What Causes Jaundice?

Medically known as icterus, jaundice occurs when the skin or whites of the eyes take on a yellowish tinge. For some patients with jaundice, a slightly greenish tinge may be present. Jaundice develops when the body cannot properly process bilirubin, a yellowish-orange substance in the blood. Although jaundice is more common in infants than in adults, it can develop at any age as a result of cancer, medications, and liver issues. Many patients with jaundice may also notice their skin feels very itchy.

Since jaundice could be a sign of a serious medical issue, patients who notice any unusual skin itching or changes to their skin color should see a doctor promptly. The doctor will assess jaundice by examining the skin and whites of the eyes. They might also need to carry out a physical examination of the abdomen to check for potential liver issues or masses. Blood tests will be ordered to check the patient's bilirubin levels, and a non-invasive device called a transcutaneous bilirubin meter may be used to measure bilirubin levels with a light placed on the skin. Infants with jaundice are typically treated with intravenous immunoglobulin, light therapy, or exchange transfusion. In adults, jaundice does not normally require treatment, and it often resolves once treatment for the underlying cause has been completed.

The conditions outlined below are some of the most common causes of jaundice.

Hyperbilirubinemia

Hyperbilirubinemia refers to elevated levels of bilirubin. This condition is considered to be the primary cause of jaundice, particularly in infants. In the first few days of an infant's life, they naturally produce more bilirubin than an adult would. This is because bilirubin is needed to break down red blood cells, and infants produce these at a much higher rate than adults do. They also have a faster rate of red blood cell breakdown than adults. While the liver is responsible for filtering bilirubin from the bloodstream into the intestinal tract, the liver of a newborn is underdeveloped, and it cannot filter bilirubin fast enough. Thus, the hyperbilirubinemia produces physiologic jaundice, a condition that typically appears on the second or third day of a newborn's life. Infants born before thirty-eight weeks have a higher risk of developing hyperbilirubinemia compared to those born at forty weeks.

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Bile Duct Obstruction Or Inflammation

Adults may develop jaundice as a result of bile duct obstruction or inflammation. Also known as the biliary ducts, the bile ducts are responsible for transporting bile (a yellow-greenish fluid manufactured by the liver to digest fats) from the liver and the gallbladder to the duodenum, an area of the small intestine. Inflammation of the biliary ducts could be caused by tumors or infections, and these could lead to obstruction of the ducts. Gallstones, cysts, abdominal injuries, hepatitis, and certain cancers may cause biliary duct blockages as well, with gallstones being the most common cause.

Patients with a bile duct obstruction or inflammation could experience jaundice, fever, unintended weight loss, dark urine, and pain in the upper right quadrant of the abdomen. Nausea, vomiting, and light-colored stools may be present as well. To assess a possible bile duct issue, doctors will perform blood tests, ultrasounds, and a biliary radionuclide scan. Patients might be asked to have MRI scans and cholangiography studies (x-rays of the bile ducts). If a bile duct obstruction is identified, treatment depends on the underlying cause. For example, obstructions due to gallstones may need to be treated with an operation to remove the stones or the gallbladder.

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Hemolytic Anemia

Red blood cells are produced by the bone marrow in the body. If these cells are destroyed more quickly than they can be produced, this results in an imbalance known as hemolytic anemia. This condition can be caused by infections, leukemia, lymphoma, and autoimmune conditions, and it is a potential side effect of some medications, including acetaminophen, ibuprofen, and penicillin. In addition to jaundice, hemolytic anemia patients could experience fatigue, heart murmurs, dizziness, rapid heart rate, and an enlargement of the spleen or liver. Doctors will check for hemolytic anemia by performing a physical examination of the spleen and liver to measure their size. Blood tests will be performed to check the patient's liver function and levels of hemoglobin, reticulocytes, and bilirubin. Patients with hemolytic anemia may be given a transfusion of red blood cells, and individuals who have an underlying autoimmune condition might need to have intravenous immunoglobulin or immunosuppressants. In cases of severe hemolytic anemia that do not respond to conservative treatment options, doctors may recommend the patient consider having their spleen removed. This can reduce the speed at which red blood cells are destroyed.

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Cirrhosis

Cirrhosis is a form of severe scarring of the liver that may develop in patients with hepatitis and other liver diseases. Individuals who consume excessive amounts of alcohol may also develop cirrhosis. Generally, the condition does not produce any symptoms until it is very advanced, and when symptoms do appear, they often include fatigue, jaundice, swelling in the legs and feet, an accumulation of fluid in the abdomen, and easy bleeding or bruising. Some patients might notice redness on the palms of the hands, and loss of appetite is also common. Many cases of cirrhosis are detected at routine physical examinations and through routine blood tests performed for other reasons. Doctors may also need to perform ultrasounds, MRI scans, and magnetic resonance elastography to properly investigate cirrhosis. A liver biopsy can be useful in determining the severity of a patient's cirrhosis. In the early stages of this condition, the patient may be able to reduce liver damage by receiving treatment for the underlying cause. For example, patients can take oral medicines to treat hepatitis, and individuals with non-alcoholic fatty liver disease might be able to improve their liver health by maintaining a healthy weight and controlling their blood sugar levels. In the later stages of cirrhosis, patients might need to receive hospital treatment.

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Gallbladder Cancer

Gallbladder cancer is an uncommon form of cancer that begins in the gallbladder. This type of cancer generally produces no symptoms until it reaches an advanced stage, though possible symptoms of gallbladder cancer include jaundice, unintended weight loss, fever, pain in the upper right side of the abdomen, and bloating. Gallbladder cancer occurs more frequently in female patients, and individuals who have had gallstones are at an increased risk of this cancer. To detect gallbladder cancer, doctors will perform MRI or CT scans, and liver function tests may be needed. In addition, some patients might be asked to have exploratory surgery or imaging studies of the bile ducts. If cancer is found in the early stages, it may be curable with an operation to remove the gallbladder, possibly along with a portion of the liver. Chemotherapy, radiation, and clinical trials may be especially helpful for patients with more advanced gallbladder cancer, and operations to remove bile duct obstructions may help patients with this cancer feel more comfortable.