Jaundice: All You Need To Know

Jaundice, also called hyperbilirubinemia or icterus, is a yellow discoloration of body tissues such as the skin or the white of the eyes (sclera) caused by high bilirubin levels (a yellow-orange bile pigment) in the bloodstream.

Bilirubin is a yellow chemical pigment present in the hemoglobin. It is produced by the hemolysis (breakdown of red blood cells) in the body and excreted by the liver. However, in the case of liver dysfunction, the pigment is not excreted and accumulates in the blood, giving rise to jaundice.

The normal bilirubin level in adults is – Direct bilirubin (also called conjugated)- 0 to 0.3 mg/dL

Total bilirubin- 0.3 to 1.9 mg/dL
Normal indirect bilirubin in newborns is under 5.2 mg/dL within the first 24 hours of birth.

Jaundice in Newborns

Neonatal jaundice or neonatal hyperbilirubinemia is a condition in which an infant’s total serum bilirubin (TSB) is increased, and the skin, sclera, and mucous membranes appear yellow for the first few days of life.

Infant jaundice is common and usually not a cause for concern, as the livers of newborns may take a few days to process and eliminate bilirubin effectively. Mild, temporary, and self-limiting newborn jaundice is called physiological jaundice, whereas the severe form is known as pathological jaundice.

Jaundice Symptoms

The symptoms of jaundice include

The yellowish discolouration of the sclera (white area of the eye), or conjunctival icterus
The skin tone appears yellow.
The yellowish colour inside the mouth
Urine colour is dark (bilirubinuria) or brown-colored.
Stools are pale or clay-colored
Bilirubin is a skin irritant; therefore, jaundice causes itching (pruritis).
Yellow or green discolouration of teeth and dental hypoplasia in growing children.
High fever
Loss of appetite
Stomach pain
Loss of weight
Vomiting

Types of jaundice

The types of jaundice are characterized by examining which part of the liver is malfunctioning and how it is affecting the excretion of bilirubin pigment from the blood circulation. The three major jaundice types that can affect you are-

Hepatocellular jaundice
Hemolytic jaundice
Obstructive jaundice

Causes of Jaundice

Jaundice, or icterus, is caused by the accumulation of high levels of bilirubin in the bloodstream. As bilirubin is treated in the liver, jaundice is a manifestation of liver disorder. The various jaundice causes are:

Viral infections like hepatitis
Liver cirrhosis or heavy alcohol consumption
Autoimmune disorders – primary biliary cirrhosis
Hereditary factors – Dubin–Johnson syndrome
Specific medications include oral contraceptives, probenecid, chlorpromazine, rifampin, steroids, and herbal medications
Pregnancy
Gilbert syndrome
Rotor syndrome
Crigler–Najjar syndrome type 1 and 2
Hyperthyroid
Hepatic crisis in sickle cell disease
Infiltrative diseases such as lymphoma, tuberculosis, amyloidosis, sarcoidosis
Sepsis and hypoperfusion states
Chronic liver disease
Gallstones or gallbladder disorders cause bile duct blockage
Blood disorders
Pancreatic, gallbladder, liver cancer
The jaundice of pregnancy
Malaria

Risk Factors

Excessive consumption of alcohol
Using illicit medications
Taking drugs that may damage the liver
Exposure to viral infections like hepatitis A, hepatitis B, or hepatitis C
Vulnerability to certain industrial chemicals

What are the Diagnosis Procedures for Infants?

By performing physical examinations of the baby, pediatrics perform jaundice tests on babies. Newborns should be examined for jaundice every 8 to 12 hours during the first 48 hours of life and continue it till they are five days old. The infant bilirubin tests include –

Light Meter: The pediatrician will use a light meter to check the transcutaneous bilirubin (TcB) level.
Blood test: To check bilirubin levels and give accurate results.

What are the Jaundice Diagnosis Procedures for Adults?

By examining the jaundice signs and symptoms, the gastroenterologist can conclude the jaundice diagnosis.Other jaundice diagnosis options include:

Blood tests: Various blood tests, such as complete blood count (CBC) and liver function tests (LFTs), are used to diagnose jaundice.
Imaging Tests: Abdominal ultrasound, computerized tomography (CT) scan, magnetic resonance imaging (MRI), or other tests are performed to monitor the flow of bile through the liver and check for blockages.
Liver biopsy: A liver biopsy is done to check for liver diseases
Endoscopic Retrograde Cholangiopancreatography (ERCP): ERCP is a jaundice test done to diagnose and manage disorders pertaining to the liver, gallbladder, bile ducts, and pancreas.
Laparoscopy (uncommon): This procedure is done to inspect the liver and gallbladder.

Jaundice Treatment

The Jaundice treatment approach differs among newborns and adults. Based on each patient’s condition and severity, the doctor adopts a more personalised treatment plan, which might also vary in duration.

How is Jaundice Treated in Infants?

Mild jaundice subsides on its own after 1 or 2 weeks. Breastfeeding in infants should be done regularly. If the baby is not getting sufficient breast milk, the pediatrician may recommend supplementing with formula.

Fluids: Giving fluids, as loss of fluids (dehydration) will cause high bilirubin levels.
Phototherapy: It is a safe treatment procedure to cure newborn jaundice.
Exchange blood transfusion: This procedure is preferred when there is no improvement. Even with phototherapy, the high bilirubin levels do not come down.
Intravenous immunoglobulin (IVIg): IVIg stops antibodies targeting the red blood cells and decreases the need for an exchange transfusion.

How is Jaundice Treated in Adults?

Jaundice often doesn’t require treatment in adults, but it is a severe condition in newborns. It can be treated for its underlying causes and effects. Treatment for jaundice involves managing the underlying hepatobiliary or hematological disease.

Jaundice is a condition characterized by the yellowing of the skin and eyes due to high levels of bilirubin in the bloodstream. Jaundice symptoms include yellowing of the skin, eyes, dark urine, and pale stools. The causes of jaundice can range from liver diseases like hepatitis to blood disorders or bile duct obstructions.

Jaundice treatment depends on the underlying cause and may involve medications, lifestyle changes, or even surgery. Jaundice diagnosis is typically made through blood tests, imaging studies, and sometimes a liver biopsy. Early detection and treatment are crucial for preventing complications and improving recovery.

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