Jaundice – Types, Symptoms, Treatments and Prevention

Jaundice is a major public health issue in India, with an annual incidence of 2.76 per 1000 population as stated by the National Institute of Communicable Diseases (NICD) through an analysis.

Jaundice is characterised by the yellow colour of the skin, eye whites and body fluids. It is a result of an increase in bilirubin levels in the blood.

What is Jaundice?

Jaundice is the yellowing of the skin and mucous membranes due to bile pigment accumulation in the blood and deposition in body tissues.

It is caused by an accumulation of an endogenous substance called bilirubin in the body’s tissues.

Bilirubin is a yellowish pigment formed by the breakdown of heme, primarily from haemoglobin and red blood cells.

Bilirubin is transported by blood to the liver. In the liver, bilirubin is processed before being excreted in bile.

Bile is a thick fluid in the combination of yellow, green and brown shades. It is secreted into the upper small intestine to eliminate waste products such as bilirubin and excess cholesterol. It aids in fat digestion.

Jaundice can occur as a result of increased red blood cell breakdown, inherited changes in bilirubin metabolism, liver disease or damage. It can also happen whenever there is an interference with bile excretion.

Jaundice in babies

The mother’s liver removes bilirubin for the baby during pregnancy. After birth, the baby’s liver has to adapt and remove bilirubin. The liver of some newborns may fail to get adequately developed to eliminate bilirubin effectively.

This results in the accumulation of excess bilirubin in the body, causing the skin and eyes of the baby to turn yellow.

Jaundice is the term for this yellow colouring.

Adult Jaundice

The cause of adult Jaundice can be attributed to many medical conditions. A few of those can be severe and also turn fatal.

The majority of the causes are disorders and drugs. Some common causes are,

• Liver diseases like Hepatitis
• Alcoholic liver disease
• Bile duct blockage due to gallstone or tumour
• Reaction to a medication
• Liver damage
• Bile flow obstruction
• Destruction of red blood cells (haemolysis)

Symptoms 

Symptoms of Jaundice are not prominent in certain individuals and the diagnosis may be just accidental. However, symptoms also depend on the cause of Jaundice.

Discolouration

Discolouration is the most common symptom of Jaundice. Due to the elevated levels of bilirubin in the blood, the skin, mucous membrane and the whites of the eyes become yellow.

Pale stools 

Pale stools are due to the bile pigments in them. It suggests the cause to be obstructive or liver disease.

Dark urine 

Jaundice can manifest in the form of dark urine. This is due to the excess bilirubin excreted by the kidneys.

Itchiness 

The association between Jaundice and itching was first recognised by Aretaeus. According to an article published in the World Journal of Gastroenterology, itchiness in the skin is caused by prickly bilious particles present within the skin.

This theory is still relatable because biliary drainage is usually associated with itch relief.

Fatigue 

One of the most common symptoms reported by patients with liver disease is fatigue. The exact cause of fatigue in liver disease is unknown.

However, the cause of fatigue in Jaundice is due to the changes in central neurotransmission caused by signalling between the brain and the damaged liver.

Abdominal pain 

The usual symptom of Jaundice due to pancreatic or biliary tract cancer is abdominal pain.

Weight loss

Jaundice that is not caused by an infection and the loss of appetite associated with the disease results in weight loss.

Vomiting 

Vomiting can be due to elevated bilirubin. Unexplained vomiting can occur in individuals with liver problems.

Fever 

Fever occurs when jaundice spreads and becomes intense.

Causes of Jaundice 

Knowing the cause of Jaundice is important for quality treatment and recovery.

Increased bilirubin production

There are several unusual conditions that cause bilirubin overproduction.

In these conditions, bilirubin levels in the blood are usually only mildly elevated, and the resulting jaundice is usually mild and difficult to diagnose.

These conditions include:

1) rapid red blood cell destruction

2) a defect in red blood cell formation known as ineffective erythropoiesis

3) absorption of large amounts of haemoglobin when there has been significant bleeding into tissues

Medications

Drugs or medications are one of the common causes of Jaundice. Some drugs can cause Hepatitis and bile duct inflammation that results in Jaundice.

They may also interfere with the processes occurring in the cells of the liver and the bile duct. These are responsible for the formation and secretion of bile to the intestine.

As a result, bile constituents such as bilirubin are retained in the body. Estrogen is the best example of a drug that causes this type of Jaundice.

The primary treatment for drug-induced Jaundice is drug discontinuation. Bilirubin levels almost return to normal within a couple of weeks, though in some cases it may take several months.

Excessive alcohol consumption

Excessive alcohol consumption can result in liver diseases like Alcoholic Hepatitis (AH), fatty liver disease and Cirrhosis. Alcoholic Hepatitis is a severe liver disease that is characterised by the sudden onset of Jaundice.

Gallstone disease

Jaundice can occur when the obstruction of bile flow happens as a gallstone passes from the gallbladder into the bile duct.

Gallbladder or pancreatic cancer

Jaundice is caused by pancreatic or gallbladder cancer due to bile duct blockage.

Chronic liver diseases

Chronic liver inflammation damages the organ which causes diseases that result in Jaundice and Cirrhosis.

Examples of diseases that cause Jaundice are Hepatitis, alcoholic liver disease with Cirrhosis and autoimmune Hepatitis.

Haemolytic Anaemia

Jaundice can occur as a result of a slight increase in indirect bilirubin due to Haemolytic Anaemia.

Types of Jaundice 

Prehepatic 

A large number of red blood cells are damaged, producing excess bilirubin and resulting in Haemolytic Jaundice.

This can be caused by conditions like Anaemia or a problem with the metabolism.

Hepatic 

Hepatic Jaundice or hepatocellular Jaundice is the most common type of Jaundice. It happens when bilirubin cannot leave the liver cells, failing to get removed from the body by the kidneys.

Hepatocellular jaundice is typically caused by the use of certain medications, liver inflammation in hepatitis, liver disease and liver failure.

Posthepatic 

Obstructive Jaundice or posthepatic Jaundice occurs when the bile duct becomes obstructed. This acts as a hindrance for the bilirubin to leave the liver.

This type of Jaundice is most usually caused due to a gallstone, cyst or a tumour in the pancreas or bile duct.

Neonatal Jaundice

Jaundice is very common in newborn babies. Neonatal Jaundice happens when the liver of the baby is underdeveloped and cannot function fully.

In most cases, neonatal Jaundice is not a concern. It does not require treatment and usually goes away after a week.

Diagnosis 

Jaundice is diagnosed by looking out for signs of liver disease.

Bilirubin tests 

The bilirubin test is for analysing the bilirubin level in the blood. Elevation of the yellow-pigmented bilirubin results in Jaundice and is a vital test for Jaundice diagnosis. The bilirubin test is a part of liver function tests (LFTs).

Blood tests 

A complete blood count (CBC), LFT and level of lipase and amylase to detect inflammation in the pancreas may be the necessary blood tests.

A pregnancy test can be obtained in women. Additional blood tests may be required depending on the test results and a patient’s history.

Hepatitis A, B and C tests 

The presence of antibodies can be confirmed through blood tests. Hepatitis antibodies in the blood can be detected through tests as a part of Jaundice diagnosis. Imaging tests like CT scan, MRI scan, ultrasound and HIDA scan may be required after the presence of Hepatic antibodies is confirmed.

Treatment

Treatment is determined by the underlying condition causing the Jaundice. Once a diagnosis is made, treatment can be decided to address that specific condition.

The condition may or may not necessitate hospitalisation depending on the severity of the disease.

Medical treatment

Treatment varies depending on the medical condition causing the Jaundice, as well as the associated symptoms and complications.

Possible treatments include the following

• Supportive care
• IV fluids to combat dehydration
• Steroids
• Antibiotics, antiviral medications
• Blood transfusions
• Chemotherapy or radiation therapy
• Phototherapy

Medication

Medication requirement changes for each individual. Drugs and medications are prescribed by a doctor after determining the cause of the Jaundice.

Surgery

Surgical treatment is necessary in certain cases of cancer, bile duct obstruction, congenital malformations, gallstones and splenic abnormalities. A liver transplant is also required in some cases.

Diet for Jaundice

The patient’s diet is critical in both the recovery and prevention of Jaundice. The liver produces bile, which is required for the digestion of fats. The liver also plays a vital role in the digestion and procession of other nutrients.

Frequent consumption of foods and liquids that aid in digestion and metabolism, protecting the liver from damage and detoxifying the liver is recommended for Jaundice patients.

Foods to be included:

• Water is the primary requirement for an individual with Jaundice.
• Fruits and vegetables – Fibre and antioxidant-rich
• Whole grains
• Nuts
• Legumes
• Lean protein

Foods to be restricted:

• High-fat foods
• Refined sugar
• Salt
• Alcohol
• Iron-rich foods

Prevention 

Preventing Jaundice stops all the complications that come along with it. By following a few precautious steps, the chances of developing Jaundice can be greatly reduced.

Eating a balanced diet 

A variety of foods that helps attain the daily vitamin and mineral recommendation can be eaten along with adequate hydration. This not only keeps Jaundice at bay but helps prevent other diseases as well.

Exercising regularly 

Exercising is beneficial. It is said that mild Jaundice can be treated solely at home through moderate exercise and yoga performed consistently for a week.

Limiting alcohol consumption 

Too much alcohol intake results in liver diseases that act as a predisposing factor for Jaundice. It is, therefore, necessary to limit alcohol consumption.

Avoiding toxins from chemicals

Exposure to chemicals can lead to liver injury. Jaundice as a result of this is known as toxic Jaundice. Staying away from disease-causing chemicals can prevent Jaundice.

Managing medications carefully 

Drug-induced Jaundice is common and it can be avoided by managing medications carefully.

Conclusion

Jaundice is a condition that is most often a symptom of a disease. It causes skin discolouration. Medical attention is required for recovery. Medication and diet are usually the primary treatment while surgery is required during obstruction.

Adult with Jaundice needs to eat a healthy diet with fruits & vegetables. The best treatment for Jaundice would be by addressing the underlying cause of the disease.

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