

Treatment

There are many possible treatments for jaundice, depending on the underlying cause.

A general overview of the recommended treatment plans for each of the main types of jaundice is outlined below, including links to more detailed information.

Pre-hepatic jaundice

In treating pre-hepatic jaundice, the objective is to prevent the rapid breakdown of red blood cells that's causing the level of bilirubin to build up in the blood.

In cases of infections, such as malaria, the use of medication to treat the underlying infection is usually recommended. For genetic blood disorders, such as sickle cell anaemia or thalassaemia, blood transfusions may be required to replace the red blood cells.

Gilbert's syndrome doesn't usually require treatment because the jaundice associated with the condition isn't particularly serious and doesn't pose a serious threat to health.

Intra-hepatic jaundice

In cases of intra-hepatic jaundice, there's little that can be done to repair any liver damage, although the liver can often repair itself over time. Therefore, the aim of treatment is to prevent any further liver damage occurring.

For liver damage that's caused by infection, such as viral hepatitis or glandular fever, anti-viral medications may be used to help prevent further damage.

If the damage is due to exposure to harmful substances, such as alcohol or chemicals, avoiding any further exposure to the substance is recommended.

In severe cases of liver disease, a liver transplant is another possible option. However, only a small number of people are suitable candidates for a transplant and the availability of donated livers is limited.

See the following topics for more information:

Post-hepatic jaundice

In most cases of post-hepatic jaundice, surgery is recommended to unblock the bile duct system.

During surgery, it may also be necessary to remove:

  • the gallbladder
  • a section of the bile duct system
  • a section of the pancreas to prevent further blockages occurring

See the following topics for more information:

Prevention

Due to the wide range of potential causes, it's not possible to prevent all cases of jaundice. However, you can take precautions to minimise your risk of developing jaundice.

These precautions include:

  • ensuring that you stick to the recommended daily amount (RDA) for alcohol consumption
  • maintaining a healthy weight for your height and build
  • if appropriate, ensuring that you're vaccinated against a hepatitis A or hepatitis B infection; vaccination would usually only be recommended depending on where in the world you're travelling (see below)
  • minimising your risk of exposure to hepatitis C because there's currently no vaccine for the condition. The most effective way of preventing hepatitis C is by not injecting illegal drugs, such as heroin, or making sure that you don't share drug injecting equipment if you do

More information about each precaution is provided below.

Alcohol

Giving up drinking alcohol altogether is the most effective way of reducing your risk of developing jaundice, particularly if you've been drinking for many years.

As a minimum preventative measure, stick to the recommended daily amounts for alcohol consumption. The recommended daily amounts are:

  • 3-4 units a day for men
  • 2-3 units a day for women

A unit of alcohol is approximately equal to half a pint of normal-strength lager, a small glass of wine or a single measure (25ml) of spirits.

Many experts would recommend that as well as sticking to the recommended daily amounts, you also spend 2-3 days not drinking any alcohol.

Visit your doctor if you're finding it difficult to moderate your alcohol consumption. Counselling services and medication are available to help you reduce your alcohol intake.

Maintaining a healthy weight

Obesity and the resulting damage it can sometimes cause to the liver (non-alcoholic fatty liver disease) is an often-overlooked cause of cirrhosis (scarring of the liver) and jaundice. Therefore, achieving and maintaining a healthy weight is an effective way of preventing jaundice.

In addition, a diet that's high in fat can increase your blood cholesterol level, which in turn will also raise your risk of developing gallstones.

The most successful weight loss programmes include at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity (i.e. cycling or fast walking) every week, eating smaller portions and only having healthy snacks in between meals. A gradual weight loss of around 0.5kg (1.1lbs) a week is usually recommended.

Read more about the treatment of obesity.

Hepatitis A and Hepatitis B

Vaccination is usually only recommended if you're travelling to parts of the world that are known to have high levels of both conditions. You may also be advised to have a vaccination if your job or lifestyle increases your risk of exposure to either type of virus.

For example, vaccination for hepatitis A is recommended for:

  • people who are travelling to places where the virus is common, such as the Indian subcontinent, Africa, central and south America, the Far East and eastern Europe
  • people who work in laboratories
  • people who work with primates, such as monkeys and chimpanzees

Vaccination for hepatitis B is recommended for:

  • visitors to parts of the world where hepatitis B is widespread, such as south-east Asia, sub-Saharan Africa and the Pacific Islands, such as Samoa or the Solomon Islands
  • those who regularly inject drugs
  • men who have sex with men
  • sex workers

Read more information and advice about preventing hepatitis A and preventing hepatitis B.

Hepatitis C

If you regularly inject drugs, such as heroin, the best way to avoid getting a hepatitis C infection is to not share any of your drug-injecting equipment with others. This doesn't just apply to needles but also to anything that could come into contact with other people's blood, such as:

  • mixing spoons
  • filters
  • water used to dissolve drugs
  • tourniquets – the belt that drug users sometimes tie around their arm to make their veins easier to inject

As hepatitis C doesn't cause any noticeable symptoms for many years, many people may not realise that they're infected. It's therefore safer to assume that anyone may have the infection.

Even if you're not a drug user, it's important to take some common sense precautions to minimise your exposure to other people’s blood, such as avoiding sharing any object that could be contaminated with blood, such as razors and toothbrushes.

There's less risk of developing hepatitis C by having sex with someone who is infected, but as a precaution it's recommended that you use a barrier method of contraception, such as a condom.

It may also be possible to get hepatitis C by sharing banknotes or ‘snorting tubes’ with an infected person to snort drugs, such as cocaine or amphetamine. These types of drugs can irritate the lining of the nose, and small particles of contaminated blood could be passed on to the note or tube, which you could then inhale.

See Hepatitis C, get tested, get treated for more information and advice about hepatitis C.

Content supplied by NHS Choices