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All About Jaundice

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Updated March 23, 2012

Jaundice is when the whites of your eyes (sclerae) and possibly your skin develop a yellowish color. Jaundice is a symptom caused by a larger problem of too much bilirubin in your blood, called "hyperbilirubinemia." When you notice parts of your body turning yellow, it's time to go see a doctor, because something may be wrong. Several things are known to cause yellow skin, and liver disease is one of the most common and important. By the way, this article addresses adult jaundice. Jaundice in babies is different.

What Causes Jaundice?

Jaundice is caused by too much bilirubin in the blood. Bilirubin is a yellow pigment (a chemical in the body that has a color) that your body makes from old red blood cells in the spleen, an organ next to your stomach. The bilirubin then goes to the liver, where it's combined with other molecules to make bile. This is a normal process that happens every day. It's your body's way of recycling unused things, such as old red blood cells, and forming them into necessary products, such as bile. You use bile every time you need to digest fats after a meal, such as from a big steak dinner. Bile is a fluid that's essential in nutrition, because it helps break down the fats into a form the body can use.

This is an important system, but it can be disrupted. If the liver becomes damaged, such as from hepatitis, it may not be able to make bile. The body, though, is constantly breaking down old red blood cells and using the salvaged iron to make bilirubin. If the liver can't use the bilirubin to make bile, the bilirubin starts concentrating in the blood and may even leak in to surrounding tissues, such as the sclerae and skin. When the tissues become overly saturated with bilirubin, it becomes noticeable as jaundice. Jaundice is a symptom of liver disease, but there are other reasons your body may develop hyperbilirubinemia. Two of these reasons are overproduction of red blood cells and some obstruction of the liver's ducts, such as a tumor. Doctors will search for these, and other, possibilities when evaluating you for jaundice.

Do I Have Jaundice?

The easiest way to verify jaundice is by physical examination. Though jaundice can turn the skin a yellow tint, it's easiest to see jaundice by looking at the whites of the eyes, because bilirubin is especially attracted to the sclerae. It's often difficult to see jaundice in the sclerae, however, under fluorescent lighting. In these instances, you may be able to better see jaundice in the tissue under your tongue. Another indicator of jaundice is a darkening of your urine.

Before you can see jaundice on your skin, you need to have a certain amount of bilirubin in your blood and tissues. Normally, adults have anywhere from 0.3 to 1 mg/dL (which stands for milligrams per deciliter) of bilirubin in their blood, which is a very small amount. For comparison, a large grain of sand weighs around 11 milligrams and one deciliter is about 7 tablespoons! To actually see jaundice in your skin, you'll need at least 3 mg/dL of bilirubin in your blood.

Are There Tests for Jaundice?

Yes, there are tests to measure the amount of bilirubin in your blood. Sometimes doctors can rule out certain causes of hyperbilirubinemia by finding out how much bilirubin is in your blood. High levels of bilirubin (anything over 7 mg/dL) are probably caused by liver disease. Severe liver disease can cause levels as high as 40 mg/dL! Doctors usually need a combination of tests to determine which type of liver disease is causing the problem. In addition to finding out the bilirubin levels, doctors need to know prothrombin times and the levels of liver enzymes and albumin. All of these are additional blood tests.

There is a urine test for bilirubin, called the "Ictotest," which (if positive) always implicates the liver as the cause of your jaundice.

Do I Have Hepatitis?

It's important to note that not all causes of hyperbilirubinemia are from hepatitis, or even other liver diseases. Sometimes the problem is with the blood or even a genetic disease. For these reasons, it's important for a physician to evaluate all cases of jaundice.

If the doctor suspects that acute viral hepatitis is creating the jaundice, you'll need blood tests to identify the viral agent. Most likely, this will include blood tests for hepatitis A IgM antibody, hepatitis B surface antigen and core IgM antibody and a hepatitis C viral RNA test. Since other viruses can cause acute hepatitis, you may also be tested for the Epstein-Barr virus and the cytomegalovirus. Jaundice, however, isn't a reliable symptom of acute viral hepatitis. Many people have acute viral hepatitis and never have jaundice.

Is Jaundice an Emergency?

Usually not, but there are situations that can lead to an emergency. This is why it's important to have a physician evaluate all cases of jaundice.

What's the Treatment for Jaundice?

Jaundice is treated by correcting the problem that caused the hyperbilirubinemia. For those with acute viral hepatitis, usually no treatment is necessary because the body will clear the virus by itself.

Sources:

Dienstag, JL. Acute Viral Hepatitis. In: AS Fauci, E Braunwald, DL Kasper, SL Hauser, DL Longo, JL Jameson, J Loscaizo (eds), Harrison’s Principles of Internal Medicine, 17e. New York, McGraw-Hill, 2008.

Kumar V, Abbas A, Fausto N. Robbins and Cotran Pathologic Basis of Disease, 7e. Philadelphia, Elsevier, 2005. 885-888.

Sjogren, MH. Hepatitis A. In: M Feldman, LS Friedman, LJ Brandt (eds), Gastrointestinal and Liver Disease, 8e. Philadelphia, Elsevier, 2006. 1639.

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