Jaundice

(Yellowing of Skin)
Pronounced: JON-dis
by Laurie Rosenblum, MPH
En Espaol (Spanish Version)

Definition
Jaundice consists of a yellow discoloration of the skin, mucus membranes (tissue including that which lines the
mouth), and whites of the eyes. It is a symptom that often occurs with liver and gallbladder disorders. It may also
be present in certain blood disorders and is occasionally due to benign (normal) metabolic conditions.

Causes
Jaundice occurs when excess bilirubin builds up in the blood. Bilirubin is a yellow-brown colored substance in the
bile that is formed during the body's normal process of breaking down red blood cells. Bile is a liquid that carries
waste products (including bilirubin) away from the liver. It also helps break down fats in the small intestine.
There are several reasons why too much bilirubin can build up in the blood. They include:
Excess breakdown of red blood cells, which can occur in:
Certain forms of anemia
Some infectious diseases like malaria
A blockage in or near the liver that prevents the flow of bile, such as:
Gallstones or pancreatitis
A tumor in the liver or bile duct
Cancer in the pancreas
Congenital defects, including biliary atresia
Pregnancy
Liver, Gallbladder, and Bile duct

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Liver damage caused by:

Viral hepatitis
Cirrhosis
Alcoholic liver disease
Adverse effects of certain medicines or environmental toxins
In babies, insufficient amounts of a certain liver enzyme during the first two weeks of life, possibly made
worse by breastfeeding
Inherited metabolic disorders, including Gilbert's, Crigler-Nager, and Dubin-Johnson syndromes

Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. The risk factors for
jaundice are those that increase the risk for liver and gallbladder disorders. They include:
Drinking too much alcohol
Using illegal drugs
Taking medicines that may harm the liver
Being exposed to hepatitis A (through contaminated food or water), hepatitis B, or hepatitis C (through
contaminated needles or unsafe sex)
Being exposed to certain industrial chemicals

Symptoms
Jaundice appears as a yellow discoloration of the skin, mucus membranes, and/or whites of the eyes.
Depending on the specific disorder that causes jaundice, other symptoms may occur, such as tiredness, fatigue,
fever, chills, and unexplained weight loss.

Diagnosis
If you have jaundice, the doctor will ask about your symptoms and medical history, and do a physical exam.
Your doctor will ask you questions about:
Use of alcohol, herbal supplements, and medicines
Abdominal surgeries
HIV exposure
Family history of liver diseases
Tests may include:
Blood teststests to detect elevated bilirubin and liver enzyme levels, or other abnormalities related to the
suspected cause of jaundice
Ultrasound a test that uses sound waves to examine internal organs; in this case, the liver, gallbladder, and
bile ducts
CT scan a type of x-ray that uses a computer to make pictures of the inside of the body; in this case, the
liver, gallbladder, bile ducts, and surrounding tissues
Cholangiographyan invasive test that uses x-rays and a large needle inserted into the liver to examine the
gallbladder and bile ducts; sometimes performed during abdominal surgery
ERCP test combines x-rays and an endoscope, which is a long, flexible, lighted tube that is inserted down
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the throat. This is done to examine the duodenum (first part of the small intestine), bile ducts, and pancreatic
ducts. The magnetic resonance cholangiopancreatography (MRCP) test is an alternative to the ERCP test.
Laparoscopy insertion of a tube and other instruments through small incisions in the abdominal wall to
directly view the liver, gallbladder, bile ducts, and other structures
Liver biopsy removal of a sample of liver tissue for testing. This is usually done with a long needle.

Treatment
Mild jaundice in newborns is common and usually clears without treatment. If bilirubin levels rise above a certain
level, the baby may receive phototherapy, which is treatment with a special ultraviolet light. In Gilbert's syndrome,
jaundice tends to occur during stressful periods and clears without treatment.
In most other types of jaundice, the specific condition causing it must be treated. There are many treatments that
may be used for liver and gallbladder problems depending on the exact condition. They include:
Avoiding a substance (alcohol or a medicine) that is causing the condition
Addressing the cause of anemia
Taking medicines to treat causative infectious diseases
Relieving bile duct obstructions by:
Excising tumors
Extracting gallstones
Removing the gallbladder
Treating inflammation of the pancreas ( pancreatitis)
If you are diagnosed with jaundice, follow your doctor's instructions.

Prevention
Prevention depends on the disorder causing jaundice. You may not be able to prevent some of the disorders.
However, you can take the steps below to decrease your chance of developing liver disease:
Limit your alcohol intake to no more than two drinks a day for men or one drink a day for women.
Be careful in mixing drugs, especially alcohol, with over-the-counter and prescription medicines.
Avoid exposure to industrial chemicals.
Do not use illegal drugs.
Do not share needles or nasal snorting equipment.
Practice safe sex.
To decrease your risk of hepatitis A, get the hepatitis A vaccine.
To decrease your risk of hepatitis B, get the hepatitis B vaccine.
RESOURCES:

American Liver Foundation

http://www.liverfoundation.org/
American Gastroenterological Association
http://www.gastro.org/
CANADIAN RESOURCES:

Canadian Liver Foundation

http://www.liver.ca/Home.aspx/

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Health Canada
http://www.hc-sc.gc.ca/index-eng.php/
REFERENCES:

American Liver Foundation website. Available at: http://www.liverfoundation.org/ . Accessed July 1, 2009.
Berkow R, Beers M, Fletcher AJ. The Merck Manual of Diagnosis and Therapy. New York, NY: Pocket Books;
1999.
The Columbia Electronic Encyclopedia website. Available at http://www.columbia.edu/cu/cup/cee/cee.html .
Accessed July 1, 2009.
Feldman M. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 8th ed. St. Louis, MO: Mosby; 2005.
Goldman L, Ausiello D, eds. Cecil Textbook of Internal Medicine. 23rd ed. Philadelphia, PA: Saunders; 2008.
Nemours website. Available at: http://www.nemours.org/index.html . Accessed July 1, 2009.

Last reviewed September 2011 by Marcin Chwistek, MD

Last Updated: 9/1/2011

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