Jaundice is a term for the skin developing a yellow hue. It occurs from an accumulation of a chemical called bilirubin in the bloodstream. It may be caused by a variety of conditions, and can often be difficult to diagnose, as issues with red blood cells and liver cells can both lead to jaundice.
- Hepatitis and gallstones are possible causes
- Many underlying conditions lead to an issue metabolising bilirubin
- Treatment is non-specific; it involves treating the underlying condition
If you are concerned about jaundice, you can speak to one of our GMC-registered clinicians via our online video consultation service. They can advise you on your symptoms and treatment options, and issue prescriptions and referrals for treatment, where appropriate. Our clinicians are available from 9.30am-4.30pm, Monday to Friday.
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What causes jaundice?
Causes of jaundice can be split into four areas: Conditions related to red blood cells, liver cells, bile ducts in the liver and common bile ducts.
Typically, unconjugated bilirubin is carried through the liver and then altered by liver cells, becoming conjugated bilirubin. This is then passed through liver bile ducts into the common bile ducts, before reaching the gallbladder, which stores the bile. The body can then excrete the bilirubin in faeces.
Jaundice is caused by a buildup of bilirubin somewhere in this process.
Red blood cells
When red blood cells break down, they turn into bilirubin. Various conditions can lead to this:
- Genetic disorders, such as haemolytic anaemias, can lead to jaundice; it’s a rare condition in which red blood cells are destroyed, resulting in a deficiency of them.
- Other red blood cell defects can also have an effect, such as sickle cell anaemia and spherocytosis (a hereditary condition where the red blood cells are abnormally shaped).
Difficulties can occur with the liver cells as a consequence of a variety of conditions. Some conditions may result in the liver cells struggling to take bilirubin on board, which increases its presence in the bloodstream. Other conditions can impact on the enzymes in the liver that process the bilirubin, or cause problems with the way in which the cells pass the bilirubin to the bile ducts.
Conditions that may have an effect on liver cells include:
- Hepatitis -
- Hepatitis A, B, C, D and E from a viral infection can all lead to jaundice.
- Autoimmune hepatitis can result in the liver becoming chronically inflamed; it’s unclear why this happens.
- Alcoholic hepatitis is caused by years of drinking too much alcohol, and often leads to liver disease.
- Cirrhosis is a condition where liver tissue turns into scar tissue, which inhibits liver function over time.
The bile ducts
Issues with the common bile duct can lead to bilirubin spilling into the bloodstream (obstructive jaundice). Examples of conditions relating to the bile ducts which may cause jaundice include:
- Gallstones: Gallstones occur when bile develops into stones; most of them are asymptomatic and will not have an effect, but sometimes complications such as jaundice can manifest.
- Pancreatitis: Inflammation of the pancreas can block the flow of fluid bile
- Biliary atresia: A condition where the bile ducts become inflamed, resulting in scarring. The ducts may also narrow.
Diagnosing the cause of jaundice
In diagnosing jaundice, a doctor will take into account someone’s medical history (particularly symptoms of other conditions), the person’s appearance (having conducted an examination) and the results of some investigations.
A doctor will ask if any sudden pain has been experienced with the jaundice which could indicate the presence of a condition such as gallstones. They will also ask about symptoms such as a loss of weight and appetite, which can be an indication of hepatitis, particularly if the person has recently been to a country where it is endemic.
In people who become jaundiced, the skin can be itchy before it turns yellow. The colour of urine and stools can also vary in the event of obstructive jaundice, where urine is darker and stools are paler before the jaundice presents itself. A doctor will ask if either of these symptoms have occurred, as well as seeking clarification as to any potential alcohol consumption and drug abuse.
In terms of an examination, a doctor will look closely at the whites of the eyes, as they are the areas of tissue that turn yellow initially after developing jaundice. Mild levels of bilirubin can sometimes mean that the whites of the eyes are the only area of the body that is yellow, whereas in cases of higher levels of bilirubin, more skin turns yellow.
A doctor will also look for indications of liver disease by examining the stomach. A tenderness and hardening of the liver can be detected with liver disease, and also with cirrhosis and viral hepatitis.
There are many tests that a doctor may conduct for jaundice, and they are vital in order to establish the underlying condition. Initially a doctor will want to take the following tests:
- Full blood count - in order to identify if there is an infection or haemolysis.
- Liver function - a series of tests measuring the levels of certain chemicals in the liver
- Amylase - which can show if there is pancreatitis
- Urinalysis - a dipstick can show the levels of conjugated bilirubin
- Imaging - Ultrasound and MRI can show if there are any biliary obstructions or gallstones
If you are experiencing symptoms of jaundice and would like to speak to a doctor online, our clinicians are available via our video consultation service, from 9.30am-4.30pm, five days a week.
How is jaundice treated?
Jaundice usually requires referral to primary care, as there are a number of serious conditions associated with it.
A doctor typically refers someone with jaundice to hospital for same-day referral if they are systemically unwell, have a fever, are dehydrated or are particularly frail.
In cases where jaundice does not warrant urgent referral, people may be referred to specialists to help identify the specific underlying causes. For example, a person with suspected hepatitis or liver disease should be referred to a gastroenterologist.
If your skin has already turned yellow in some areas, it’s advisable to make an appointment with your GP urgently. If you are seeking advice online about jaundice, our GPhC-registered clinicians are available via our video consultation service. They can discuss your symptoms and treatment options with you, and refer you to specialists for treatment, where suitable. You can book an appointment to speak with one of our clinicians between 9.30am and 4.30pm, Monday to Friday.
How long is it normal to have jaundice for?
There is no specific window of time in which jaundice is present for; it depends on how long the underlying condition takes to resolve.
Severe conditions such as liver disease can result in jaundice enduring for several months, whereas jaundice from gallstones may disappear once the gallstones have been removed.
Is jaundice serious?
Although jaundice is not particularly common, it can often be a symptom of a serious condition such as hepatitis or liver disease.
There are a few warning signs that you should look out for with jaundice. If it’s accompanied by a fever or severe abdominal pain, you should seek urgent medical attention.
Can I get treatment for jaundice?
There is no specific treatment available for jaundice; the underlying condition has to be treated for it to resolve. There are hereditary conditions which lead to jaundice that cannot be treated, such as sickle cell anaemia.
How can I prevent jaundice?
Jaundice can in some cases be prevented. Avoiding excessive drinking can make jaundice and the development of alcohol-related liver disease less likely. There are also vaccines available for hepatitis A and B.
Can I speak to a doctor about jaundice?
If you would like to speak to a doctor online about jaundice, you can do so using our video consultation service. One of our GMC-registered clinicians can provide input on symptoms and treatment, and prescriptions and referrals to specialists, where appropriate. They are available for consultation between 9.30am and 4.30pm, five days a week.
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