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Jaundice

 

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.

Bilirubin is a waste product that's produced during the normal breakdown of red blood cells. The liver combines bilirubin with bile and it's released into the digestive system and passed out of the body in urine or stools. It is bilirubin that gives urine its light yellow colour and stools their dark brown colour.

Jaundice can occur as a result of any condition or disorder that disrupts the functions of the liver, such as sickle cell anaemia, Gilbert's syndrome or cirrhosis.

It's very common for newborn babies to be born with the symptoms of jaundice. Newborn jaundice tends not to be a cause for concern. It usually resolves within two weeks without treatment.

See Newborn jaundice for more information.

Jaundice symptoms

The most common symptoms of jaundice are:

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

Read more about the symptoms of jaundice.

When to see your GP

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

Types of jaundice

The types of jaundice are classified by the point at which disruption to the normal removal of bilirubin from the body occurs.

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. Most cases of pre-hepatic jaundice are the result of conditions that cause the red blood cells to break down too rapidly, such as malaria or sickle cell anaemia (a genetic blood disorder).
  • Intra-hepatic jaundice (also known as hepatocellular jaundice) - the disruption occurs inside the liver. Common causes are conditions that affect the liver, such as alcoholic cirrhosis or hepatitis C. People who are obese can also develop cirrhosis as a result of a build-up of fat inside their liver. This type of liver damage is known as non-alcoholic fatty liver disease.
  • 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. A common cause of post-hepatic jaundice is gallstones, which create a blockage in the bile duct system.  

Read more about the causes of jaundice.

Who's at risk

Due to the associated risk factors, 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.

Treating Jaundice

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

After having different tests to determine the cause of jaundice, the appropriate treatment will be recommended.

GlossaryBlood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Liver
The liver is the largest organ in the body. Its main jobs are to secrete bile (to help digestion), detoxify the blood and change food into energy.

Jaundice is caused by a build-up of bilirubin in the blood, resulting in a yellow tinge to the skin and the whites of the eyes 

Newborn jaundice

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

Newborn jaundice tends not to be a cause for concern. It usually resolves within two weeks without treatment.

See Newborn jaundice for more information.

Common symptoms

The most common symptoms of jaundice are:

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

Additional symptoms

Depending on the underlying cause of your jaundice, you may have a number of additional symptoms.

In cases where jaundice is the result of an infection, such as hepatitis C, you may have symptoms such as:

  • a high temperature (fever) of 38ºC (100.4ºF)  or above
  • chills
  • abdominal pain
  • flu-like symptoms, such as muscle and joint pain

In cases where jaundice is caused by damage to the liver, such as cirrhosis, common additional symptoms include:

  • unexplained weight loss
  • itchy skin

In cases of post-hepatic jaundice (where an obstruction, such as a gallstone, is preventing bile from draining out of the gallbladder) common additional symptoms include:

  • upper abdominal pain
  • high temperature
  • chills

When to seek medical advice

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

If you have the signs and symptoms of jaundice, contact your GP as soon as possible.

GlossaryFever
A high temperature, also known as a fever, is when someone's body temperature goes above the normal 37°C (98.6°F).
Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
Stools
Stool (also known as faeces) is the solid waste matter that is passed from the body as a bowel movement.
Vomiting
Vomiting is when you bring up the contents of your stomach through your mouth.

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

Bilirubin is a waste product that's produced when red blood cells break down. Human blood cells have a lifespan of 120 days, after which they're broken down and replaced with new cells.

The bilirubin is transported in the bloodstream to the liver where specialised cells help to combine it with digestive fluid called bile. Bile is stored in the gall bladder and is released into the digestive system through a series of tubes known as the bile duct system or biliary system.

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

Jaundice can occur as a result of any condition, problem or underlying factor that disrupts the movement of bilirubin from the blood to the liver and then 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 results in an increase in bilirubin levels in the blood and triggers the symptoms of 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

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.

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 and uncommon in Ireland
  • 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 (a compound used in the manufacture of plastic) or carbon tetrachloride (a compound that was 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

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:

  • 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)
GlossaryBlood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Cyst
A cyst is a fluid-filled sac or cavity in the body.
Inflammation
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Kidneys
Kidneys are a pair of bean-shaped organs located at the back of the abdomen, which remove waste and extra fluid from the blood and pass them out of the body as urine.
Liver
The liver is the largest organ in the body. Its main jobs are to secrete bile (to help digestion), detoxify the blood and change food into energy.
Oxygen
Oxygen is an odourless, colourless gas that makes up about 20% of the air we breathe.
Red blood cells
Red blood cells transport oxygen around the body and remove carbon dioxide.

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 GP 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 the onset of jaundice (this would point towards a diagnosis of hepatitis)
  • whether you're currently experiencing any other symptoms, such as abdominal pain, itchy skin or weight loss
  • whether you've recently travelled to a country where conditions such as malaria or hepatitis A are widespread
  • whether you've noticed a change of colour in your urine and stools
  • whether you have a history of prolonged alcohol abuse
  • whether you're currently taking recreational drugs or have taken them in the past
  • whether 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 any evidence of infections that are known to trigger the symptoms of jaundice, such as malaria and hepatitis C.

Blood tests can also be used to screen for autoimmune conditions (where the immune system attacks healthy tissue), such as autoimmune hepatitis.

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 any abnormalities inside the liver or bile duct systems.

Imaging techniques that can be used to help diagnose jaundice include:

  • ultrasound scan - this uses high-frequency sound waves to produce an image of the inside of your body
  • computerised tomography (CT) scan - a series of X-rays are taken to build up a more detailed, three-dimensional image of your body
  • magnetic resonance imaging (MRI) scan, which 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 serious health condition such as cirrhosis or liver cancer, a liver biopsy may be recommended to assess the condition of the tissue of your liver.

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

GlossaryBiopsy
A biopsy is a test that involves taking a small sample of tissue from the body so it can be examined.
Blood test
During a blood test, a sample of blood is taken from a vein using a needle, so it can be examined in a laboratory.
Liver
The liver is the largest organ in the body. Its main jobs are to secrete bile (to help digestion), detoxify the blood and change food into energy. 
Local anaesthetic
A local anaesthetic is a drug that is injected by needle or applied as a cream, which causes a loss of feeling in a specific area of the body.
Magnetic resonance imaging
MRI stands for magnetic resonance imaging. It is the use of magnets and radio waves to take detailed pictures of inside the body.
Red blood cells
Red blood cells transport oxygen around the body and remove carbon dioxide.
Tissue
Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.  
Ultrasound
Ultrasound scans are a way of producing pictures of inside the body using sound waves.

It's beyond the scope of this article to discuss all of the options for treating the potential causes of jaundice. Instead, a general overview of the recommended treatment plans for each of the main types of jaundice is outlined, 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:

  • Alcoholic liver disease 
  • Cirrhosis 
  • Glandular fever 
  • Hepatitis A 
  • Hepatitis B 
  • Hepatitis C 
  • Leptospirosis 
  • Liver cancer 
  • Liver transplant 
  • Primary biliary cirrhosis 

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:

  • Cancer of the bile duct
  • Cancer of the gallbladder
  • Gallbladder removal
  • Gallstones
  • Pancreatitis, acute
  • Pancreatitis, chronic
GlossaryLiver
The liver is the largest organ in the body. Its main jobs are to secrete bile (to help digestion), detoxify the blood and change food into energy.

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

  • ensuring that you stick to the recommended limits for alcohol consumption
  • maintaining a healthy weight for your height and build
  • if appropriate, ensuring that you're vaccinated against a hepatitis A or B infection, which are more common in certain parts of the world compared to England; therefore, 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; in Ireland, 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 weekly amounts are:

  • 21 standard drinks for men
  • 14 standard drinks for women

A standard drink of alcohol is approximately equal to half a pint of normal-strength lager, a small glass of wine or a single pub measure of spirits.

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

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

See Alcohol misuse - treatment and Alcohol for more information and advice. 

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 and losing weight safely.

Hepatitis A and Hepatitis B

As both hepatitis A and hepatitis B are relatively uncommon conditions in England, 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 the Hawaiian Islands
  • those who regularly inject drugs
  • men who have sex with men
  • sex workers

See the topics about Hepatitis A - Prevention and Hepatitis B - Prevention for more information and advice.

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.

GlossaryLiver
The liver is the largest organ in the body. Its main jobs are to secrete bile (to help digestion), detoxify the blood and change food into energy.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.