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DESCRIPTION
Jaundice in an adult patient can be caused by a wide variety of benign or life-threatening disorders.
Jaundice is a yellowing of the skin and eyes that is caused by a buildup of bilirubin in the blood. Bilirubin is a yellow-brown substance that results from the breakdown of old red blood cells. When red blood cells are removed from the bloodstream, hemoglobin, the molecule in red cells that carries oxygen, is broken down into bilirubin. If you have ever had a bruise, you may have noticed that the skin went through a series of color changes as it healed. When you saw yellow in the bruise, you were seeing bilirubin. Normally, about 1 percent of our red blood cells retire every day, to be replaced by fresh red blood cells. The bilirubin from the old blood cells, the byproduct of red blood cell destruction, is carried to the liver and excreted into the intestine as a component of bile. Much of the resulting bilirubin leaves the body in the stool. If there are too many red blood cells retiring for the liver to handle, this waste product is not removed from the bloodstream by the liver, as it should be, a backup of bilirubin in the blood occurs, producing a yellowing of the tissues and body fluids of the body. Jaundice can be caused by too many red blood cells retiring, by the liver being overloaded or damaged, or by the inability to move processed bilirubin from the liver through the biliary tract to the gut. The discoloration typically is detected clinically once the serum bilirubin level rises above 3 mg per dL (51.3 µmol per L).
Jaundice was once called the "morbus regius" (the regal disease) in the belief that only the touch of a king could cure it.
NEONATAL JAUNDICE
Jaundice is common in newborns because there is some hemolysis during labor and delivery. This occurs because the baby needs to get rid of the extra blood supply that was required during pregnancy. The ordeal of birth can send many red blood cells to an early retirement (especially if a vacuum extractor is used!), and babies' livers are often unprepared for the load. The newborn's liver is immature and may not be fully up to the task of handling the bilirubin for a few days. Before the mother's breast milk comes in and stooling begins in earnest, bilirubin accumulates more easily. Some degree of neonatal jaundice is considered normal (physiological) in a newborn, while other types of jaundice (pathological) are not normal. Premature babies are more prone to have higher bilirubin levels than full term babies. See NEONATAL JAUNDICE for more information about newborn jaundice and a description of the various types of jaundice found in newborn babies.
Physiologic jaundice is the name for normal jaundice commonly seen in healthy babies. Pathologic jaundice is the name given when jaundice presents a health risk, either because of its degree or its cause. Pathologic jaundice can occur in babies, children or adults. It arises for many reasons, including blood incompatibilities, blood diseases, genetic syndromes, hepatitis, cirrhosis, bile duct blockage, other liver diseases, infections, or medications. The term also applies to physiologic jaundice exaggerated by dehydration, prematurity, difficult delivery, or other reason.
GILBERT SYNDROME
A common but harmless (benign) genetic condition in which a liver enzyme essential to the disposal of bilirubin (the chemical that results from the normal breakdown of hemoglobin from red blood cells) is abnormal. This enzyme abnormality results in mild elevations of bilirubin pigment in the blood and the elevated bilirubin pigment can sometimes cause mild yellowing (jaundice) of the eyes. People with Gilbert syndrome are otherwise entirely normal with no other signs or symptoms and their liver enzymes in blood serum are also entirely normal. The mild hyperbilirubinemia of Gilbert syndrome is found incidentally on routine liver function testing but may progress to jaundice during periods of stress, fasting, or illness.
Gilbert syndrome is an autosomal dominant trait. If someone has Gilbert syndrome, the chance of their transmitting the Gilbert gene to each of their children is one-half (50%) and each child who gets the gene gets Gilbert syndrome.
There is no need for treatment in Gilbert's syndrome, and the prognosis (outlook) is excellent. Gilbert's syndrome is a frequent finding in people in North America and Europe. The condition is usually detected serendipitously (purely by accident) in the course of routine blood screening. Gilbert's syndrome is thus an accidentally-encountered enzyme abnormality of no health consequence.
Gilbert syndrome is caused by mutation in the UDP-glucuronosyltransferase gene. Mutations in the same gene cause the Crigler-Najjar syndrome, which is a more severe and dangerous form of hyperbilirubinemia (high bilirubin in the blood).
HYPERCAROTENMIA / CAROTENEMIA
This is a yellow-to-orange color which may be imparted to the skin by consuming too much beta carotene, the orange pigment seen in carrots. In this condition, the whites of the eyes remain white, while people with true jaundice often have a yellowish tinge to the eyes.
JAUNDICE TERMS (FYI)
The figurative use of "jaundice" in "to view things with a jaundiced eye" refers to an attitude of distaste. This may reflect the distaste with which a jaundiced person views food, since severe jaundice typically brings a loss of appetite, nausea, and malaise.
"Jaundice" is often said to have come from the French "jaune" for yellow. This is incorrect. The word "jaundice" stemmed from the Latin "galbinus" which described a light greenish-yellow color. In Old French this became "jaunisse" and, in crossing the English Channel, it became "jaundice. " In French "jaundice" is still "jaunisse."
The term "icterus" is synonymous with jaundice. A person who is icteric is jaundiced. Abnormally high blood bilirubin is termed hyperbilirubinemia.
SIGNS & SYMPTOMS
Jaundice is not a disease in itself, but a sign of any one of several blood or liver disorders. There may be no symptoms present in a person with mild jaundice. The wide range of possibilities is based on the variety of underlying causes and whether disease onset is quick or slow moving.
Jaundice may include:
- Yellowing of the skin and the whites of the eyes.
- Dark colored urine (darker than normal).
- Light colored stools (yellowish in color).
- Loss of appetite.
- Abdominal pain.
- Nausea.
- Malaise, a vague feeling of discomfort, one that cannot be pinned down but is often sensed as feeling "just not right.""
- Weight loss.
- Signs of infection, such as fever, chills, abdominal pain, and flu-like symptoms.
For More detailed information about certain disorders, visit these webpages:
MoonDragon's Obgyn Health & Wellness: Alcoholism
CAUSES OF JAUNDICE IN CHILDREN
Newborn Jaundice (physiologic jaundice).
Breastfeeding Jaundice. Breastfeeding jaundice may occur in the first week of life in more than 1 in 10 breastfed infants. The cause is thought to be inadequate milk intake, leading to dehydration or low caloric intake. It is a type of physiologic or exaggerated physiologic jaundice.
Breastmilk Jaundice. Breast milk jaundice is far less common and occurs in about 1 in 200 babies. Here the jaundice isn't usually visible until the baby is a week old. It often reaches its peak during the second or third week. Breast milk jaundice can be caused by substances in mom's milk that decrease the infant's liver's ability to deal with bilirubin. Breast milk jaundice rarely causes any problems, whether it is treated or not. It is usually not a reason to stop nursing.
Viral Hepatitis (hepatitis A, hepatitis B, hepatitis C, hepatitis D, and hepatitis E).
Hemolytic Anemia: Hemolytic anemia is a condition of an inadequate number of circulating red blood cells (anemia), caused by premature destruction of red blood cells. There are a number of specific types of hemolytic anemia which are described individually. Hemolytic anemia occurs when the bone marrow is unable to compensate for premature destruction of red blood cells by increasing their production. When the marrow is able to compensate, anemia does not occur. There are many types of hemolytic anemia, which are classified by the location of the defect. The defect may be in the red blood cell itself (intrinsic factor), or outside the red blood cell (extrinsic factor). Causes of hemolytic anemia include infection, certain medications, autoimmune disorders, and inherited disorders. Types of hemolytic anemia include Sickle-cell anemia; Paroxysmal nocturnal hemoglobinuria; Hemoglobin SC disease; Hemolytic anemia due to G6PD deficiency; Hereditary elliptocytosis; Hereditary spherocytosis; Hereditary ovalocytosis; Idiopathic autoimmune hemolytic anemia; Non-immune hemolytic anemia caused by chemical or physical agents; Secondary immune hemolytic anemia; Thalassemia. Symptoms include: Chills, Fatigue, Pale color, Shortness of breath, Rapid heart rate, Yellow skin color (jaundice), Dark urine, and Enlarged spleen. These are tests for hemolysis (red blood cell destruction). There are specific tests which identify the specific types of hemolytic anemia. They are performed after hemolysis has been established: Elevated indirect bilirubin levels; Low serum haptoglobin; Hemoglobin in the urine; Hemosiderin in the urine; Increased urine and fecal urobilinogen; Elevated absolute reticulocyte count; Low red blood cell count and hemoglobin; Elevated serum LDH; Direct measurement of the red cell life span by isotopic tagging techniques shows a decreased life span. This disease may also alter the following test results depending on the specific cause: Uric acid; TIBC; RBC indices; Protein electrophoresis - serum; Potassium test; Platelet count; Peripheral smear; Leukocyte alkaline phosphatase; Serum iron; Hematocrit; Ferritin; Febrile or cold agglutinins; Donath-Landsteiner test; Coombs' test, indirect; Coombs' test, direct; CBC; Blood differential; AST; and 24 hour urine protein test. Treatment depends upon the type and cause of the hemolytic anemia. Folic acid, iron replacement, and corticosteroids may be used. In emergencies, transfusion of blood may be necessary. The outcome depends upon the type of hemolytic anemia. The complications vary with the specific type of hemolytic anemia. Severe anemia can cause cardiovascular collapse. Severe anemias can aggravate pre-existing heart disease, lung disease, or cerebrovascular disease. Call for an appointment with your health care provider if symptoms of hemolytic anemia develop. There is no known prevention for hemolytic anemia.
Disorders present since birth that cause problems processing bilirubin:
- Gilbert's Syndrome: Also known as Icterus intermittens juvenilis; Low-grade chronic hyperbilirubinemia; Familial non-hemolytic-non-obstructive jaundice; Constitutional liver dysfunction; Unconjugated benign bilirubinemia. Gilbert's disease is a multifactorial inherited disorder that affects the way bilirubin is processed by the liver and causes jaundice. Gilbert's disease is common, affecting up to 10% of some Caucasian populations. The most significant symptom of this condition is jaundice. Affected individuals ordinarily have no jaundice. However, jaundice appears under conditions of exertion, stress, fasting, and infections. The condition is usually benign. Symptoms of Gilbert's Syndrome are mild jaundice (yellowing of skin and whites of eyes) and fatigue. In some cases there may be no symptoms. Signs and tests include a serial serum indirect bilirubin shows changes consistent with Gilbert's disease. Usually no treatment is necessary. The focus should be on the underlying condition that caused the jaundice. Jaundice may fluctuate and persist throughout the patients life but usually causes no health problems. There are usually no complications. Call your health care provider if you have jaundice or persistent abdominal pain. Because this is an inherited disorder, there is no proven prevention.
- Dubin-Johnson syndrome: Dubin-Johnson syndrome is an inherited disorder characterized by mild jaundice throughout life. Dubin-Johnson syndrome is a very rare autosomal recessive disorder, which means that in order to inherit the condition, a child must get a copy of the defective gene from both parents. The transport of bilirubin from the liver is dysfunctional in people with this condition. Bilirubin is a product of the liver's metabolism of worn-out red blood cells and is normally sent into the digestive system. When bilirubin is not properly processed, it builds up in the bloodstream and causes the skin and the whites of the eyes take on a yellow tinge. Severely high levels can damage the brain and other organs. People with Dubin-Johnson syndrome have life-long low-grade jaundice that may be aggravated by alcohol, pregnancy, oral contraceptive use, infection, and other environmental factors that affect the liver. Mild jaundice that may not appear until puberty or adulthood is the only symptom of Dubin-Johnson syndrome. Diagnostic tests that may be abnormal include: Serum bilirubin; Urinary coproporphyrin levels (mostly coproporphyrin I in Dubin-Johnson patients versus coproporphyrin III in normal subjects); and Liver biopsy. No specific treatment is required. The prognosis for this condition is very positive. Dubin-Johnson syndrome generally does not shorten the patient's life span. Complications are unusual but may include the following: Severe jaundice and reduced liver function. Call your health care provider if any of the following occurs: Jaundice is severe; Jaundice progressively worsens; Abdominal pain or other symptoms are also present (may indicate another disorder is causing the jaundice). Genetic counseling may be valuable for prospective parents with a family history of Dubin-Johnson syndrome.
- Rotor's syndrome.
- Crigler-Najjar syndromes.
Biliary atresia: Biliary atresia is an obstruction of the bile ducts caused by their failure to develop normally in the fetus. This is a congenital condition (present at birth). Biliary atresia is caused by the abnormal development of the bile ducts inside or outside the liver. The purpose of the biliary system is to remove waste products from the liver, and to carry bile salts necessary for fat digestion to the small intestine. In babies with biliary atresia, bile flow from the liver to the gallbladder is blocked. This can lead to liver damage and cirrhosis of the liver, which, if not treated, will eventually be fatal. Newborns with this condition may appear normal at birth but jaundice develops by the 2nd or 3rd week of life. The infant may gain weight normally for the 1st month, then weight loss and irritability develop accompanied by increasing levels of jaundice. It is not known why the biliary system fails to develop normally. Symptoms include jaundice, a yellow color of the skin and eyes, which may be present at birth or develop over several months. The jaundice may be progressive or intermittent. A slow or absent weight gain and slow growth in a child 0-5 years old may occur. Irritability, dark urine, splenomegaly (enlarged spleen), pale or clay colored stools, and floating stools that are foul smelling. During a physical examination, the health care provider may detect an enlarged liver. Tests that reveal biliary atresia include: increased bilirubin in the blood; abdominal x-ray shows an enlarged liver and spleen; abdominal ultrasound; HIDA scan (nuclear test to determine bile flow); cholangiogram to determine patency of ducts; liver biopsy to determine degree of cirrhosis or to rule out other causes of jaundice. Treatment may consist of an operation called the Kasai procedure, which is done to connect the liver to the small intestine, bypassing the malformed ducts. It is most successful if performed before the baby is 10 to 12 weeks old. However, a liver transplant may still ultimately be required. Early surgical intervention will improve the survival of more than one-third of those affected by the condition. The long-term benefit of liver transplant is not yet known, but is expected to improve survival. Complications may include liver failure, infection, surgical complications, failure of the Kasai procedure, and/or irreversible cirrhosis. Call your health care provider if your child appears jaundiced, or if other symptoms suggestive of this disorder develop.
Autoimmune hepatitis. Also known as Lupoid hepatitis, autoimmune hepatitis involves inflammation of the liver caused by rogue immune cells that mistake the liver's normal cells for a foreign tissue or pathogen (disease-causing agent). A person with autoimmune hepatitis has autoantibodies circulating in the bloodstream that cause the immune system to attack the liver. This disease is associated with other autoimmune diseases, including the following: Thyroiditis; Type 1 diabetes; Ulcerative colitis; Hemolytic anemia; Proliferative glomerulonephritis. Autoimmune hepatitis sometimes occurs in relatives of people with autoimmune diseases, suggesting a genetic cause. This disease is most common in young girls and women. Symptoms include dark urine; loss of appetite; fatigue; general discomfort, uneasiness, or ill feeling (malaise); abdominal distension; generalized itching; pale or clay-colored stools; nausea and vomiting. Additional symptoms that may be associated with this disease include amenorrhea (absence of menstruation). Signs and tests that may be used for diagnosis include: Liver biopsy showing chronic hepatitis; Abnormal liver function tests. Tests associated with autoimmune hepatitis: Positive ANA; Positive anti-smooth muscle antibody; Positive anti-liver kidney microsomal antibody; Positive anti-mitochondrial antibody; Elevated sedimentation rate; Elevated serum IgG. Treatment may include Prednisone or other corticosteroids help reduce the inflammation. Azathioprine or mercaptopurine are drugs used to treat other autoimmune disorders, and they have benefited patients with autoimmune hepatitis as well. Modify your activity level according to your symptoms. The outcome varies. Corticosteroid therapy may slow the disease progression. However, autoimmune hepatitis may progress to cirrhosis and require liver transplant. Complications may include Cirrhosis; Liver cell failure; Hepatocellular carcinoma; Complications related to steroids and other medications. Call your health care provider if you notice symptoms of autoimmune hepatitis. Autoimmune hepatitis is usually not preventable. Awareness of risk factors may allow early detection and treatment.
Malaria. Also known as Quartan malaria; Falciparum malaria; Biduoterian fever; Blackwater fever; Tertian malaria; Plasmodium. Malaria is a parasitic disease characterized by fever, chills, and anemia. Malaria is caused by a parasite that is transmitted from one human to another by the bite of infected Anopheles mosquitoes. In humans, the parasites (called sporozoites) migrate to the liver where they mature and release another form, the merozoites. These enter the bloodstream and infect the red blood cells. The parasites multiply inside the red blood cells, which then rupture within 48 to 72 hours, infecting more red blood cells. The first symptoms usually occur 10 days to 4 weeks after infection, though they can appear as early as 8 days or as long as a year later. Then the symptoms occur in cycles of 48 to 72 hours. The majority of symptoms are caused by the massive release of merozoites into the bloodstream, the anemia resulting from the destruction of the red blood cells, and the problems caused by large amounts of free hemoglobin released into the circulation after red blood cells rupture. Malaria can also be transmitted congenitally (from a mother to her unborn baby) and by blood transfusions. Malaria can be carried by mosquitoes in temperate climates, but the parasite disappears over the winter. The disease is a major health problem in much of the tropics and subtropics. The CDC estimates that there are 300 to 500 million cases of malaria each year, and more than one million people die. It presents the greatest disease hazard for travelers to warm climates. In some areas of the world, mosquitoes that carry malaria have developed resistance to insecticides, while the parasites have developed resistance to antibiotics. This has led to difficulty in controlling both the rate of infection and spread of this disease. Falciparum malaria, one of four different types, affects a greater proportion of the red blood cells than the other types and is much more serious. It can be fatal within a few hours of the first symptoms. Symptoms include: Sequential chills, fever, and sweating; Headache; Nausea and vomiting; Muscle pain; Anemia; Bloody stools; Jaundice; Convulsion; and Coma. During a physical examination, the health care provider identify an enlarged liver and an enlarged spleen. Malaria blood smears taken at 6 to 12 hour intervals confirm the diagnosis. Anti-malarial drugs can be prescribed to people traveling to areas where malaria is prevalent. It is important to see your health care provider well in advance of your departure, because treatment may begin 2 weeks before entering the area, and continue for 4 weeks after leaving the area. The types of anti-malarial medications prescribed will depend on the drug-resistance patterns in the areas to be visited. According to the CDC, travelers going to South America, Africa, the Indian subcontinent, Asia, and the South Pacific should take one of the following drugs: mefloquine, doxycycline, chloroquine, hydroxychloroquine, or Malarone. Malarone is a relatively new anti-malarial drug in the U.S. and is a combination of atovaquone and proguanil. It may be recommended over the other drugs mentioned, depending on your destination and the possibility of mefloquine resistance. It is very important to know the countries and areas you will be visiting to obtain appropriate preventive support for malaria. FOR ACTIVE INFECTIONS: Malaria, especially Falciparum malaria, is a medical emergency requiring hospitalization. Chloroquine is the most frequently used anti-malarial medication, but quinidine or quinine, or the combination of pyrimethamine and sulfadoxine, are given for chloroquine-resistant infections. The outcome is expected to be good in most cases of malaria with treatment, but poor in Falciparum infection with complications. Complications may include: Liver failure and kidney failure; Destruction of blood cells (hemolytic anemia); Meningitis; Rupture of the spleen and subsequent massive hemorrhage. Call your health care provider if you develop fever and headache after visiting the tropics. Most people living in malaria-prevalent areas have acquired some immunity to the disease. Visitors will not have immunity, and will need to take preventive medications. Even pregnant women should take preventive medications because the risk to the fetus from the medication is less than the risk of acquiring a congenital infection. People on anti-malarial medications may still become infected. Avoid mosquito bites by wearing protective clothing over the arms and legs, using screens on windows, and using insect repellant. Chloroquine has been the drug of choice for protection from malaria. With emerging resistance, it is now only indicated for use in areas where Plasmodium vivax, P. oval, and P. malariae are present. Falciparum malaria is becoming increasingly resistant to anti-malarial medications. For travelers headed for areas Falciparum malaria is known to occur, the present drug of choice is mefloquine. Mefloquine has been approved by the FDA and is effective at preventing Falciparum malaria. Mefloquine can cause confusion and other mental side effects. Other drugs include Proguanil (available only in Africa), Fansidar (pyrimeth/sulfadoxine) and Malarone. Travelers can call the CDC for information on types of malaria in a given geographical area, preventive drugs, and times of the season to avoid travel. For information, call 1-800-311-3435 or go to the CDC web site and click on Travel Health.
CAUSES OF JAUNDICE IN ADULTS
There are several conditions that may interrupt the elimination of bilirubin from the blood and cause jaundice. Hemolytic jaundice is caused by excessive disintegration of erythrocytes; it occurs in hemolytic and other types of anemia and in some infectious diseases like malaria. Another type of jaundice results from obstruction in or about the liver; usually a stone or stricture of the bile duct blocks the passage of bile from the liver into the intestines. A third type of jaundice occurs when the liver cells are damaged by diseases such as hepatitis or cirrhosis of the liver; the damaged liver is unable to remove bilirubin from the blood. Treatment of jaundice is directed to the underlying cause. Many instances of obstructive jaundice may require surgery.
Among the conditions that can cause jaundice are:
- Cirrhosis of the liver. This may be alcoholic cirrhosis or primary biliary cirrhosis.
- Pernicious Anemia.
- Viral hepatitis.
- Drug-induced hepatitis (hepatitis triggered by erythromycin sulfa drugs, antidepressants, anti-cancer drugs, Aldomet, rifampin, steroids, chlorpropamide, tolbutamide, oral contraceptives, testosterone, propylthiouracil).
- Autoimmune hepatitis. See Autoimmune Hepatitis above.
- Hemolysis (abnormal destruction of red blood cells). See Hemolytic Anemia above.
- Jaundice can also be a sign of an obstruction in the path of the bile flow, from the liver through the bile ducts to the gallbladder and then to the intestinal tract. This may be by infection, tumor or gallstones. If the biliary tract is obstructed, the bile (which contains bilirubin) passes back into the bloodstream instead of into the digestive system, producing jaundice.
- Gallbladder disease and gallstones.
- Drug induced cholestasis (bile pools in the gallbladder because of the effects of drugs).
- Occasionally, jaundice is caused by some form of parasitic infestation such as tapeworm or hookworm, or a bit from a flea or mosquito that carries a viral, bacterial, or parasitic infection. See Malaria above.
- It can be caused by a tumor.
- Inflammation.
Causes of Jaundice and Jaundice-like Symptoms
The following medical conditions are some of the possible causes of Jaundice-like symptoms as a symptom. There are likely to be other possible causes, so ask your health care provider about your symptoms.
- Jaundice
- Neonatal jaundice
- Liver conditions
- Liver infection (see Liver symptoms)
- Hepatitis, Viral hepatitis, Hepatitis A
- Cirrhosis of the liver
- Hemochromatosis
- Bile duct blockage
- Gallstone
- Biliary system tumor
- Biliary infection
- Gallbladder cancer
- Bile duct cancer
- Hemolytic anemia (type of Anemia)
- Pernicious anemia
- Malaria
- Stomach cancer
- Secondary liver cancer (type of Liver cancer)
- Pancreatic cancer
- Typhoid fever
- Leptospirosis
- Yellow fever
- Snake venom
The following drugs, medications, substances or toxins are some of the possible causes of Jaundice-like symptoms as a symptom. This list is incomplete and various other drugs or substances may cause your symptoms. Always advise your health care provider of any medications or treatments you are using, including prescription, over-the-counter, supplements, herbal or alternative treatments.
- Mercury
- Certain antibiotics
- Erythromycin
- Sufa
- Certain antidepressants
- Certain cancer drugs
- Aldomet
- Rifampin
- Steriods
- Certain anti-diabetic drugs
- Chlorpropamide
- Tolbutamide
- Oral contraceptives
- Testosterone
- Propylthiouracil
- Carbon tetrachloride - a cleaning chemical that causes liver damage if inhaled or swallowed.
- Snake venom
The following list of conditions have "Jaundice-like symptoms" or a similar symptom. This list may be inaccurate or incomplete. Always seek prompt professional medical advice about the cause of any symptom.
- Alcoholic liver disease ... jaundice
- Alveolar Hydatid Disease ... jaundice
- Anemia ... jaundice, yellow eyes, yellow skin
- Autoimmune Hepatitis ... jaundice
- Carotenemia ... yellow skin
- Cholangitis ... jaundice
- Cholecystitis ... jaundice
- Chronic Hepatitis C ... Jaundice, Yellow eyes, Yellow skin
- Cirrhosis of the liver ... Jaundice
- Classic galactosemia ... jaundice
- Congenital syphilis ... jaundice, yellow eyes, yellow skin
- Congenital Toxoplasmosis ... jaundice
- Eclampsia ... jaundice
- Favism ... jaundice
- Gallstones ... jaundice, yellow eyes, yellow skin
- Hemochromatosis ... jaundice
- Hemolytic disease of the newborn ... jaundice, neonatal jaundice
- Hepatitis ... jaundice, yellowing eyes, yellowing skin
- Hepatitis A ... jaundice, yellow eyes, yellow skin
- Hepatitis B ... jaundice, yellow eyes, yellow skin
- Hepatitis C ... jaundice, yellow eyes, yellow skin
- Hepatitis D ... jaundice, yellow eyes, yellow skin
- Hepatitis E ... jaundice, yellow eyes, yellow skin
- Hepatitis X ... jaundice, yellow eyes, yellow skin
- Hepatoma ... jaundice
- Hodgkin's Disease ... jaundice
- Jaundice ... yellow eyes, yellow skin
- Leptospirosis ... jaundice
- Liver cancer ... jaundice, yellow eyes, yellow skin
- Liver failure ... Jaundice
- Lymphoma ... jaundice
- Marburg virus ... jaundice
- Meningitis ... Jaundice
- Mononucleosis ... jaundice
- Myxedema ... yellow skin
- Neonatal Jaundice ... yellow eyes, yellow skin
- Pancreatic cancer ... jaundice, yellow eyes, yellow skin
- Primary biliary cirrhosis ... jaundice, yellow eyes, yellow skin
- Primary sclerosing cholangitis ... jaundice, yellow eyes, yellow skin
- Relapsing fever ... jaundice
- Septo-Optic Dysplasia ... jaundice
- Shingles ... small yellow skin blisters
- Sickle Cell Anemia ... jaundice, yellow eyes, yellow skin
- Thalassemia ... jaundice
- Viral Hepatitis ... jaundice, yellowing eyes, yellowing skin
- Viral meningitis ... Jaundice
- Weil's syndrome ... jaundice
- Wilson's Disease ... jaundice, yellow eyes, yellow skin
- Yellow fever ... jaundice, yellow eyes, yellow skin
- Zellweger Syndrome ... Jaundice
The following list of conditions have "Jaundice-like symptoms" or a similar complication. The distinction between a symptom and complication is not always clear, and conditions mentioning this symptom as a complication may also be relevant. This list may be inaccurate or incomplete. Always seek prompt professional medical advice about the cause of any symptom.
- Autoimmune Hepatitis ... jaundice
- Cirrhosis of the liver ... jaundice
- Eclampsia ... jaundice
- Fascioliasis ... jaundice
- Hemochromatosis ... jaundice
- Hepatitis A ... jaundice
- Hepatitis B ... jaundice
- Hepatitis C ... jaundice
- Hepatitis D ... jaundice
- Hepatitis E ... jaundice
- Hepatitis X ... jaundice
- Hepatoma ... jaundice
- Hodgkin's Disease ... jaundice
- Liver cancer ... jaundice
- Malaria ... jaundice
- Premature Birth ... neonatal jaundice
- Primary sclerosing cholangitis ... jaundice
- Q fever ... jaundice
- Rhesus isoimmunisation ... neonatal jaundice
- Sickle Cell Anemia ... jaundice
- Toxoplasmosis ... neonatal jaundice
- Weil's syndrome ... jaundice
- Yellow fever ... jaundice
RISK FACTORS
Gallbladder disease and gallstones.
Cirrhosis of the Liver and other liver diseases.
TREATMENT
DIAGNOSIS
Organizing the differential diagnosis by prehepatic, intrahepatic, and posthepatic causes may help make the work-up more manageable.
Prehepatic causes of jaundice include hemolysis and hematoma resorption, which lead to elevated levels of unconjugated (indirect) bilirubin.
Intrahepatic disorders can lead to unconjugated or conjugated hyperbilirubinemia. The conjugated (direct) bilirubin level is often elevated by alcohol, infectious hepatitis, drug reactions, and autoimmune disorders.
Posthepatic disorders also can cause conjugated hyperbilirubinemia. Gallstone formation is the most common and benign posthepatic process that causes jaundice; however, the differential diagnosis also includes serious conditions such as biliary tract infection, pancreatitis, and malignancies.
The laboratory work-up should begin with a urine test for bilirubin, which indicates that conjugated hyperbilirubinemia is present. If the complete blood count and initial tests for liver function and infectious hepatitis are unrevealing, the work-up typically proceeds to abdominal imaging by ultrasonography or computed tomographic scanning. In a few instances, more invasive procedures such as cholangiography or liver biopsy may be needed to arrive at a diagnosis.
QUESTIONS YOUR MIDWIFE OR HEALTH CARE PROVIDER MAY ASK?
Jaundice is a condition produced when excess amounts of bilirubin circulating in the blood stream dissolve in the subcutaneous fat (the layer of fat just beneath the skin), causing a yellowish appearance of the skin and the whites of the eyes. With the exception of normal newborn jaundice in the first week of life, all other jaundice indicates overload or damage to the liver, or inability to move bilirubin from the liver through the biliary tract to the gut.
Your midwife or health care provider will perform a physical examination. To help diagnose the cause of yellow skin, your midwife or health care provider will ask medical history questions, such as:
- Is the inside of the mouth (mucous membranes) yellow?
- Are the eyes yellow?
- When did the jaundice start?
- Has the jaundice occurred repeatedly?
- What other symptoms are present?
The following diagnostic tests may be performed by your health care provider:
- Blood serum bilirubin.
- Liver function tests and cholesterol.
- Prothrombin time.
- Complete blood count (CBC).
- Ultrasound of the abdomen.
- Liver biopsy.
- Urine and fecal urobilinogen.
PATHOPHYSIOLOGY
The classic definition of jaundice is a serum bilirubin level greater than 2.5 to 3 mg per dL (42.8 to 51.3 µmol per L) in conjunction with a clinical picture of yellow skin and sclera. Bilirubin metabolism takes place in three phases--prehepatic, intrahepatic, and posthepatic. Dysfunction in any of these phases may lead to jaundice.
PREHEPATIC PHASE: The human body produces about 4 mg per kg of bilirubin per day from the metabolism of heme. Approximately 80 percent of the heme moiety comes from catabolism of red blood cells, with the remaining 20 percent resulting from ineffective erythropoiesis and breakdown of muscle myoglobin and cytochromes. Bilirubin is transported from the plasma to the liver for conjugation and excretion.
INTRAHEPATIC PHASE: Unconjugated bilirubin is insoluble in water but soluble in fats. Therefore, it can easily cross the blood-brain barrier or enter the placenta. In the hepatocyte, the unconjugated bilirubin is conjugated with a sugar via the enzyme glucuronosyltransferase and is then soluble in the aqueous bile.
POSTHEPATIC PHASE: Once soluble in bile, bilirubin is transported through the biliary and cystic ducts to enter the gallbladder, where it is stored, or it passes through Vater's ampulla to enter the duodenum. Inside the intestines, some bilirubin is excreted in the stool, while the rest is metabolized by the gut flora into urobilinogens and then reabsorbed. The majority of the urobilinogens are filtered from the blood by the kidney and excreted in the urine. A small percentage of the urobilinogens are reabsorbed in the intestines and re-excreted into the bile.
DIAGNOSTIC PROCEDURES
MRI: An MRI (or magnetic resonance imaging) scan is a radiology technique which uses magnetism, radio waves, and a computer to produce images of body structures. The MRI scanner is a tube surrounded by a giant circular magnet. The patient is placed on a moveable bed which is inserted into the magnet. The magnet creates a strong magnetic field which aligns the protons of hydrogen atoms, which are then exposed to a beam of radio waves. This spins the various protons of the body, and they produce a faint signal which is detected by the receiver portion of the MRI scanner. The receiver information is processed by a computer, and an image is then produced. The image and resolution produced by MRI is quite detailed and can detect tiny changes of structures within the body. For some procedures, contrast agents such as gadolinium are used to increase the accuracy of the images.
CAT SCAN: A computerized axial tomography scan is more commonly known by its abbreviated name, CAT scan or CT scan. It is an x-ray procedure which combines many x-ray images with the aid of a computer to generate cross-sectional views and, if needed, three-dimensional images of the internal organs and structures of the body. A CAT scan is used to define normal and abnormal structures in the body and/or assist in procedures by helping to accurately guide the placement of instruments or treatments. A large donut-shaped x-ray machine takes x-ray images at many different angles around the body. These images are processed by a computer to produce cross-sectional pictures of the body. In each of these pictures the body is seen as an x-ray "slice" of the body, which is recorded on a film. This recorded image is called a tomogram. "Computerized Axial Tomography" refers to the recorded tomogram "sections" at different levels of the body.
Imagine the body as a loaf of bread and you are looking at one end of the loaf. As you remove each slice of bread, you can see the entire surface of that slice from the crust to the center. The body is seen on CAT scan slices in a similar fashion from the skin to the central part of the body being examined. When these levels are further "added" together, a three-dimensional picture of an organ or abnormal body structure can be obtained.
ULTRASOUND: An ultrasound test is a radiology technique, which uses high-frequency sound waves to produce images of the organs and structures of the body. The sound waves are sent through body tissues with a device called a transducer. The transducer is placed directly on top of the skin, which has a gel applied to the surface. The sound waves that are sent by the transducer through the body are then reflected by internal structures as "echoes." These echoes return to the transducer and are transmitted electrically onto a viewing monitor. The echo images are then recorded on a plane film and can also be recorded on videotape. After the ultrasound, the gel is easily wiped off.
The technical term for ultrasound testing and recording is "sonography." Ultrasound testing is painless and harmless. Ultrasound tests involve no radiation and studies have not revealed any adverse effects.
LAPAROSCOPY: Laparoscopy is the use of a viewing tube called a laparoscope to see inside of the abdomen and pelvis. Laparoscopy can be performed for the diagnosis and surgical treatment of conditions within the belly. Through a very small incision in the abdominal cavity instruments can be inserted to perform the various steps in the procedure. The abdominal cavity is distended and made visible by the instillation of absorbable gas (typically, carbon dioxide). Most patients receive general anesthesia during the procedure.
Laparoscopy comes from two Greek words. The first is lapara, which means "the soft parts of the body between the rib margins and hips," or, more simply, the "flank or loin." The other Greek word is skopein, which means "to see or view or examine." Skopein has become -scope in English.
The technique of laparoscopy was developed in the beginning of the 20th century and found use mainly in Europe. The procedure has undergone rapid development in recent years, thanks to the efforts of both European and American surgeons and endoscopists. Laparoscopy has been used for years extensively by gynecologists for the diagnosis of diseases of the ovary and uterus.
The advantages of laparoscopy include a much shortened post-operative period and less post-operative pain. The avoidance of large abdominal incisions decreases some of the post-operative complications related to the heart and lungs. In addition, recent studies show decreased mortality with some laparoscopic procedures, such as cholecystectomy (removal of the gallbladder), as compared to the old open surgical procedures.
Laparoscopic surgery entered a new era in the late 1980s when removal of the gallbladder by laparoscopic techniques was developed, again by European surgeons. Fiberoptic instruments and video cameras have come to allow procedures on the smallest of structures.
Today, the use of laparoscopy has been extended to surgical procedures involving the appendix, colon, uterus, repair of hiatal hernias, and more. The procedure has come full circle from one of diagnosis to what is now known as "minimally invasive" surgery.
CHOLESCINTIGRAPHY: Cholescintigraphy is a test done by nuclear medicine physicians to diagnose obstruction of the bile ducts (for example, by a gallstone or a tumor), disease of the gallbladder, and bile leaks. It sometimes is referred to as a HIDA scan or a gallbladder scan.
ERCP: ERCP is a diagnostic test to examine the duodenum (the first portion of the small intestine), the papilla of Vater (a small nipple-like structure with openings leading to the bile ducts and the pancreatic duct), the bile ducts, the gallbladder and the pancreatic duct. The procedure is performed by using a long, flexible, viewing instrument (a duodenoscope) about the diameter of a pen. The duodenoscope is flexible and can be directed and moved around the many bends of the stomach and intestine. Two types of duodenoscopes are currently available. A fiber-optic duodenoscope uses a thin fiber-optic bundle to transmit images to the lens at the viewing end of the instrument. A videoscope uses a thin wire with a chip at the tip of the instrument to transmit images to a TV screen. The duodenoscope is inserted through the mouth, to the back of the throat, down the food pipe, through the stomach and into the first portion of the small intestine (duodenum). Once the papilla of Vater is identified, a small plastic catheter (cannula) is passed through an open channel of the duodenoscope into the papilla of Vater, and into the bile ducts and/or the pancreatic duct. Contrast material (dye) is then injected and x-rays are taken of the bile ducts and the pancreatic duct. The open channel also allows other instruments to be passed through it in order to perform biopsies, to insert plastic or metal tubing to relieve obstruction of bile ducts caused by cancer or scarring, and to perform incision by using electrocautery (electric heat). For further information on the anatomy and physiology of bile production (by the liver) and circulation, please visit the webpage about GALLBLADDER DISEASE.
The liver is a large solid organ located beneath the right diaphragm. The liver produces bile, which is stored in the gallbladder (a small sac located beneath the liver). After meals, the gallbladder contracts and empties the bile through the cystic duct, into the bile ducts, through the papilla of Vater, and into the intestine to help with digestion. The pancreas is located behind the stomach. It also produces digestive juice which drains through the pancreatic duct into the papilla of Vater, and into the intestine. See THE LIVER for more information.
TREATMENT
The cause of jaundice must be determined before treatment can be given. Follow prescribed therapy to treat the underlying cause.
MEDICATIONS
Medications, including vitamin B-12 injections will be given upon determination of the cause of jaundice. Jaundice is a symptom of other problems that have their own treatment and prevention strategies.
SURGERY
Surgery may be required after the cause is determined (such as gallbladder or tumor removal or liver transplant options or repair of tissues.
OTHER TREATMENT OPTIONS
To prevent or relieve mild physiologic jaundice in newborn babies, feed babies frequently and don't let them become dehydrated. Newborns may need to be treated with sunlight (at home) or ultraviolet (UV) light therapy (in a hospital) to help breakdown bilirubin for removal by the infant's liver. See Neonatal Jaundice for more information about symptoms, prevention and treatment.
With jaundice, the important thing is to prevent kernicterus - toxic levels of bilirubin accumulating in the brain. Early identification and treatment of jaundice will usually prevent kernicterus, whatever the cause.
HOLISTIC & NUTRITIONAL RECOMMENDATIONS
Eat only raw vegetables and fruits for one week. Then eat a diet consisting of 75 percent raw food for a month. Take fresh lemon enemas daily during this period. See Enemas for more information.
Drink the following juices: lemon juice and water, beet and beet greens, and dandelion or black radish extract. All are good for rebuilding and cleansing the liver. Rub the body with lemon slices.
Never consume raw or undercooked fish, meat, or poultry. All raw fish pose a risk of infection from bacteria, parasites, and viruses.
Do not consume any alcohol. Alcohol places a great strain on the liver, which can aggravate the condition further.
If jaundice is caused by hemolytic anemia, where the red blood cells disintegrate before they become old, insufficient vitamin E is part of the problem. Vitamin E strengthens these red blood cells. Additional nutrients are needed to support the building of red blood cells. Vitamin E, with mixed tocopherols, 400-800 IU daily for hemolytic anemia.
During hepatitis, jaundice can be avoided or treated with large amounts of choline and vitamin C. These supplements should be added for all jaundice conditions, since the liver needs extra support to carry out its detoxifying function at this time. Choline supports liver function and is necessary for lecithin production, a substance which breaks down fats and oils. Vitamin C is used in the treatment of viral hepatitis. It also reduces the effects of toxins on the body and helps relieve jaundice. During acute attacks of jaundice, the need for vitamin C increases dramatically. If diarrhea occurs as a result of high vitamin C intake, reduce dosage. Choline, 1,000 mg daily in divided doses and Vitamin C, with bioflavonoids, 1,000 mg every few hours during acute liver problems, once daily for jaundice treatment.
If spasming of the bile duct causes jaundice, nutrients for nerve support and relaxation are necessary. These include calcium, magnesium and vitamin B6. Vitamin B6, 50 mg, Calcium, 1,200 mg, Magnesium, 600 mg daily.
Apply hot compresses to the liver area. Use whole cabbage leaves instead of cloth compresses. One traditional method of making a cabbage poultice is to cut out the midrib of a leaf and iron it, placing it while still hot on the area to be treated. Romans used cabbage leaves, eaten raw or cooked to aid digestion and aid in the breakdown of toxins in the liver.
Bedrest, warmth and diet are essential for recovery.
Two to three times a week take a wheat germ bath. Put 2 pounds of wheat germ in a cotton pouch, tie open end with a string and attach to the water faucet so that the bag is immersed in the water.
Daily, wash the whole body with a cotton cloth moistened with a mixture of 2 quarts water with 1/2 quart apple cider vinegar.
Nursing frequently helps the baby's intestinal tract excrete broken-down red blood cells, which cause jaundice. It also prevents dehydration, which is important when treating jaundice.
Place the baby's crib near natural light. Five minutes of early morning sunlight exposure daily, covering the baby's eyes, will help break down the bilirubin which causes jaundice.
HERBS
Detoxification of the liver and gall-bladder is necessary to alleviate jaundice permanently.
Black radish juice and some other kinds of radishes are excellent for jaundice. Make fresh black radish juice, with the black skin on, and drink 1 tablespoon diluted in water three times daily.
Beet leaves and roots rejuvenate and rebuild the liver. Add 1 cup of boiling water to 1 teaspoon of leaves and roots, steep and drink twice daily.
Burdock root and red clover aid in cleansing the blood.
Dandelion extract aids in proper liver function. Stimulate the gall-bladder and liver with a dandelion, silverweed and black radish juice therapy. Drink 1 tablespoon of dandelion juice mornings and evenings for a week, then silverweed for a week and the third week black radish juice.
Silymarin, an active flavonoid extracted from the her milk thistle, is known to repair damaged tissues in the liver. As a prevention, for adults and expectant mothers, cleanse with dandelion leaf salad and tea of the roots. Be sure to include 2 tablespoons of milk thistle and artichoke juice to strengthen liver tissue.
Other useful herbs that support liver functions: stinging nettle, St. John's wort, boldo leaves, birch leaves, fennel, horsetail, Irish moss, rose hips, plantain, centaury, chamomile, celandine, angelica and blackthorn. Any of these can be made into healing teas by pouting 1 cup of boiling water over 1 tsp. of herbs and steeping for ten minutes. Take 1 cup three times daily for two weeks.
More useful herbs: Artemisia, Barberry, Basil Thyme, Bearbind, Bogbean, Chicory, Corn, Couch Grass, Dodder, Fringe Tree, Gentian, Gotu Kola, Holly, Licorice, Lovage, Phyllanthus, Pineapple, Polypody, Self-Heal, Skullcap, Sweet Violet, Teasel, Turmeric, Vervain, Wild Strawberries, Wormwood.
NUTRITIONAL RECOMMENDATIONS
Nutrients Supplement Suggested Dosage Comments Very Important Burdock root or red clover As directed on label. Aid in cleansing the blood. Dandelion extract As directed on label. Aids in proper liver function. Milk Thistle
Or
Liv-R-Actin from Nature's PlusAs instructed on label. Contains silymarin, an active flavonoid extracted from the milk thistle herb. It is known to repair damaged tissues in the liver. Liv-R-Actin from Nature's Plus is a good source of silymarin. L-Glutathione
And
L-Methionine500 mg each daily, on an empty stomach. Take with water or juice. Do not take with milk. Take with 50 mg vitamin B6 and 100 mg vitamin C for better absorption. Substances that work together to protect the liver. See Amino Acids for more information.
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
ALL jaundice in an infant, child, or adult should be evaluated. Always call your midwife or health care provider if jaundice is present.
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch
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