Book menuJAUNDICE - Full extract 

Jaundice is the yellow discoloration of the skin that occurs when there is a build-up of a substance called bilirubin in the blood. In many cases, yellowness in the white part of the eyes is more obvious than in the skin. Milder degrees of jaundice tend to be noted by the doctor rather than patient.

There are many causes, and a little physiology might help to explain how jaundice occurs. Blood is red because there is haemoglobin in the red blood cells. These cells last for only about 120 days, after which they become fragile and are broken down in parts of the body such as the spleen. Among other things formed from the old haemoglobin is bilirubin. This is transported to the liver where a series of biochemical processes occur before it winds up being excreted as bile. There are several ways that a build- up can occur:

  • If red blood cells are being broken down too rapidly the system can become overloaded; too much bilirubin is produced to be handled by the liver. Unprocessed bilirubin accumulates in the bloodstream and eventually the skin and eyes will look yellow. This condition is called haemolytic anaemia. Sometimes the condition is inherited; it may even be present at birth. Haemolytic anaemia may also occur as a side-effect of certain drugs.

  • Sometimes the problem is in the liver cells. If there is a fault in the uptake, processing or excretion of bilirubin, it will accumulate in the bloodstream. Newborn babies can be temporarily jaundiced because of lack of mature enzymes needed to process bilirubin. In adults, alcoholism is a common cause of damage to liver cells. Other toxins and certain drugs can also cause acute damage to the liver. Likewise, a number of infections can interfere with liver function, and the various types of viral hepatitis are often associated with jaundice.

  • A blockage in the bile duct will cause a build-up of fully processed bilirubin. This can spill over into the urine and cause it to become very dark. Because no file is finding its way down into the small bowel, the faeces become very pale. The blockage is most commonly caused by a gallstone. Occasionally it can be caused by a tumor.

Severe jaundice in newborn babies can cause a number of health problems. For this reason it is monitored closely, and special treatments such as phototherapy may be recommended by a paediatrician.

In adults, the jaundice itself usually doesn't cause any particular problem, apart from some itching. However, the underlying cause of the jaundice may show itself in various ways. In cases of haemolytic anaemia, the person may be very pale. With hepatitis, the person may have nausea and a fever. With blockage of the bile duct, there may be symptoms such as upper abdominal pain, dark urine and pale stools. Weight loss may be a clue to an underlying malignancy.

When anyone presents with jaundice, a detailed history and examination is essential. Aside from the usual questions, it is important to know whether the person drinks alcohol to excess, has been in contact with someone with hepatitis, or takes medication of any sort. We also inquire about family history, the person's occupation, recent overseas travel, a history of drug use and so on.

During a detailed physical examination, the doctor looks for signs of liver disease, and whether the abdomen feels normal. A rectal examination and urine test might also be done.

A few basic investigations will usually reveal the cause of the problem. Blood tests will show whether hepatitis is present and what type, or whether there is a blockage of the bile duct. If there is any suggestion of gallstones, an upper abdominal ultrasound is organised.

Further management then depends on the underlying cause. If the person is very ill, hospital admission might be arranged at the first consultation, before any tests at all. If the jaundice is related to an obvious viral infection or perhaps a reaction to medication, serial blood tests are done to see that the condition subsides fully. Specialist referral is often necessary.

Some people can have a sallow complexion and not be jaundiced at all. Similarly, a minor abnormality in a liver enzyme can cause a slight tinge of jaundice and little else. In these situations, careful investigation is still needed.

Health Tip:
* Jaundice is a symptom that needs prompt discussion with your doctor. It always needs thorough investigation.


 Dr. Andrew Pattison: Common Consultations
North East Valley Division General Practice, Melbourne, Australia.   Disclaimer
  - Last modified: August 18, 2001