Jaundice: Types, Causes, Symptoms, and Treatment

Jaundice symptoms, such as yellowing of the skin and eyes, can be concerning and may indicate an underlying health issue. It is essential to understand jaundice for early diagnosis and effective treatment. In this article, we will explore the types, causes, symptoms, and treatments of jaundice to provide you with a comprehensive overview of this condition. Let’s begin by understanding what jaundice is.

What is Jaundice?

Jaundice is a medical condition characterised by the yellowing of the skin, eyes, and other tissues due to an accumulation of bilirubin, a byproduct of red blood cell breakdown. This condition can arise from problems in the production, processing, or excretion of bilirubin. To better understand jaundice, let’s explore the different types.

Types of Jaundice

Jaundice is classified into different types based on its cause and the stage at which bilirubin metabolism is disrupted. Each type has unique characteristics, making it essential to understand their differences for accurate diagnosis and treatment.

1. Pre-Hepatic Jaundice

Prehepatic jaundice occurs when there is an excessive breakdown of red blood cells (RBCs), leading to an overproduction of bilirubin. The liver cannot process the excess bilirubin, causing it to accumulate in the blood.

• Primary Cause: Hemolysis (destruction of RBCs).
• Conditions Associated:
  • Hemolytic anemia
  • Sickle cell anemia
  • Malaria
  • Thalassemia
  • Autoimmune disorders
• Key Indicator: Elevated levels of unconjugated (indirect) bilirubin.

2. Hepatic Jaundice

Hepatic jaundice is caused by damage or dysfunction in the liver cells, affecting their ability to metabolize and excrete bilirubin properly. This can lead to the accumulation of both unconjugated and conjugated bilirubin in the bloodstream.

• Primary Cause: Liver diseases.
• Conditions Associated:
  • Viral hepatitis (A, B, C, D, or E)
  • Alcoholic hepatitis
  • Cirrhosis
  • Liver cancer
  • Genetic disorders (e.g., Gilbert’s syndrome)
• Key Indicator: Mixed elevation of conjugated (direct) and unconjugated (indirect) bilirubin.

3. Post-Hepatic Jaundice

Also known as obstructive jaundice, this type occurs when there is a blockage in the bile ducts, preventing bilirubin from being excreted into the intestines. This leads to a build-up of conjugated (direct) bilirubin in the blood.

• Primary Cause: Obstruction in bile flow.
• Conditions Associated:
  • Gallstones
  • Pancreatic cancer
  • Bile duct strictures
  • Cholangiocarcinoma (bile duct cancer)
  • Parasites like liver flukes
• Key Indicator: Elevated levels of conjugated (direct) bilirubin, often accompanied by pale stools and dark urine.

4. Neonatal Jaundice

This type is specific to newborns, particularly premature babies, due to their immature liver not being fully capable of processing bilirubin. Neonatal jaundice is usually temporary and resolves as the liver matures.

• Primary Cause: Immaturity of the liver.
• Conditions Associated:
  • Physiological jaundice (normal in most newborns).
  • Breastfeeding jaundice.
  • Hemolytic disease of the newborn (Rh or ABO incompatibility).
• Key Indicator: Elevated unconjugated (indirect) bilirubin levels.

5. Inherited Jaundice

Some genetic disorders affect bilirubin metabolism, leading to recurrent or chronic jaundice. These conditions often present mild symptoms but can occasionally lead to complications.

• Primary Cause: Genetic mutations impacting bilirubin processing.
• Conditions Associated:
  • Gilbert’s syndrome: A mild and common inherited disorder causing occasional jaundice.
  • Crigler-Najjar syndrome: A rare, severe condition affecting bilirubin metabolism.
  • Dubin-Johnson syndrome: A disorder that impairs bilirubin excretion, causing a buildup of conjugated bilirubin.
  • Rotor syndrome: Similar to Dubin-Johnson syndrome but less severe.
• Key Indicator: Varies depending on the specific genetic condition.

Summary Table of Jaundice Types

Common Symptoms of Jaundice

If you notice any of the following symptoms, it’s crucial to consult your doctor promptly for an accurate diagnosis and appropriate treatment.

• Yellowing of the skin and the whites of the eyes (scleral icterus)
• Fever and chills
• Abdominal pain
• Dark-coloured urine and pale, clay-coloured stools
• Flu-like symptoms, including fatigue and weakness
• Itchy skin (pruritus)
• Unintended weight loss
• Irritability and confusion
• Excessive drowsiness
• Easy bruising or bleeding
• Blood in vomit (haematemesis)

Causes of Jaundice

Jaundice occurs when bilirubin builds up in the bloodstream, often due to issues with the liver, bile ducts, or blood cells. Here are some common causes:

1. Hepatitis

• Hepatitis is an inflammation of the liver, often caused by viral infections or side effects of certain medicines.
• Hepatitis can lead to an increase in bilirubin levels, causing jaundice (yellowing of the skin and eyes).
• Hepatitis B is a type of viral hepatitis that can cause chronic infection and liver damage.

2. Alcohol-Related Liver Disease

• Alcohol-related liver disease progresses through stages, including fatty liver, alcoholic hepatitis, and cirrhosis. Cirrhosis is the most advanced stage and is most likely to cause jaundice.
• Symptoms include yellowing of the skin and eyes, dark urine, pale stools, itchy skin, and unintentional weight loss.
• Excessive alcohol consumption damages liver function, leading to irreversible scarring (cirrhosis) in advanced stages.

3. Blocked Bile Ducts

• Bile ducts can be blocked by gallstones, cancer, inflammation, or rare liver diseases.
  When bile ducts are blocked, bile cannot reach the small intestine, leading to a buildup of bilirubin and causing jaundice.
• Blocked bile ducts can cause symptoms similar to those of jaundice, including dark urine and pale stools.

4. Pancreatic Cancer

• Pancreatic cancer can block the bile duct, preventing bile from flowing into the intestine.
• Symptoms include jaundice, abdominal pain, bloating, vomiting, dark urine, fatigue, and diarrhoea.
• Pancreatic cancer often affects the liver due to their close proximity and shared bile ducts.

5. Certain Medicines

• Some drugs can cause liver injury or affect bilirubin processing, leading to jaundice.
• Medications that induce liver inflammation or damage liver cells can cause jaundice.
  It’s essential to monitor for signs of jaundice when taking potentially liver-toxic medications.

6. Blood Clots

• Blood clots are not a direct cause of jaundice but can be a symptom of underlying conditions like pancreatic cancer.
• Deep vein thrombosis or blood clots can be an early warning sign of cancer affecting liver and pancreas function.
• Blood clots can exacerbate conditions leading to jaundice by obstructing blood flow to the liver.

7. Haemolytic Anaemias

• Haemolytic anaemias are conditions in which red blood cells are destroyed faster than they can be produced.
• The rapid breakdown of red blood cells increases bilirubin levels, leading to jaundice.
• In addition to jaundice, haemolytic anaemias can cause other symptoms of anaemia, such as fatigue and pale skin.

Diagnosing Jaundice

Proper diagnosis helps determine the underlying cause of jaundice to guide appropriate treatment. Here are some ways jaundice might be diagnosed:

• Blood tests measure bilirubin levels and liver function
• Urinalysis checks for substances related to liver function
• Imaging tests like CT scans, MRI, and ultrasound examine the liver and bile ducts
• Endoscopic procedures visualise the bile ducts and liver
• Biopsy may be done to analyse liver tissue for conditions like cancer

Jaundice Treatment

Treatment focuses on addressing the root cause of jaundice:

• For acute viral hepatitis, jaundice often resolves as the liver heals
• Surgery may be needed to open a blocked bile duct
• Medications like cholestyramine can relieve itching from bile acids
• Phototherapy helps break down bilirubin in newborns but not in adults
• Supportive care manages symptoms like itching, weakness, and appetite loss

Prevention of Jaundice

Reduce your risk of developing jaundice through these preventive measures:

• Avoid excessive alcohol, stop smoking and intravenous drug use
• Maintain a healthy weight and keep cholesterol levels in check
• Practice safe sex and don’t exceed prescribed medication dosages
• Get recommended vaccines before overseas travel
• Be cautious with herbal supplements as they may harm the liver

When To See the Doctor

If you or your baby exhibit symptoms of jaundice, it is crucial to seek medical attention promptly. Adults should consult a doctor immediately if they experience severe abdominal pain, changes in mental function, blood in stool or vomit, fever, or easy bruising or bleeding. For newborns, contact your paediatrician if the jaundice worsens, the whites of the eyes turn yellow, the baby feeds poorly, or shows signs of dehydration or abnormal behaviour. Timely diagnosis and treatment can prevent serious complications associated with jaundice.

Conclusion

Jaundice is a condition characterised by the yellowing of the skin, eyes, and mucous membranes due to elevated bilirubin levels. It can result from various causes, including liver injury, red blood cell breakdown, and blockage of bile ducts. While jaundice in newborns is common and often resolves on its own, monitoring bilirubin levels is essential to prevent serious complications. For adults, jaundice usually indicates an underlying medical condition that requires treatment. Early diagnosis and appropriate management can significantly improve outcomes and prevent long-term health issues associated with jaundice.

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