Jaundice is a yellow discoloration that affects the skin, whites of the eyes and mucous membranes (e.g., inside the mouth). Although jaundice is not typically dangerous in itself, it may signify the presence of an underlying condition. For example, jaundice is a common sign of advanced liver disease. Typically, jaundice develops after a condition has been present for a while. Other symptoms of the disorder tend to occur before jaundice is noticeable.

Jaundice is the deposition of pigments in the skin that results from high levels of the yellow pigment bilirubin in the blood. Bilirubin is a product of the natural breakdown of red blood cells. The bloodstream carries the bilirubin to the liver, where it is processed and used as a component of bile. The bile is either secreted through bile ducts directly into the small intestine to help with digestion or stored in the gallbladder until it is needed. Some of the bile that has been secreted into the intestines is reabsorbed. Much of the bilirubin, however, is eliminated from the body through bowel movements. If bilirubin is not properly eliminated from the body, it builds up in the blood and body tissues, resulting in jaundice. In addition to jaundice, high levels of bilirubin in the blood can also cause generalized itchiness (pruritus).

Jaundice may result from liver conditions such as hepatitis and cirrhosis. Obstruction of the bile ducts (often caused by gallstones) can also cause jaundice.

Jaundice is common in newborn infants. The newborn liver is often not mature enough to process bilirubin. Because the liver is overwhelmed, bilirubin is not removed from the bloodstream fast enough and is deposited in the tissues of the body. In most cases, infant jaundice causes no harm and goes away in a week or two. However, it must still be monitored because it can progress to severe jaundice with serious complications.

Jaundice is a yellow discoloration in the skin, whites of the eyes and mucous membranes (e.g., inside the mouth). It results from high levels of the yellow pigment bilirubin in the blood. Jaundice is a sign of many disorders, particularly those that affect the liver or the flow of bile.

Red blood cells are constantly being 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. The bloodstream carries the bilirubin to the liver, where it is processed and used as a component of bile.

Bile has many functions. It assists in the digestion and absorption of fats and helps eliminate certain waste products from the body, including bilirubin and excess cholesterol. Bile also helps the body absorb cholesterol, fats and fat-soluble vitamins. In addition, it stimulates the secretion of water by the large intestine to help move contents through the digestive system.

Bile leaves the liver through the hepatic duct (duct connected to the liver) and travels to and from the gallbladder through the cystic duct. The junction of the cystic and hepatic ducts forms the common bile duct, which transports bile to the first portion of the small intestine (called the duodenum).

Some bile flows directly from the liver into the duodenum. However, about half is stored in the gallbladder. When food enters the duodenum after a meal, nerve signals are sent to the gallbladder causing it to contract and release more bile into the duodenum. The food is digested and eventually eliminated by the large intestine. It is the bilirubin in the bile that gives stool its brown color.

There are three primary ways in which bilirubin builds up in the bloodstream:

• Conditions directly affecting the liver. These can interfere with its ability to process bilirubin. Cirrhosis and hepatitis are examples of liver conditions that can cause jaundice.
  
  
• Obstruction of the bile ducts (cholestasis). Gallstones are the most common cause of the buildup of bilirubin due to obstruction.
  
  
• The rapid breakdown of red blood cells (hemolysis). The excess level of bilirubin can overwhelm the liver. This is comparatively rare in adults but more common in newborns.

Any excess bilirubin that is not properly eliminated is eventually deposited in the tissues of the body. This is visible as the yellow discoloration called jaundice.

Typically, jaundice develops after a condition has been present for a while. Other symptoms of the disorder tend to occur before jaundice is noticeable.

Other symptoms that occur along with jaundice generally depend on the underlying cause of the jaundice. However, some are so common that they may be expected when the skin discoloration occurs. These include:

• Generalized itching (pruritus). High levels of bilirubin in the blood often cause itching all over the body. This itching can be merely annoying or it can be severe enough to interfere with sleep or daily activities.
  
  
• Urine discoloration. The urine is also frequently affected in jaundiced individuals. When levels of bilirubin are high, the pigment may be expelled through the kidneys. This frequently results in dark brown urine. The color may even be dark enough to resemble the color of tea or cola.
  
  
• Stool discoloration. When jaundice occurs because of an obstruction in a major bile duct (cholestasis), bile is not secreted into the intestines in sufficient amounts. This tends to result in light, pale yellow or white stools. These stools are also greasy and oily due to high amounts of fat.

Although jaundice in adults may be a warning sign of a more serious condition, it is very common and frequently harmless in infants. Jaundice often develops in the first few days after birth. It is generally first visible in the face and gradually progresses over the chest, arms and, eventually, legs.

The newborn liver is often not mature enough to handle the processing of bilirubin. Because the liver is overwhelmed, bilirubin is not removed from the bloodstream fast enough and is deposited in the tissues of the body. Also, the breakdown of red blood cells tends to occur more rapidly in newborns. In some cases, the infant is bruised during childbirth or has a blood type that is incompatible with that of the mother. This causes the rapid breakdown of red blood cells to increase even more, further overwhelming the liver.

In most cases, infant jaundice causes no harm and goes away in a week or two. However, the symptom must be monitored because on rare occasions high levels of bilirubin can cause serious complications. One serious complication called kernicterus occurs when extremely high levels of bilirubin cause brain damage. Kernicterus may result in a number of problems, including deafness, severe developmental disabilities and one form of cerebral palsy.

An infant’s bilirubin levels may be measured through blood tests or with a bilirubinometer. This is a device that measures bilirubin levels through the skin using a special light without the need of a blood sample.

Physicians generally recommend that infants with jaundice receive frequent feedings. This provides them with plenty of calories and encourages more bowel movements, which help to reduce bilirubin levels. Mothers who breastfeed may be directed to temporarily supplement or replace breast milk with formula for a few days. This may help lower bilirubin levels quickly. Breastfeeding can be resumed after the jaundice has been treated.

Phototherapy (light therapy) may also help. This uses special ultraviolet light to change bilirubin into a form that is easier for the infant’s body to expel. In some cases, a fiber-optic blanket of light may be used to administer this treatment. Recent research indicates that infants who receive phototherapy for jaundice may be more likely to develop moles and skin cancer later in life. Therefore, infants who receive this therapy may benefit from continued monitoring for skin conditions.

Severe jaundice, particularly when due to incompatibility between the mother and infant’s blood, may require blood transfusions.

Because elevated bilirubin levels can cause brain damage, there has been some concern that infants who receive treatment for jaundice could sustain lasting neurological damage. However, recent research indicates that this is not the case.

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.

The treatment and prevention of jaundice generally relies on the underlying cause. If the disorder that causes jaundice is prevented, jaundice is prevented. Similarly, if a condition that causes jaundice in later stages (e.g., liver disease) is treated early on, jaundice is usually prevented.

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following jaundice-related questions:

1. What seems to have caused my jaundice?
   
   
2. What diagnostic procedures are best to determine what is causing my jaundice?
   
   
3. Could any of my medications be responsible for my jaundice?
   
   
4. Is my jaundice associated with a problem with my liver?
   
   
5. How serious is the condition that caused my jaundice?
   
   
6. What other symptoms may I expect to develop?
   
   
7. What are the treatment options for the condition that caused my jaundice?
   
   
8. How long may my jaundice last when the condition that caused it is treated?
   
   
9. Once my jaundice is treated, how may I prevent a recurrence of the condition that caused it?
   
   
10. What are the chances that my children will also develop jaundice?