What Is Jaundice (Icterus)?

Jaundice (also known as icterus) is a condition that causes the skin and sclera (the white part of your eyes) to turn yellow. This condition occurs when your body has high levels of bilirubin—a yellow-colored pigment that your body makes when it breaks down red blood cells. If your body is not functioning properly, bilirubin can build up in the blood, causing your skin and eyes to look yellow.

Several underlying health conditions can cause jaundice. While jaundice is common in newborn babies, adults can develop this condition too.

Types of Jaundice

There are four types of jaundice. Each type depends on where the problem occurs as your body produces and removes bilirubin.

Pre-Hepatic Jaundice

In pre-hepatic jaundice, the problem occurs before the liver processes bilirubin. This type of jaundice is often related to medical conditions affecting the blood, such as autoimmune hemolytic anemia, which occurs when the immune system attacks and destroys red blood cells.

Hepatic Jaundice

Hepatic jaundice occurs when the liver is not functioning properly and can’t process bilirubin. Liver diseases, such as hepatitis (inflammation of the liver) or liver damage from alcohol, can cause this type of jaundice.

Post-Hepatic Jaundice

The bile ducts (small tubes that carry a digestive juice called bile, which contains bilirubin) can sometimes become blocked, leading to post-hepatic jaundice. In this case, the liver processes bilirubin, but your body can't remove the bilirubin due to some type of blockage in your liver or gallbladder ducts. Gallstones, cholangitis (inflammation or infection of the bile ducts), or some types of cancer can cause post-hepatic jaundice.

Neonatal Jaundice

Neonatal jaundice is jaundice in newborns. About 80% of infants who are born prematurely and more than half of full-term babies experience jaundice during the first week of their life. Neonatal jaundice happens when a newborn's immature liver can't process bilirubin quickly enough, causing it to accumulate in the blood. Most of the time, neonatal jaundice is a temporary and harmless condition that goes away on its own. But in some cases, it can become serious.

Jaundice Symptoms

In addition to the yellowing of the skin and eyes, you may experience various other symptoms depending on the type of jaundice you have and its underlying cause. Symptoms may also depend on whether the condition developed suddenly or gradually over time. It's worth noting that jaundice often causes other symptoms, but sometimes, you might not experience any additional symptoms at all. Symptoms commonly seen alongside jaundice include:

• Yellowing of your tongue or the inside of your mouth
• Fatigue
• Pruritus (itchy skin) usually due to an accumulation of bile salts
• Loss of appetite
• Clay-colored stools
• Dark urine resembling the color of tea
• Nausea and vomiting
• Abdominal pain
• Unintentional weight loss
• Fever

However, if your jaundice is the result of a blood cell disorder, such as autoimmune hemolytic anemia, you may also notice pale skin and weakness.

Eating large amounts of foods high in beta carotene, like carrots and squash, can make your skin appear yellow, but not the whites of your eyes. This yellow skin color may not be jaundice, but seeing a healthcare provider can help confirm the cause. 

Keep in mind: jaundice may be harder to see if you have brown or black skin. In these cases, healthcare providers may look inside the mouth or in the sclera to check for signs of jaundice.

Symptoms of Jaundice in Babies

With neonatal jaundice, your newborn’s skin appears yellow. It usually starts on the face and spreads to the abdomen (belly), legs, and the bottom of the feet. However, it's important to contact your baby's pediatrician right away if you notice the following symptoms in your baby:

• Yellow skin on the first day after birth or yellow skin that lasts longer than two weeks after birth
• Extreme fatigue
• Not feeding well
• Being fussy
• Trouble breathing
• Fever

What Causes Jaundice?

Several health conditions can cause a buildup of bilirubin, leading to jaundice. The most common causes overall are hepatitis, alcohol-related liver disease, and blockage in the bile ducts. The causes of jaundice are divided into three main categories based on where the problem occurs in the process of bilirubin production and elimination. These include pre-hepatic causes, hepatic causes, and post-hepatic causes.

Pre-Hepatic Causes

Certain blood disorders can cause hemolysis (the breakdown of red blood cells) to occur faster than usual. When this happens, the liver may not be able to keep up with the increased amount of bilirubin your body produces. This can lead to a buildup of bilirubin in the body, which can cause symptoms of jaundice. Conditions that can cause hemolysis to happen too fast or too often include:

• Autoimmune disorders, such as hemolytic anemia
• Bone marrow failure
• Certain infections, such as malaria
• Inherited blood conditions, like sickle cell disease and thalassemia

Hepatic Causes

A variety of conditions can affect the liver’s ability to remove bilirubin from your body, which can increase your risk of developing jaundice. These include:

• Viral infections, such as hepatitis A, hepatitis B, hepatitis C, hepatitis D, and hepatitis E, or a parasitic infection
• Drinking excess alcohol
• Exposure to toxins, such as poisonous mushrooms
• Cirrhosis (scarring of the liver)
  
• Certain medications, like taking high doses of Tylenol (acetaminophen)
• Inherited conditions, including Gilbert syndrome, Dubin-Johnson syndrome, and Crigler-Najjar syndrome
• Long-term liver disease, such as non-alcoholic fatty liver disease
• Liver cancer

Post-Hepatic Causes

A blockage or obstruction in the bile ducts can prevent bilirubin from being removed from the body, leading to post-hepatic jaundice. Some common causes of this type of jaundice include:

• Gallstones or other gallbladder problems that block the bile ducts
• Bile duct infection or inflammation, medically known as cholangitis
• Pancreatic cancer or gallbladder cancer, which can cause tumors to compress nearby bile ducts
  

Diagnosis

If you are experiencing jaundice, it's important to see your healthcare provider sooner rather than later. Determining what’s causing jaundice requires a healthcare provider’s expertise and some tests. Your healthcare provider may perform a physical exam to check for signs of illness, like an enlarged liver. They may also order additional tests, including:

• Blood tests: Check your bilirubin levels, liver function, and overall bloodwork to asses for signs of anemia, infection, or hemolysis
  
• Imaging scans: An abdominal ultrasound, computed tomography (CT) scan, magnetic resonance imaging (MRI), or endoscopic retrograde cholangiopancreatography (ERCP) can help look for a bile duct blockage by taking detailed images of the bile and pancreatic ducts
  
• Liver biopsy: Takes a small sample of tissue from your liver to check for signs of damage, disease, infection, or inflammation
• Laparoscopy: Makes a small incision (cut) near your belly button and inserts a tube with a camera to get a direct view of your liver and gallbladder to check for damage or infection
  

Treatment 

Since jaundice is usually a sign of elevated bilirubin levels in your body, treatment depends on what's causing the bilirubin buildup. Here are the most common treatments, based on what's causing your jaundice symptoms:

How to Prevent Jaundice

Certain inherited blood conditions, such as Gilbert syndrome and Crigler-Najjar syndrome, can’t be prevented. Sometimes, it's also not possible to prevent conditions like liver cancer or bile duct blockage. However, there are some strategies you can use to reduce your risk of other conditions that cause jaundice, such as hepatitis, cirrhosis, or gallstones. Consider the following:

• Getting the hepatitis vaccination
• Washing your hands after using the bathroom or before handling food
• Avoiding sharing needles or personal items like toothbrushes or razors
• Practicing safe sex by using condoms or dental dams
• Reducing your alcohol intake
• Limiting eating foods high in cholesterol
• Getting treatment for underlying liver, pancreatic, or gallbladder conditions
  

Complications

Bilirubin is a toxic substance. If left untreated, the conditions that cause jaundice can lead to serious complications. For instance, untreated hepatitis can eventually lead to cirrhosis, liver failure, and an increased risk of liver cancer. But when a bile duct blockage doesn't get the treatment it needs, you may be at risk of a gallbladder of bile duct infections, pancreatitis, and sepsis.

While rare, a severe buildup of bilirubin in the brain, known as kernicterus, can occur. Kernicterus can cause brain damage, particularly in newborns with severe jaundice. That said, if your baby is experiencing jaundice symptoms immediately after birth or for longer than two weeks, it's essential to get medical support from their pediatrician.

A Quick Review

Jaundice is a condition that makes your skin and eyes look yellow due to too much bilirubin in your body. Other common symptoms include itchy skin, pale stools, dark urine, fatigue, and abdominal pain. Many health conditions can lead to jaundice, such as blood disorders, liver diseases, and gallstones. Treatment depends on what’s causing your symptoms—but often includes medications or medical procedures.