Jaundice: MedlinePlus Medical Encyclopedia Too many red blood cells are dying or breaking down and going to the liver The liver is overloaded or damaged The bilirubin from the liver is unable to properly move into the digestive tract Jaundice is often a sign of a problem with the liver, gallbladder, or pancreas. Things that can cause jaundice include: Infections Use of certain drugs Cancer Blood disorders, gallstones, birth defects and a number of other medical conditions can lead to jaundice. For more information on the causes of jaundice see: Jaundice causes Symptoms Jaundice may appear suddenly or develop slowly over time. Symptoms of jaundice commonly include: Yellow skin and the white part of the eyes (sclera) -- when jaundice is more severe, these areas may look brown Yellow color inside the mouth Dark or brown-colored urine Pale or clay-colored stools Note: If the whites of your eyes are not yellow, you may not have jaundice. Your skin can turn a yellow-to-orange color if you eat a lot of beta carotene, the orange pigment in carrots.

Other symptoms depend on the disorder causing the jaundice: Cancers may produce no symptoms, or there may be fatigue, weight loss, or other symptoms Hepatitis may produce nausea, vomiting, fatigue, or other symptoms Exams and Tests The health care provider will perform a physical exam. This may show liver swelling. A bilirubin blood test will be done. Other tests may include: Hepatitis virus panel to look for infection of the liver Liver function tests to determine how well the liver is working Complete blood count to check for low blood count or anemia Jaundice - Causes, Symptoms, Treatment, Diagnosis - Canada.com Health Column The Facts Jaundice is a symptom of many medical problems but it is most often associated with conditions of the liver or the gallbladder. Jaundice causes yellow skin and eyes because of an excess amount of the bile pigment bilirubin in the fat layer under the skin. Either the body is producing too much, or it's not getting rid of it fast enough. In addition to being caused by problems with the liver, jaundice can also occur among newborns, particularly premature babies.

Jaundice that occurs at the time of birth generally disappears within days, but some babies require phototherapy treatment (special lights that help break down bilirubin). In this case, the yellowing of the skin is not due to liver or gallbladder disease. Instead, jaundice is caused by the fact that fetuses have a different kind of red blood cell than adults. They are just getting rid of these cells around the time of birth, which releases a lot of bilirubin. Newborns also temporarily lack sufficient amounts of the enzymes that break down bilirubin. With time, the liver cells mature and are able to rid the body of excess bilirubin, and the jaundice will disappear. Causes Normally, large amounts of blood flow each minute through the liver, which may be thought of as the body's chemical processing plant. The liver breaks down old, inefficient red blood cells in a process called hemolysis. This releases large amounts of bilirubin. The liver also manufactures the other components of bile. Bile is a greenish-yellow fluid secreted by the liver that contains cholesterol, bile salts, and waste products such as bilirubin.

The bilirubin leaves the liver via the bile ducts to be stored in the gallbladder directly underneath. It's then slowly released into the intestine from the gallbladder. It helps digest food in the intestine and exits the body in the stool. Too much bilirubin can be toxic and can cause jaundice. Therefore, it's important to eliminate it from the body as fast as it's produced. There are three basic ways this process can go wrong: The liver itself can be temporarily or permanently damaged, reducing its ability to break down bilirubin (mix it with bile) and move it into the gallbladder. The gallbladder or its bile ducts can become blocked, preventing excretion of bilirubin into the intestine. Bilirubin will then back up into the liver and then into the bloodstream. Any condition that leads to very rapid destruction of red blood cells can create too much bilirubin for even a healthy liver to handle. Again, the excess is carried into the bloodstream. Some causes of jaundice due to poor liver function include: viral hepatitis: Hepatitis A, B, C, D, and E can all cause temporary liver inflammation.

Types B and C can also cause chronic, lifelong inflammation. medication-induced hepatitis: This may be caused by alcohol, erythromycin*, methotrexate, amiodarone, statins (e.g., lovastatin, pravastatin, rosuvastatin), nitrofurantoin, testosterone, oral contraceptives, acetaminophen, and many other medications. autoimmune hepatitis: In this condition, the body's immune system attacks its own liver cells. Autoimmune hepatitis is more common in people and families with other autoimmune diseases, such as lupus, thyroid disease, diabetes, or ulcerative colitis. Primary biliary cirrhosis is another autoimmune condition of the liver and involves inflammation of the bile ducts. alcoholic liver disease: This involves damage to the liver caused by excessive, long-term consumption of alcohol. Gilbert's syndrome: This harmless inherited condition is quite common, affecting about 2% of the population. Minor defects in the liver's metabolism of bilirubin cause jaundice to appear in times of stress, exercise, hunger, or infection.

Some causes of jaundice due to obstruction (blockage) include: gallstones: Formed in the gallbladder, gallstones can block the bile ducts, preventing bile (and bilirubin) from reaching the intestine. Sometimes, the bile ducts may become infected and inflamed. cholestasis of pregnancy: This problem can be caused by genetic or hormonal factors. It usually causes severe itching and rarely, jaundice. tumours: These may be in the liver, pancreas, or gallbladder. They are occasionally responsible for obstruction. Some causes due to excessive red blood cell destruction (hemolysis): malaria: The liver destroys red blood cells infected with the parasite. Hemolytic anemia: This includes conditions such as sickle cell disease and thalassemia. It may also be an autoimmune condition. newborn jaundice: This condition is found in many newborn babies. Symptoms and Complications When you are jaundiced, your skin and the whites of your eyes are yellow. Sometimes, people who eat a lot of carrots or beta-carotene tablets take on a yellowish colour.

This is called carotenemia, and can be easily distinguished from jaundice because the whites of the eyes don't turn yellow. Other symptoms depend on the cause of jaundice. If a fever or flu-like illness comes before jaundice, it's usually a sign of a viral hepatitis infection. Brown urine, common in hepatitis, is generally a sign of poor liver function or increased red blood cell destruction. The body is trying to get rid of excess bilirubin in the urine. Pale, white, or clay-coloured stool, on the other hand, is an indicator of obstruction in the gallbladder or bile ducts. Many people with obstruction due to gallstones experience abdominal pain, while those with obstruction due to tumours usually have painless jaundice. Jaundice itself is unlikely to hurt you unless the bilirubin reaches very high concentrations. It is a sign, however, of an underlying problem. There are too many possible causes of jaundice to attempt diagnosis at home. You should see a doctor if you think you have jaundice. Making the Diagnosis Your doctor will take a medical history and perform a physical exam.

Your doctor will ask how suddenly the jaundice came on, what other symptoms accompanied it, and how the stool and urine look. A blood sample will also be taken and checked for hepatitis virus antibodies, abnormal red blood cells, bilirubin levels, and various other substances that give clues about liver function. Your doctor may also order other tests such as an ultrasound or biopsy to determine the cause of jaundice. Treatment and Prevention There's no treatment for jaundice as such, since it's not a disease but a sign of a medical problem. The approach is to treat the underlying cause, if possible. Some of the medical problems that cause jaundice are curable, like malaria. Others, like thalassemia, are treatable. Many, like hepatitis A, newborn jaundice, or cholestasis of pregnancy, aren't curable but go away on their own. Usually treatment is unnecessary. Conditions like cirrhosis and chronic hepatitis are lifelong problems that may cause permanent or recurring jaundice. Some types of cancer can cause jaundice and should be investigated by a physician as early as possible, since early detection and treatment can improve survival.

Many of these diseases are inherited or autoimmune conditions that we don't know how to prevent. People can, however, do something about the two most common causes of jaundice - viral hepatitis and alcoholic liver disease. There are vaccines against hepatitis A and B (although, unfortunately, not against type C). The hepatitis B vaccine can protect you against lifelong complications of this disease. People suffering from alcoholism can help reduce their risk of alcoholic liver disease by seeking treatment for their condition. More on Body and Health Jaundice: Causes, Symptoms, and Treatments - Medical News Today Jaundice: Causes, Symptoms, and Treatments Written by Caroline GillottReviewed by University of Illinois-Chicago, School of Medicine 4 31 Jaundice, also known as icterus, is a term used to describe a yellowish tinge to the skin and sclerae (the white part of the eye) that is caused by an excess of bilirubin in the blood (hyperbilirubinemia). Body fluids may also be yellow. The color of the skin and sclerae varies depending on levels of bilirubin; mildly elevated levels display yellow skin and sclerae, while highly elevated levels display brown.

In this article, we will discuss what jaundice is, why it happens, and how it is diagnosed and treated. Contents of this article: Fast facts on jaundice Here are some key points about jaundice. More detail and supporting information is in the main article. Jaundice is caused by a build up of bilirubin Jaundice can be caused by a number of conditions, including an inflamed liver and an obstructed bile duct Symptoms include a yellow tinge to the skin and whites of the eyes, dark urine, and itchiness Diagnosis of jaundice can involve a range of tests What is jaundice? A yellow tinge to the whites of the eyes is a common symptom of jaundice Bilirubin (bil-ih-ROO-bin) is a yellow-colored substance that is responsible for the yellowing of the skin and sclerae in jaundice. Bilirubin is a waste product that remains in the bloodstream after iron is removed from hemoglobin in red blood cells. When there is an excess of bilirubin, it can leak out into surrounding tissues, saturating them with this yellow substance.

Bilirubin that is circulating freely in the blood is called unconjugated bilirubin. One of the liver's functions is to filter out waste, such as bilirubin, from the blood. Once bilirubin is in the liver, other chemicals are latched on to it, creating a substance called conjugated bilirubin, which is secreted in bile (a digestive juice released by the liver) and then excreted. A product of bilirubin is what gives feces its brown color. Causes of jaundice Jaundice most often occurs as a result of an underlying disorder that either causes overproduction of bilirubin or prevents the liver from disposing of it, both of which result in bilirubin being deposited in tissues. Some underlying conditions that may cause jaundice are: Acute inflammation of the liver - may impair the ability of the liver to conjugate and secrete bilirubin, resulting in a buildup. Inflammation of the bile duct - may prevent the secretion of bile and removal of bilirubin, causing jaundice. Obstruction of the bile duct - prevents the liver from disposing of bilirubin.

Hemolytic anemia - production of bilirubin increases when large quantities of red blood cells are broken down. Gilbert's syndrome - an inherited condition that impairs the ability of enzymes to process the excretion of bile. Cholestasis - a condition where the flow of bile from the liver is interrupted. The bile containing conjugated bilirubin remains in the liver instead of being excreted.

More rare conditions that may cause jaundice include: Crigler-Najjar syndrome - an inherited condition that impairs the specific enzyme responsible for processing bilirubin Dubin-Johnson syndrome - an inherited form of chronic jaundice that prevents conjugated bilirubin from being secreted out of the liver's cells Pseudojaundice - a harmless form of jaundice in which the yellowing of the skin results from an excess of beta-carotene , not from an excess of bilirubin; usually from eating lots of carrots, pumpkin , or melon Symptoms of jaundice There are three main types of jaundice: Hepatocellular jaundice - occurs as a result of liver disease or injury Hemolytic jaundice - occurs as a result of hemolysis (an accelerated breakdown of red blood cells) leading to an increase in production of bilirubin Obstructive jaundice - occurs as a result of an obstruction in the bile duct (a system of tubes that carries bile from the liver to the gallbladder and small intestine), which prevents bilirubin from leaving the liver Jaundice, not to be confused with infant jaundice , is usually a sign of an

 underlying disorder.

Treatments for jaundice Treatment of jaundice typically requires a diagnosis of the specific cause in order to select suitable treatment options. Treatment would then target the cause, rather than the jaundice itself. Anemia-induced jaundice may be treated by increasing the amount of iron in the blood; either by taking iron supplements or eating more iron-rich foods. Hepatitis-induced jaundice may be treated with anti-viral or steroid medications. Obstruction-induced jaundice may be treated via surgery to remove the obstruction. Medication-induced jaundice is treated by selecting an alternative medication and by discontinuing medications that caused jaundice. Diagnosis of jaundice Doctors will most likely diagnose jaundice based on the patient's history and a physical exam, paying close attention to the abdomen. Doctors will be feeling for masses (tumors) in the abdomen and/or checking the firmness of the liver; a firm liver indicates cirrhosis , while a rock-hard liver indicates cancer . The severity of jaundice is determined by several tests, the first of which is a liver function test to find out whether or not the liver is functioning properly.

If the cause of the symptoms cannot be identified, a doctor may require blood tests to check levels of bilirubin and evaluate the composition of the blood. Some of these tests include: Bilirubin tests - a high level of unconjugated bilirubin relative to levels of conjugated bilirubin indicates hemolysis (accelerated breakdown of red blood cells) Full blood count (FBC), or complete blood count (CBC) - measures levels of red blood cells, leukocytes (white blood cells), and thrombocytes (platelets) Hepatitis A, B, and C tests If an obstruction of the liver is suspected, the liver's structure will be looked at with the help of imaging tests. Some of these tests include: MRI scan - uses magnetic signals to create image "slices" of the soft tissues of the human body.

Abdominal ultrasonography (ultrasound) - uses high-frequency sound waves to create a two-dimensional image of the soft tissues inside the human body CT or CAT scan - uses a thin X-ray beam to create image "slices" of soft tissues in the body Endoscopic retrograde cholangiopancreatography ( ERCP ) - a procedure that combines an endoscopy and X-ray imaging A liver biopsy is particularly useful in checking for inflammation , cirrhosis, cancer, and fatty liver. This test involves injecting a needle through the skin and into the liver to obtain a sample of the tissue, which is examined under a microscope. Complications from jaundice The symptom pruritis (itching) can sometimes be so intense that patients scratch their skin raw, have insomnia , or even commit suicide. Most complications that arise are a result of the underlying cause of jaundice, not from jaundice itself. For example, jaundice caused by a bile duct obstruction may lead to uncontrolled bleeding due to a deficiency of vitamins needed for normal blood clotting.

Prevention of jaundice Jaundice is related to the function of the liver, so it is essential that individuals maintain this vital organ's health by eating a balanced diet, exercising regularly, and refraining from exceeding recommended amounts of alcohol. Written by Caroline Gillott Click the stars to rate this article Jaundice: Causes, Symptoms, and Treatments Public / Patient Jaundice: causes, symptoms, diagnosis, treatment, prevention If you have signs of jaundice, seek medical advice . Symptoms of jaundice As well as the classic yellow tinge to the skin and whites of the eyes , someone with jaundice may also have yellowing of mucous membranes in the mouth and nose. Stools (faeces or poo) can be pale in colour and urine dark in colour. Some underlying conditions, which lead to jaundice, may feel like flu , and may also result in fever, chills , stomach pain , itching or weight-loss or be without an explanation such as a diet . Causes of jaundice When red blood cells break down naturally in a 120-day cycle, bilirubin is produced as a waste by-product.

The journey bilirubin takes out of the body's waste disposal systems sees it carried by blood to the liver . There is it combined with bile (digestive fluid) from the gallbladder . This mixture exits the body through faeces and urine. If everything is working well, faeces should be brown and urine light yellow. Infections or damage can disrupt this process, leading to jaundice. Pre-hepatic jaundice If an infection or medical condition makes the red blood cells break down sooner than usual, bilirubin levels rise. This is known as pre-hepatic jaundice. Conditions that may trigger this include malaria , sickle cell anaemia , thalassaemia , Gilbert's syndrome, hereditary spherocytosis and Crigler-Najjar syndrome. Intra-hepatic jaundice If the liver is damaged, it may be less able to process bilirubin. This causes what doctors call intra-hepatic jaundice. The liver damage may be a result of causes that include hepatitis, alcoholic liver disease , glandular fever , liver cancer , illegal drug use including ecstasy, and paracetamol overdose.

Obesity and non- alcoholic fatty liver disease can be a cause of cirrhosis of the liver and jaundice. Post-hepatic jaundice Gallstones, pancreatitis , pancreatic cancer and cancers of the gallbladder or bile duct may also disrupt the bilirubin removal process leading to jaundice. This is called post-hepatic jaundice. Eating a high-fat diet can raise your cholesterol levels and increase the risk of having gallstones. Jaundice diagnosis The yellowing of skin and eyes are likely to be the main clues a doctor will use before confirming a jaundice diagnosis. A person will be asked about other symptoms and risks, such as foreign travel or drug misuse. A physical examination will be carried out to look for signs of swelling of the liver and legs, ankles or feet , which might indicate cirrhosis of the liver. Urine can be tested for urobilinogen, which is produced when bilirubin is broken down. Finding high or low levels can help pinpoint the type of jaundice. Blood tests may be used to check for conditions like malaria or hepatitis. A liver function blood test may indicate hepatitis, cirrhosis or alcoholic liver disease.

Sometimes a liver biopsy - removal of small tissue sample - is needed to confirm or rule out conditions such as cirrhosis or liver cancer. Doctors may also need to look inside the body for problems with the liver or bile duct using ultrasound , X-ray with contrast, MRI or CT scans. Jaundice | Doctor | Patient Jaundice See also separate Neonatal Jaundice and Jaundice in Pregnancy articles. Jaundice is the yellow discolouration caused by accumulation of bilirubin in tissue. The normal serum bilirubin is approximately 3-20 μmol/L. Jaundice is not usually apparent until serum bilirubin is over 35 μmol/L. The detection and differential diagnosis of jaundice are important in clinical assessment. It is important to determine what investigations are appropriate and the significance of the results of investigations. Jaundice results from interference in the normal metabolism of bilirubin (including uptake, transport, conjugation and excretion). This may result from: Pre-hepatic causes (unconjugated hyperbilirubinaemia) - eg, haemolytic anaemia. Hepatocellular disease.

Add notes to any clinical page and create a reflective diary Automatically track and log every page you have viewed Print and export a summary to use in your appraisal Click to find out more » Pathophysiology Bilirubin is produced from the breakdown of haemoglobin in the reticuloendothelial system. 95% of the circulating bilirubin is unconjugated and bound to albumin. The bilirubin-albumin complex is broken down by hepatocytes leaving free albumin circulating. The bilirubin is excreted in bile but only when made water-soluble by conjugation with glucuronic acid in the liver. Bile is stored and concentrated in the gallbladder and then excreted into the duodenum under the influence of cholecystokinin. Bilirubin is conjugated with glucuronic acid in the liver. Much of the conjugated bilirubin enters the intestine. Conjugated bilirubin is deconjugated into colourless urobilinogen by colonic bacteria. The urobilinogen can then be oxidised to form urobilin and stercobilin, which colour the stools brown.

A small trace of urobilinogen is reabsorbed into the enterohepatic circulation, either to be re-excreted in the bile or to pass through the kidneys to colour the urine yellow. Blood transfusions. Contact with other jaundiced patients. Medication history (both prescribed and non-prescription drugs). Drugs associated with jaundice and contra-indicated in jaundice include: amitriptyline, chlorpromazine, erythromycin, halothane, imipramine, indometacin, isoniazid, methyldopa, monoamine-oxidase inhibitors (MAOIs), oral contraceptive pill, rifampicin, salicylates, sulfonamides, thiouracil. Past medical history: A past history of hepatitis raises the possibility of chronic active hepatitis. A history of previous biliary surgery raises the possibility of a stone in the common bile duct. Malignancy, particularly with breast or bowel carcinoma, may present with jaundice. Occupational history may be important - eg, in sewerage workers or people exposed to hepatotoxic chemicals. Family history of jaundice Obstetric cholestasis is a cause of mild jaundice.

Examination Jaundice is most easily recognised in fair-skinned individuals and difficult to detect in darkly pigmented patients. It is most easily seen in the sclera and best seen in natural light by pulling down the lower eyelid to expose the sclera and asking the patient to look up. it is yellow-green in appearance in chronic, severe obstructive jaundice (biliverdin). It should not to be confused with carotenaemia (the sclera remains white). Carotenaemia is prominent in the palms, soles and face. Signs of underlying liver disease include: Spider naevi. Liver palms (erythema of the thenar and hypothenar eminences; may also affect the soles of the feet). Gynaecomastia. In viral hepatitis the liver is slightly enlarged and tender. The liver edge in cirrhosis is firm. An irregular liver edge suggests malignant disease. If the gallbladder is palpable, it is probable that the cause of jaundice is not a stone (Courvoisier's law). The liver is usually smoothly enlarged in posthepatic obstructive jaundice. Pancreatic tumours may be palpable.

Splenomegaly is suggestive of cirrhosis, haematological disorders or reticulosis. Also check for lymphadenopathy. Differential diagnosis Difficulties can arise with overlapping of diseases such as autoimmune hepatitis with primary biliary cirrhosis (PBC) and autoimmune hepatitis with hepatitis C . Pre-hepatic (unconjugated hyperbilirubinaemia): Gilbert's syndrome is the most common inherited cause of unconjugated hyperbilirubinaemia. It is caused by underactivity of the conjugating enzyme system. It is found in 3-7% of the population. Crigler-Najjar syndrome is a rare autosomal recessive disorder of bilirubin metabolism, caused by deficient diphosphate glycosyltransferase. Hepatocellular disease: Viral hepatitis (including hepatitis A and hepatitis B ). Other possible infective causes include leptospirosis, brucellosis, Coxiella burnetii and glandular fever.[ 3 ][ 4 ] Alcoholic hepatitis. Autoimmune hepatitis (10-20% of chronic hepatitis). Can be associated with other autoimmune diseases.

Drug-induced hepatitis: paracetamol is by far the most common cause of drug-induced liver disease.[ 5 ] Hepatotoxic chemicals - eg, phosphorous, carbon tetrachloride and phenol.[ 6 ] Decompensated cirrhosis. Biliary obstruction may be mechanical and extrahepatic or by metabolic factors in the hepatic cells (intrahepatic). Overall, gallstones are the most common cause of extrahepatic obstruction: Intrahepatic cholestasis. See separate Abnormal Liver Function Tests article. Jaundice will be apparent if the total bilirubin is >35 μmol/L. It is usually easy to differentiate pre-hepatic causes of jaundice from hepatic and posthepatic. It is more difficult to differentiate hepatic and posthepatic, as they often co-exist (eg, obstructive jaundice with biliary cirrhosis).

In jaundice, the essential and rapid differentiation of the main causes (hepatitis, biliary stasis, haemolysis, resolution of haematoma or congenital causes) can often be achieved by performing the following investigations; Urinary bilirubin and urobilinogen Urinary bilirubin is normally absent but is conjugated when present (dark urine). Raised urinary bilirubin with absent or reduced urobilinogen is suggestive of obstructive jaundice. Normal or raised urinary bilirubin with elevated urobilinogen suggests hepatocellular failure or increased red cell breakdown (eg, haemolytic jaundice). Urine dipstick analysis: urine should be tested fresh using reagent dipsticks (if left standing, pH changes and light degradation affect results). Reagent strips are very sensitive and detect very low levels of bilirubin. If clinically jaundiced but serum bilirubin normal and negative urinary bilirubin then the cause is hypervitaminosis A or high serum carotene from carrots, pumpkins, etc. False negatives for urinary bilirubin occur with rifampicin or if the urine is not fresh.

False positives for urobilinogen occur in acute porphyria. False positive for urinary bilirubin may occur with phenothiazines. Checking LFTs If normal, ask for: Levels of conjugated/unconjugated bilirubin (direct/indirect bilirubin). Light may reduce the bilirubin content and shaking the sample can artificially elevate the bilirubin: Raised unconjugated (indirect) bilirubin suggests: Gilbert's syndrome. Crigler-Najjar syndrome (levels over 85 μmol/L). Raised conjugated (direct) bilirubin (>10 μmol/L) suggests obstructive jaundice, including: Liver disease Dubin-Johnson syndrome Further investigations More investigations (listed with occasional notes on interpretation of results) will be necessary to allow further diagnostic differentiation: FBC should include a reticulocyte count and blood smear to detect haemolysis. ESR may be elevated - for example, in PBC. Lactate dehydrogenase is raised in haemolysis. LFTs: Alkaline phosphatase: considerably increased with either extrahepatic or intrahepatic biliary disease.

The most common diseases associated with raised alkaline phosphatase include: Gallstones causing bile duct obstruction. Pancreatic cancer. Drugs. More rarely, PBC. Serum transaminases are usually very high in hepatocellular disease (like viral hepatitis) but more modestly elevated in chronic hepatocellular damage and obstruction: Aspartate aminotransferase (AST) is raised more than alanine aminotransferase (ALT) in cirrhosis, intrahepatic neoplasia, haemolytic jaundice and alcoholic hepatitis. ALT is raised more than AST in acute hepatitis and in extrahepatic obstruction. ALT levels of less than 100 IU/L with jaundice suggest obstructive jaundice. ALT over 400 IU/L suggests diffuse acute hepatocellular damage (for example, in viral hepatitis). ALT between 150-400 IU/L suggests chronic active hepatitis or viral or drug-induced hepatitis. Very high levels of ALT (over 1,000 IU/L) suggest acute parenchymal disease. Gamma-glutamyltransferase (GGT): GGT is sensitive but not specific for excess alcohol intake.

A raised MCV with raised GGT is suggestive of alcohol abuse and, if accompanied by raised ALT, suggests liver cell damage. Biliary obstruction and hepatic malignancies cause very high GGT levels (x 10 normal). Raised GGT with raised alkaline phosphatase (over x 3 normal) suggests cholestasis. Hepatitis serology should be done in all patients with cholestasis, as differentiating hepatitis from extrahepatic obstructive causes may be very difficult. Prothrombin time may be prolonged because of vitamin K malabsorption. Injection of vitamin K will correct deficiency in cholestasis but not in parenchymal liver disease. Serum antinuclear antibodies (ANAs), anti-smooth muscle antibody (ASMA): the hallmark of PBC is antimitochondrial antibodies (90-95% of patients with PBC are positive); ANA is positive in 20-50% of patients with PBC. Serum immunoglobulins and serum electrophoresis in acute hepatitis when autoimmune hepatitis is suspected. IgG is raised in acute hepatitis, IgM is raised in autoimmune disease, PBC or chronic infection.

Alpha-1-antitrypsin levels: deficiency causes cirrhosis and emphysema. Ferritin to screen for haemochromatosis. Imaging:[ 11 ] Plain radiographs are of little value, as few biliary tract calculi are radiopaque. Abdominal ultrasound can detect liver abnormalities, hepatosplenomegaly and gallstones.[ 12 ] It is useful to identify the extrahepatic causes of biliary obstruction but is also good at identifying intrahepatic disease (for example, malignant disease).[ 13 ] CT scan. MRI scanning and magnetic resonance cholangiopancreatography (MRCP): MRCP has been recommended with a predictive scoring system to reduce the number of patients undergoing unnecessary endoscopic retrograde cholangiopancreatography (ERCP).[ 14 ] It may become the test of choice in obstructive jaundice.[ 15 ] Percutaneous transhepatic cholangiography is used much less often. ERCP is accurate at diagnosing benign and extrahepatic obstruction and can be combined with procedures to relieve obstruction.[ 16 ] Liver biopsy can be done laparoscopically or percutaneously.

It may be necessary, for example, to stage disease in PBC. Laparotomy may ultimately be required to make the diagnosis in some cases of jaundice.[ 17 ] Management This will depend on the diagnosis and cause of the jaundice in each individual case but factors to consider here include managing any pruritus that may be present - including lifestyle and dietary advice and cholestyramine treatment.[ 18 ] Jaundice in Healthy Newborns Jaundice in Healthy Newborns La ictericia en recién nacidos sanos Jaundice, a common condition in newborns, refers to the yellow color of the skin and whites of the eyes that happens when there is too much bilirubin in the blood. Bilirubin (bill-uh-ROO-bin) is produced by the normal breakdown of red blood cells. Normally, it passes through the liver, which releases it into the intestines as bile (a liquid that helps with digestion). Jaundice happens when bilirubin builds up faster than a newborn's liver can break it down and pass it from the body.

Here are some reasons why: Newborns make more bilirubin than adults do since they have more turnover of red blood cells. A newborn baby's still-developing liver might not be able to remove enough bilirubin from the blood. A baby's intestines absorb bilirubin that would normally leave the body in the stool (poop). Severe jaundice (when levels of bilirubin are high, usually above 25 mg) that is not treated can cause deafness, cerebral palsy , or other forms of brain damage. In rare cases, jaundice may be a sign of of another condition, such as an infection or a thyroid problem. Doctors recommend that all infants be checked for jaundice within a few days of birth. Types of Jaundice The most common types of jaundice are: Physiological (normal) jaundice: Most newborns have this mild jaundice because their liver is still maturing. It often appears when a baby 2 to 4 days old and disappears by 1 to 2 weeks of age. Jaundice of prematurity: This is common in premature babies since their bodies are even less ready to excrete bilirubin effectively.

To avoid complications, they'll be treated even when their bilirubin levels are lower than those of full-term babies with normal jaundice. Breastfeeding jaundice: Jaundice can happen when breastfeeding babies don't get enough breast milk due to difficulty with breastfeeding or because the mother's milk isn't in yet. This is not caused by a problem with the breast milk itself, but by the baby not getting enough of it. If a baby has this type of jaundice, it's important to involve a lactation (breastfeeding) consultant. Breast milk jaundice: In 1% to 2% of breastfed babies, jaundice is caused by substances in breast milk that can make the bilirubin level rise. These can prevent the excretion of bilirubin through the intestines. It starts after the first 3 to 5 days and slowly improves over 3 to 12 weeks. Blood group incompatibility (Rh or ABO problems): If a mother and baby have different blood types, the mother's body might produce antibodies that destroy the infant's red blood cells. This creates a sudden buildup of bilirubin in the baby's blood.

Incompatibility jaundice can begin as early as the first day of life. Rh problems once caused the most severe form of jaundice, but now can be prevented by giving the mother Rh immune-globulin injections. continue Signs & Symptoms Jaundice usually appears around the second or third day of life. A jaundiced baby's skin usually will appear yellow first on the face, then the chest and stomach, and finally, the legs. It can also make the whites of a baby's eyes look yellow. Most newborns now go home from the hospital 1 or 2 days after birth, so it's important for their doctors to check them for jaundice 1 to 2 days later. Parents also should watch their baby for jaundice. Jaundice can be hard to see, especially in babies with dark skin. If you're unsure, gently press the skin on your baby's nose or forehead — if jaundice is present, the skin will appear yellow when you lift your finger. When to Call the Doctor Call your doctor know if you think your baby might have jaundice. The doctor might take a small blood sample to measure your baby's bilirubin level .

Some offices use a light meter to get an approximate measurement, and then if it's high, take a blood sample. Also call your doctor immediately if: your baby has jaundice during the first 24 hours of life the jaundice is spreading or getting darker or more intense your baby has a fever over 100°F (37.8°C) rectally your baby starts to look or act sick your baby is not feeding well you feel your baby is sleepier than usual It is difficult to tell how significant jaundice is just by looking at a baby, so any baby with yellow eyes or skin should be checked by a doctor. Treatment Most cases of newborn jaundice don't require treatment. Mild or moderate jaundice will go away after 1 or 2 weeks as the baby's body becomes able to get rid of the excess bilirubin on its own. More frequent feedings of breast milk or supplementing with formula to help infants pass the bilirubin in their stools also might be recommended. In some cases, the doctor may ask a mother to temporarily stop breastfeeding. If this happens, pump often to keep producing breast milk, then start nursing again once the jaundice has cleared.

For high levels of jaundice, phototherapy — treatment with a special light that helps rid the body of the bilirubin — may be used. If a baby has severe jaundice that hasn't responded to other treatments, a blood transfusion may be done. Jaundice - Symptoms, Diagnosis, Treatment of Jaundice - NY Times Health Information Back to Top Causes A small number of red blood cells in your body die each day, and are replaced by new ones. The liver removes the old blood cells. This creates bilirubin. The liver helps break down bilirubin so that it can be removed by the body in the stool. Jaundice can occur when too much bilirubin builds up in the body. Jaundice can occur if: Too many red blood cells are dying or breaking down and going to the liver The liver is overloaded or damaged The bilirubin from the liver is unable to move into the digestive tract properly Jaundice is often a sign of a problem with the liver, gallbladder, or pancreas. Things that can cause jaundice include: Infections Back to Top Symptoms Jaundice may appear suddenly or develop slowly over time.

Symptoms of jaundice commonly include: Yellow skin and the white part of the eyes (sclera) -- when jaundice is more severe, these areas may look brown Yellow color inside the mouth Dark or brown-colored urine Pale or clay-colored stools Note: If the whites of your eyes are not yellow, you may not have jaundice. Your skin can turn a yellow-to-orange color if you eat a lot of beta carotene, the orange pigment in carrots. Other symptoms depend on the disorder causing the jaundice: Cancers may produce no symptoms, or there may be fatigue, weight loss, or other symptoms Hepatitis may produce nausea, vomiting, fatigue, or other symptoms Lidofsky SD. Jaundice. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease . 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 20. More Information on This Topic News & Features Review Date: 4/15/2013 Reviewed By: George F.

Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang. A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission ( URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation ( A.D.A.M. Copyright The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies.

Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited. Jaundice - Causes - NHS Choices Jaundice - Causes Jaundice Treatment Causes of jaundice Jaundice is caused by a build-up of a substance called bilirubin in the blood and tissues of the body. Any condition that disrupts the movement of bilirubin from the blood to the liver and out of the body can cause jaundice. Bilirubin Bilirubin is a waste product created when red blood cells break down. It's transported in the bloodstream to the liver, where it's combined with a digestive fluid called bile. This eventually passes out of the body in urine or stools. It's bilirubin that gives urine its light yellow colour and stools their dark brown colour. Types of jaundice There are three types of jaundice, depending on what's affecting the movement of bilirubin out of the body.

Pre-hepatic jaundice Pre-hepatic jaundice occurs when a condition or infection speeds up the breakdown of red blood cells. This causes bilirubin levels in the blood to increase, triggering jaundice. Causes of pre-hepatic jaundice include: malaria – a blood-borne infection spread by mosquitoes sickle cell anaemia – an inherited blood disorder where the red blood cells develop abnormally; it's most common among black Caribbean, black African and black British people thalassaemia – similar to sickle cell; it's most common in people of Mediterranean, Middle Eastern and, in particular, South Asian descent Crigler-Najjar syndrome – a genetic syndrome where an enzyme needed to help move bilirubin out of the blood and into the liver is missing hereditary spherocytosis – a genetic condition that causes red blood cells to have a much shorter life span than normal Intra-hepatic jaundice Intra-hepatic jaundice happens when a problem in the liver – for example, damage due to infection or alcohol, disrupts the liver’s ability to process bilirubin.

Causes of intra-hepatic jaundice include: alcoholic liver disease – where the liver is damaged as a result of drinking too much alcohol leptospirosis – a bacterial infection that's spread by animals, particularly rats glandular fever – a viral infection caused by the Epstein-Barr virus drug misuse – leading causes are ecstasy and overdoses of paracetamol primary biliary cirrhosis – a rare condition that causes progressive liver damage Gilbert's syndrome – a common genetic syndrome where the liver has problems breaking down bilirubin at a normal rate liver cancer – a rare and usually incurable cancer that develops inside the liver exposure to substances known to be harmful to the liver – such as phenol (used in the manufacture of plastic) or carbon tetrachloride (widely used in the past in processes such as refrigeration, although now its use is strictly controlled) autoimmune hepatitis – a rare condition where the immune system starts to attack the liver primary sclerosing cholangitis – a rare type of liver disease that causes long-lasting (chronic) inflammation of the liver Dubin-Johnson syndrome – a rare genetic syndrome where the liver is unable to move bilirubin out of the liver Post-hepatic jaundice Post-hep

atic jaundice is triggered when the bile duct system is damaged, inflamed or obstructed, which results in the gallbladder being unable to move bile into the digestive system.

Causes of post-hepatic jaundice include: gallstones – obstructing the bile duct system gallbladder cancer or bile duct cancer pancreatitis – inflammation of the pancreas, which can either be acute pancreatitis (lasting for a few days) or chronic pancreatitis (lasting for many years) Some causes of jaundice are common, such as hepatitis and gallstones, whereas other causes, such as Crigler-Najjar syndrome and Dubin-Johnson syndrome, are much rarer. Page last reviewed: 09/02/2015

Question: What colour is associated with jaundice?
Answer: Yellow