Jaundice, also known as icterus, is a condition that causes a yellowish discoloration of the skin, the sclera (whites of the eyes), and mucous membranes. This discoloration occurs due to elevated levels of bilirubin in the blood—a yellow pigment produced during the breakdown of red blood cells. Under normal conditions, bilirubin is processed by the liver and eliminated through bile. When this process is disrupted, bilirubin builds up in the body, leading to jaundice.

Jaundice is a symptom, not a disease itself. It can affect individuals of all ages, including newborns and adults, and is often a sign of an underlying medical condition affecting the liver, gallbladder, or blood.

Types of Jaundice

There are four primary types of jaundice, categorized based on where the bilirubin processing issue arises:

Pre-Hepatic Jaundice Occurs before bilirubin reaches the liver, usually due to increased breakdown of red blood cells. Conditions such as autoimmune hemolytic anemia and infections like malaria can cause this type.

Hepatic Jaundice This type results from liver dysfunction, where the liver cannot process or conjugate bilirubin properly. Common causes include hepatitis, cirrhosis, alcohol-related liver damage, or drug-induced liver injury.

Post-Hepatic Jaundice Also called obstructive jaundice, it occurs when bilirubin is processed by the liver but cannot be excreted due to a blockage in the bile ducts. Common causes include gallstones, tumors, or bile duct infections.

Neonatal Jaundice Affects newborns due to their immature liver function. While common and usually temporary, neonatal jaundice needs monitoring as high bilirubin levels can be dangerous if left untreated.

Symptoms

Jaundice manifests primarily through yellowing of the skin and eyes. Depending on the underlying cause, additional symptoms may include:

  • Fatigue or weakness

  • Itchy skin (pruritus)

  • Pale or clay-colored stools

  • Dark urine (tea-colored)

  • Nausea or vomiting

  • Loss of appetite

  • Abdominal pain, especially in the upper right quadrant

  • Fever (if infection is present)

  • Unintentional weight loss

In cases caused by blood disorders, symptoms like pale skin and shortness of breath may also be observed. In neonates, jaundice often starts on the face and spreads downward.

Causes

Jaundice results from an imbalance in bilirubin production and clearance. Its causes are grouped into three categories:

Pre-Hepatic Causes

  • Hemolytic anemia

  • Malaria and other infections

  • Sickle cell disease

  • Thalassemia

  • Autoimmune disorders

Hepatic Causes

  • Hepatitis (A, B, C, D, E)

  • Alcoholic liver disease

  • Cirrhosis

  • Drug toxicity (e.g., acetaminophen overdose)

  • Liver cancer

  • Inherited disorders (Gilbert syndrome, Crigler-Najjar syndrome)

  • Non-alcoholic fatty liver disease

Post-Hepatic Causes

  • Gallstones

  • Cholangitis (inflammation of bile ducts)

  • Pancreatic or bile duct tumors

  • Biliary atresia (in infants)

Diagnosis

Diagnosing jaundice involves identifying its cause through a series of tests and physical examinations:

Physical Exam

  • Checking skin, eyes, and abdomen for signs of jaundice or liver enlargement

Blood Tests

  • Bilirubin levels (total, direct, indirect)

  • Liver function tests (ALT, AST, ALP, GGT)

  • Complete blood count (CBC)

  • Viral hepatitis panel

  • Autoimmune markers if suspected

Imaging Tests

  • Ultrasound to detect bile duct obstruction or liver abnormalities

  • CT or MRI for detailed organ views

  • HIDA scan for gallbladder function

  • MRCP or ERCP for bile duct evaluation

Liver Biopsy Used in chronic cases to assess liver inflammation, fibrosis, or tumors.

Laparoscopy May be performed to directly view the liver and gallbladder.

 

Treatment Options

Treatment for jaundice focuses on resolving the underlying cause. If the condition is drug-induced, stopping the use of the medication can help. In cases of hemolytic anemia, corticosteroids or blood transfusions may be necessary. Hepatitis A is typically managed with rest, hydration, and supportive care, while hepatitis B or C is treated with antiviral medications. If the cause is a bile duct obstruction, an ERCP procedure, stenting, or surgery may be required. For gallstones, a cholecystectomy (surgical removal of the gallbladder) is the most common approach. Liver failure may necessitate a liver transplant. Itchy skin due to jaundice can often be managed with antihistamines or bile acid binders.

In newborns, phototherapy (light treatment) is commonly used to lower bilirubin levels. Severe neonatal cases may require exchange transfusions.

Prevention

Some types of jaundice, especially inherited conditions, cannot be prevented. However, you can reduce your risk by taking steps to protect your liver and overall health:

  • Get vaccinated against hepatitis A and B

  • Practice safe sex and hygiene to avoid infections

  • Avoid sharing needles, razors, or toothbrushes

  • Moderate or avoid alcohol consumption

  • Eat a balanced, low-cholesterol diet

  • Avoid exposure to liver toxins (e.g., certain wild mushrooms)

  • Manage chronic conditions like diabetes and obesity

  • Seek prompt treatment for gallstones or hepatitis

Complications

If left untreated, the root causes of jaundice can lead to serious complications:

  • Chronic hepatitis can progress to cirrhosis or liver cancer

  • Obstructive jaundice can result in bile duct infections, pancreatitis, or sepsis

  • Prolonged hemolysis may cause severe anemia

  • Kernicterus: a rare but life-threatening complication in infants where excess bilirubin affects the brain, leading to permanent neurological damage

Immediate treatment of jaundice is essential to prevent these outcomes.

Living With Jaundice

Managing jaundice involves treating the root condition and maintaining healthy habits. This may include:

  • Following medication regimens closely

  • Attending regular check-ups and liver function monitoring

  • Avoiding substances that stress the liver (alcohol, certain medications)

  • Eating liver-friendly foods like leafy greens, beets, and whole grains

  • Staying hydrated

  • For infants, ensuring regular pediatric follow-ups if jaundice is present at birth

With appropriate care and intervention, most people with jaundice recover fully, especially if the condition is diagnosed and treated early.