Jaundice is not a disease but rather a symptom that can occur in many different diseases. So, its treatment depends upon its cause’.

The term ‘jaundice’, derived from the French language (meaning yellow), refers to the yellowish discoloration of skin and sclera caused by the elevation of serum bilirubin level in the blood. Bilirubin is a yellowish pigment produced from the breakdown of hemoglobin and red blood cells (RBCs).

The normal serum levels of bilirubin are between 0.2 mg/dL and 1.2 mg/dL; however, when the serum bilirubin level exceeds 3 mg per dL (51.3 µmol per L) or higher, it represents the clinical presentation of jaundice as scleral icterus.

The continuous elevation of serum bilirubin levels in the blood will progressively discolor the skin from lemon yellow to apple green.

The skin discoloration depends on multiple factors, including how long the episode lasts and whether it results from predominantly direct (conjugated) or indirect (unconjugated) hyperbilirubinemia.

The pervasiveness of jaundice and its related causes vary among different age groups of the patient population;

  • It is mainly found that around 20% of newborns are diagnosed with the symptoms of jaundice due to immature hepatic conjugation process, congenital disorders, overproduction from hemolysis, defective bilirubin uptake, defects in conjugation, and Hepatitis A. Among all mentioned reasons, Hepatitis A is observed as the most common and afflicting cause of jaundice among infants and children.
  • While, in the elderly population, jaundice is caused by intrahepatic disorders, including viral hepatitis, alcoholic liver disease, drug-induced liver injury, gallstone disease, hemolysis, and malignancy.

Here, it is essential to highlight that the most prevalent medical condition, ‘jaundice’ found in newborn babies, is usually cleared up without treatment. While, for adults, if the causes of jaundice are not timely investigated and treated, it can lead to damage failure.

Several symptoms are most commonly found in jaundice patients of different age groups:

  • Abdominal pain
  • Extreme weakness
  • Headache and fever, including chills or cold sweats
  • Loss of appetite
  • Feeling itchy
  • Dark urine or pale stool
  • Abnormal weight loss
  • Severe constipation
  • Nausea
  • Yellow discoloration of the eyes, tongue, skin, and urine
  • Dull pain in the liver region

Types of Jaundice:

Following are the main types of the jaundice

  • Based on source/placement (where it happen within the liver’s process of taking in and filtering out bilirubin):
  • Pre-hepatic Jaundice (before the liver): Pre-hepatic jaundice causes the excessive breakdown of red blood cells, which crushes the liver’s ability to conjugate bilirubin.
  • Hepatic Jaundice (in the liver): Hepatic jaundice occurs due to dysfunction of the hepatic cells in which the liver loses the ability to conjugate bilirubin.
  • Post-hepatic Jaundice (after the liver) refers to the obstruction of biliary drainage.
  • Based on the patient’s age
  • Neonatal Jaundice: It is common in newborn babies that mainly occur due to underdeveloped or improper functioning of the liver. There is no need to worry about neonatal jaundice in most cases as it requires no treatment and usually disappears after a week.
  • Jaundice in adults and other children: Jaundice in adults and other children is mainly characterized as a sign of a health problem that needs to be cured timely and adequately.
  • Hepatocellular Jaundice: It is considered the most common type of jaundice in adults and other children. It occurs when bilirubin is unable to leave the liver cells and cannot be removed from the body by the kidneys. It is caused by liver failure, liver disease, and hepatitis or using specific medication.
  • Haemolytic Jaundice: It causes the overproduction of bilirubin, anemia, or a metabolism problem.
  • Obstructive Jaundice: It occurs when there is an obstruction (blockage) in the bile duct, which prevents bilirubin from leaving the liver. Gallstone, a tumor, or a cyst in the bile duct or pancreas are reported as the major causes of obstructive jaundice.

Causes of Jaundice:

The extensive review of medical literature highlighted the various major causes of jaundice;

  • Increased production of bilirubin
  • Acute inflammation of the liver
  • Chronic liver diseases
  • Infiltrative diseases of the liver (when the liver is filled with unassociated-cells or substances)
  • Inflammation of the bile ducts
  • Blockage of the bile ducts
  • Drugs
  • Genetic disorders
  • Developmental abnormalities of bile ducts
  • Jaundice of pregnancy
  • Cholestasis of pregnancy (occurs in the third trimester of pregnancy accompanied by itching)
  • Acute fatty liver of pregnancy

Investigation of Jaundice:

The evaluation and diagnosis of jaundice rely on the patient’s history, physical examination, and medical examination/laboratory test.

  • History: A thorough questioning and inquiry are required from the patient about personal or family history, drug usage, a risk factor for hepatitis, HIV status, presence of coexisting jaundice symptoms, duration of jaundice, ulcerative colitis patient, or any other common symptoms of jaundice.
  • Physical Examination: It is essential to thoroughly examine the body habitus, nutritional status, and entire patient’s body, especially skin, abdomen, upper body parts, urine color, etc.  
  • Medical Examination/Laboratory Tests: Additional testing is usually required to determine the underlying cause of jaundice.
  • Blood Test: Initially, a complete blood count (CBC), liver function tests (including a bilirubin level), lipase/amylase level to detect inflammation of the pancreas (pancreatitis), and electrolytes panel, and pregnancy test (for women) are required. Additional blood test depends upon the results of an initial blood test.
  • Urinalysis: An urine analysis is also a very useful test in screening jaundice.
  • Imaging Studies: Ultrasound, CT scan, HIDA scan, MRI, and liver biopsy can be used to diagnose the symptoms of jaundice if the above-mentioned test couldn’t diagnose it.

Treatment/Management:

 The definite treatment of jaundice depends upon its cause, nature, intensity, and stage. It is essential to monitor the complications caused by jaundice and recommend treatment/medication accordingly. There are several commonly used treatments to address the particular situation;

  • Expectant management (watchful waiting) at home with rest
  • Medical treatment with intravenous fluids, medications, antibiotics, or blood transfusions
  • Discontinuation of drug/toxin
  • In some instances of newborn jaundice, exposing the baby to unique colored lights
  • Surgical treatment

References:

  • Evers, B. M., Mattox, K., Cofer, J. B., McMasters, K., Herndon, D. N., Britt, L. D., & Eberlein, T. Officers For 2013-2014.
  • Fargo, M. V., Grogan, S. P., & Saguil, A. (2017). Evaluation of jaundice in adults. American family physician95(3), 164-168.
  • https://teachmesurgery.com/hpb/presentations/jaundice/ retrieved on 29th October 2021.
  • https://www.healthline.com/health/jaundice-types#neonatal-jaundice retrieved on 29th October 2021.
  • Joseph, A., & Samant, H. (2021). Continuing Education Activity.
  • Joseph, A., & Samant, H. (2021). Jaundice. Stat Pearls [Internet].
  • Poduri, C. D. (2016). Jaundice: A brief historical perspective. Apollo Medicine13(2), 76-79.
  • Walker, H. K., Hall, W. D., & Hurst, J. W. (1990). Clinical methods: the history, physical, and laboratory examinations.
  • Zhang, J., & Zheng, S. (2020). Clinical features and differential diagnosis of hemolytic jaundice. Journal of Clinical Hepatology, 1423-1427.

 

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