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 body's tissues.

Signs of jaundice

The most common signs of jaundice are:

  • yellowing of the skin, eyes and the lining of the inside of parts of the body, such as the mouth and nose (mucus membrane)
  • pale-coloured stools
  • dark-coloured urine

When to seek medical advice

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

Speak to your GP as soon as possible. If this isn't possible, telephone NHS Direct Wales on 0845 46 47 or contact your local out-of-hours service.

Types of jaundice

There are three types of jaundice depending on what's disrupting the normal removal of bilirubin from the body. They are:

  • pre-hepatic jaundice – the disruption happens before bilirubin has been transported from the blood to the liver; it's caused by conditions such as sickle cell anaemia and haemolytic anaemia
  • intra-hepatic jaundice (also known as hepatocellular jaundice) – the disruption happens inside the liver; it's 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; it's 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 prevent jaundice. For example, maintaining a healthy weight, not drinking too much alcohol, and minimising your risk of hepatitis, will all help.

Diagnosing jaundice

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

You'll probably have a urine test and liver function and blood 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.

Read more about diagnosing jaundice.

Treating jaundice

Treatment for jaundice in adults and older children depends on what's causing it. This may involve treating the underlying condition, a blood transfusion or surgery.

Read more about treating jaundice.

Preventing jaundice

It's not possible to prevent all cases of jaundice because it can be caused by a wide range of conditions or circumstances.

However, you can take precautions to minimise your risk of developing jaundice. These include:

  • ensuring you don't exceed the recommended daily amount (RDA) for alcohol consumption
  • maintaining a healthy weight for your height and build
  • if appropriate, ensuring you're vaccinated against hepatitis A or hepatitis B if you're travelling to high-risk areas of the world
  • minimising your risk of exposure to hepatitis C because there's currently no vaccine for the condition; In Wales, 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

Newborn jaundice

Newborn babies are often born with jaundice. At a very young age, the various systems the body uses to remove bilirubin from the body aren't fully developed.

Newborn jaundice isn't usually a cause for concern and often resolves within two weeks without treatment.

Read more about newborn 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 out of the body can cause jaundice.

Bilirubin

Bilirubin is a waste product created when red blood cells break down. It's transported in the bloodstream to the liver, where it's combined with a digestive fluid called bile.

This eventually passes out of the body in urine or stools. It's 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's affecting the movement of bilirubin out of the body.

Pre-hepatic jaundice

Pre-hepatic jaundice occurs when a condition or infection speeds up the breakdown of red blood cells. This causes bilirubin levels in the blood to increase, triggering jaundice.

Causes of pre-hepatic jaundice include:

  • malaria – a blood-borne infection spread by mosquitoes
  • sickle cell anaemia – an inherited blood disorder where the red blood cells develop abnormally; it's most common among black Caribbean, black African and black British people
  • thalassaemia – similar to sickle cell; it's most common in people of Mediterranean, Middle Eastern and, in particular, South Asian descent
  • Crigler-Najjar syndrome – a genetic syndrome where an enzyme needed to help move bilirubin out of the blood and into the liver is missing
  • hereditary spherocytosis – a genetic condition that causes red blood cells to have a much shorter life span than normal

Intra-hepatic jaundice

Intra-hepatic jaundice happens when a problem in the liver – for example, damage due to infection or alcohol, disrupts the liver’s ability to process bilirubin.

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 drinking too much alcohol
  • leptospirosis – a bacterial infection that's spread by animals, particularly rats
  • glandular fever – a viral infection caused by the Epstein-Barr virus
  • drug misuse – leading causes are ecstasy and overdoses of paracetamol
  • primary biliary cirrhosis – a rare condition that causes progressive liver damage
  • Gilbert's syndrome – a common genetic syndrome where the liver has problems breaking down bilirubin at a normal rate
  • liver cancer – a rare and usually incurable cancer that develops inside the liver
  • exposure to substances 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 starts to attack the liver
  • primary sclerosing cholangitis – a rare type of liver disease that causes long-lasting (chronic) inflammation of the liver
  • Dubin-Johnson syndrome – a rare genetic syndrome where the liver is unable to move bilirubin out of the liver

Post-hepatic jaundice

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.

Causes of post-hepatic jaundice include:

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Diagnosis

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

Medical history and examination

It's likely your GP or hospital doctor will take a detailed medical history to try to determine why you have jaundice.

You may be asked whether:

  • you had any flu-like symptoms before jaundice (this may indicate hepatitis)
  • you're currently experiencing 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 alcohol misuse
  • you're currently taking drugs or have taken them in the past
  • your occupation could have exposed you to harmful substances

It's likely you'll also have 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), or 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. It's produced when bacteria break down bilirubin inside the digestive system.

Higher-than-expected levels of urobilinogen in your urine may suggest 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 used to help diagnose certain liver conditions including:

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 fall.

By measuring the levels of these enzymes and proteins, it's possible to build up a picture of how well the liver is functioning. In addition, your blood can be tested for infections known to trigger jaundice, such as malaria and hepatitis C.

Imaging tests

If intra-hepatic jaundice or post-hepatic jaundice is suspected, imaging tests can be used to check for abnormalities inside the liver or bile duct systems. These include:

Liver biopsy

A biopsy may be recommended to assess the condition of the liver tissue if it may have been damaged by a condition such as cirrhosis or liver cancer.

During a liver biopsy, your tummy is numbed with a local anaesthetic, 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.

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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. 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:

Newborn jaundice

Newborn babies are often born with jaundice. At a very young age, the various systems that are used to remove bilirubin from the body aren't fully developed.

Newborn jaundice isn't usually a cause for concern and often resolves within two weeks without treatment.

Read more about newborn jaundice.

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The information on this page has been adapted by NHS Wales from original content supplied by NHS Choices.
Last Updated: 10/03/2015 10:38:55