Jaundice occurs as a symptom of many disorders. It is a common sign of advanced liver disease. However, it may also be due to a benign or curable problem.

Most of the causes of jaundice can be classified according to where in the body they begin. Jaundice that originates with problems of hemolysis, or the breakdown of red blood cells, begins before blood reaches the liver.

Red blood cells only live for about 120 days before they are broken down into different materials that the body can use for various functions. Heme (the part of the cell that carries iron) is broken down into bilirubin. If red blood cells are broken down into bilirubin too quickly, the liver may be overwhelmed. When this occurs, most of the bilirubin is not eliminated from the bloodstream. This is much less common in adults than in newborn infants.

In rare cases, certain forms of anemia (too few red blood cells), including sickle cell anemia, can result in jaundice. The presence of a large hematoma (collection of red blood cells that occurs outside of the blood vessels) may also cause jaundice. However, these conditions usually occur without jaundice.

Jaundice caused by a specific disease or damage begins in the liver. Problems with the liver are generally the most serious. If the liver is not able to properly process bilirubin, it cannot be removed from the bloodstream.

Nearly any kind of liver damage may inhibit the ability of the liver to process bilirubin. Hepatitis (inflammation of the liver), cirrhosis (scarring of the liver) and liver cancer are major causes of jaundice. Symptoms of these conditions vary, but may include a loss of appetite, nausea, vomiting and fever. Symptoms may occur suddenly or gradually.

Certain medications (e.g., some drugs used to treat the infectious disease tuberculosis) can interfere with the processing of bilirubin in the liver. Because the liver is overwhelmed with the processing of these medications, it cannot handle bilirubin properly.

Jaundice caused by obstructions in the ducts of the biliary system (cholestasis) occurs after bilirubin has been processed in the liver. When a problem impairs the flow of bile, it builds up. Bilirubin is not properly eliminated from the body if the bile does not enter the intestines.

Gallstones are among the most common causes of bile obstruction leading to jaundice. These can get stuck in the bile ducts and block the flow of bile. Stricture (narrowing) of the bile ducts also causes obstruction.

In some cases of pancreatitis (inflammation of the pancreas), the pancreas can swell until it becomes large enough to press against a bile duct. This may cause the duct to narrow or close, resulting in blockage. Pressure that occurs during pregnancy may do the same thing.

Other possible causes of bile obstruction include primary biliary cirrhosis, primary sclerosing cholangitis and biliary, pancreatic or gallbladder cancer. Conditions that cause jaundice due to the obstruction of bile usually result in pale stools and generalized itchiness (pruritus) over the skin surface. They may also cause fever and pain in the upper right part of the abdomen.

There are also some mild, often hereditary conditions that may result in jaundice. Dubin-Johnson syndrome and Rotor’s syndrome generally cause jaundice without any accompanying symptoms. These syndromes tend to develop during adolescence. Gilbert syndrome is a condition characterized by slightly elevated levels of bilirubin in the blood. It tends to cause no symptoms and only rarely results in jaundice. It is generally detected in adolescents or young adults during routine blood tests. Fasting is known to cause a rise in bilirubin in patients with Gilbert syndrome. The bilirubin concentration returns to normal within 24 to 28 hours of resuming a normal diet.

Researchers recently developed a revolutionary “jaundice chip,” which screens for mutations in five separate genes that cause inherited jaundice in children. However, the chip is not commercially available at this time.

The skin may take on a yellow discoloration in a few instances that are not related to jaundice. Carotenoderma is a yellow discoloration concentrated on the palms, soles, forehead and the creases that run from the nose to the corners of the mouth. It causes no problems and results from eating excessive amounts of food that are high in the pigment carotene (e.g., carrots, leafy vegetables, squash, peaches, oranges). The medication quinacrine may also cause a yellow discoloration of the skin and whites of the eyes in some patients.