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Jaundice is a yellowish discoloration of the skin and of the whites of the eyes caused by abnormally high levels of the pigment bilirubin in the bloodstream.

Jaundice

• Liver damage or a blockage in a bile duct can cause jaundice.
• The skin and whites of the eyes look yellow, the skin may itch, and urine is often dark.
• Laboratory and often imaging tests help identify the cause.
• Often, jaundice disappears as its cause resolves, but surgery or endoscopy is sometimes needed.

Old or damaged red blood cells are constantly being removed from the circulation, mainly by the spleen. During this process, hemoglobin, the part of red blood cells that carries oxygen, is broken down into a dark greenish yellow pigment called bilirubin. Bilirubin is then carried in the bloodstream to the liver and is excreted into the intestine as a component of bile (the digestive fluid produced by the liver). If bilirubin cannot be excreted into bile quickly enough, it builds up in the blood. The excess bilirubin is deposited in the skin, resulting in the yellowish discoloration called jaundice.

Did You Know... Eating too many carrots can make the skin look yellow but does not cause jaundice.

Causes

High levels of bilirubin in the blood may result from problems originating either within the liver or outside the liver. Damage to the liver, such as that due to inflammation or scarring, can impair its ability to excrete bilirubin into bile. Alternatively, the bile ducts, which carry bile from the liver to the small intestine, may be blocked, for example, by a gallstone or a tumor. Less commonly, overproduction of bilirubin, due to excessive breakdown of red blood cells, can overwhelm the liver with more bilirubin than the liver is capable of processing. Overproduction is most common in newborns with jaundice (see Problems in Newborns: Hyperbilirubinemia).

In Gilbert's syndrome, bilirubin levels are slightly increased but usually not enough to cause jaundice. This disorder, which is sometimes hereditary, is most often detected in young adults during routine screening tests. It causes no other symptoms and no problems.

The skin of people who eat large amounts of food rich in beta-carotene (such as carrots, squash, and some melons) may develop a mild yellow tint, but their eyes do not turn yellow. This condition is not jaundice and is unrelated to liver disease.

Symptoms

In jaundice, the skin and whites of the eyes appear yellow. Urine is often dark because excess bilirubin is excreted through the kidneys. People may have itching, light-colored stools, or other symptoms, depending on the cause of jaundice. For example, acute inflammation of the liver (acute hepatitis) may cause loss of appetite, nausea, vomiting, and fever. Blockage of bile may result in abdominal pain and fever.

Diagnosis and Treatment

A doctor uses laboratory tests and imaging studies to determine the cause of the jaundice. If the problem is a disease of the liver, such as acute viral hepatitis, the jaundice usually disappears gradually as the condition of the liver improves. If the problem is blockage of a bile duct, surgery or surgical endoscopy (using a flexible viewing tube with surgical instruments attached—see Symptoms and Diagnosis of Digestive Disorders: Endoscopy) is usually performed as soon as possible to reopen the affected bile duct. Itching caused by jaundice can be treated with cholestyramine Some Trade Names
QUESTRAN
taken by mouth. Usually, the itching gradually disappears as the liver's condition improves.

Last full review/revision August 2006 by Sidney Cohen, MD