Definition and Overview
Jaundice is a medical condition characterized by the yellowish pigmentation of the skin and the whites of the eyes. In some cases, it also affects the color of the mucus. This occurs due to a high level of bilirubin in the bloodstream.
Blood is one of the essential fluids needed by the body. Roughly 7% of a person’s weight is composed of blood, which can be platelets, white blood cells, and red blood cells, along with plasma. Blood is produced by the bone marrow, which is found in the bones of the arms and legs.
Platelets work with plasma proteins to initiate the clotting process, which is a critical step to preventing serious blood loss. White blood cells act as the body’s natural defense against pathogens while red blood cells transport oxygen to different cells.
To make sure the body uses only the optimum blood cells, they are renewed continuously with platelets and white blood cells having the shorter lifespan than red blood cells. In the course of being broken down, bilirubin, a yellow-colored substance that makes up the red blood cells, is also released. Bilirubin is then processed by the liver. Any problem in this process can leave an excessive amount of bilirubin in the bloodstream, which results in jaundice.
Causes of Condition
Jaundice can occur at any age and affect even newborns. Infant jaundice is one of the most common conditions affecting newborns, particularly if they are born pre-term. Experts believe that this occurs because the liver hasn’t fully matured that it cannot process bilirubin very well. However, it is expected that the discoloration will disappear over time. Nevertheless, babies are expected to stay in the hospital for a few days if the pediatrician has discovered that the level of bilirubin is high, which is more than 2.5mg/dL.
A baby may also develop jaundice while being breastfed as a component of the breast milk may affect the way the liver processes bilirubin in the bloodstream. However, this doesn’t have to mean that mothers need to stop breastfeeding as the problem can also clear itself up over time.
It’s a different case when jaundice happens after infancy. By then, it’s possible that an underlying condition, usually a problem in the liver, may be causing it. These include:
Liver cirrhosis – This is characterized by the formation of scarred tissues in the organ. Although many factors can lead to liver cirrhosis, including medications, alcohol consumption remains to be one of the most common causes. As the healthy tissue is replaced by the scarred one, the liver may eventually cease to function properly.
Liver cancer – This is a disease that involves the presence of malignant tumor or cells in the liver. It can be primary, which means the cancer originated in the organ, or secondary, which means the cancer begun elsewhere. Liver cirrhosis is a common risk factor for liver cancer.
Hepatitis – This is a medical term for inflammation of the liver. One of the most common causes of hepatitis is a virus, which means the infection can be contagious. The subtypes of this condition include (1) Hepatitis A, which is often mild when compared to the other types of hepatitis, (2) Hepatitis B, which is spread through contact with infected fluid including semen, and (3) Hepatitis C, which is acquired when the patient is exposed to contaminated blood. People with hepatitis B may also be susceptible to Hepatitis D. Hepatitis E, on the other hand, is spread through contaminated food and water.
The distinct symptom of jaundice is the yellowish pigmentation of the skin, eyes, and mucus membranes. This is then accompanied by other signs and symptoms such as:
- Lack of appetite
- Abdominal pain
- Muscle pain
- Joint pain
- Changes in urine and bowel movements
- Weight loss
Jaundice among infants should not be a cause for alarm if it occurs a few days after birth and at least two to three weeks at the start of breastfeeding. If the baby develops jaundice within a day after birth, it’s expected that the pediatrician will conduct more tests to determine the actual cause. If the discoloration occurs in children, teens, and adults, medical evaluation should be sought.
Who to See and Types of Treatments Available
Infant jaundice is treated and managed by a pediatrician while jaundice among adults is often handled by an internist.
Jaundice itself is easy to spot during the physical exam because of its distinct characteristic, which is the yellowing of the skin and whites of the eyes. However, tests will still be conducted to identify the cause of the condition.
A consultation often begins with a thorough physical exam. The doctor may feel the abdominal area to assess if there’s swelling or inflammation of the liver. He will also obtain the weight and temperature, as well as look into the medical history and activity of the patient before the symptoms were experienced.
The doctor may then request for tests, such as blood tests, that can provide information on how well the liver is functioning. Imaging tests such as ultrasounds and scans can be helpful in assessing structural changes of the liver. A biopsy, meanwhile, may be needed if the tests reveal the presence of tumors in the organ.
Normal infant jaundice usually doesn’t need any medical intervention, although a high level of bilirubin before discharge may compel the doctor to place the baby in a bili light to speed up the processing of the substance in the bloodstream.
Otherwise, the following treatments are recommended:
- Avoidance of alcohol
- Medications to eliminate the virus that causes the swelling
- Surgery including a liver transplant
- Cessation of medications that may be causing the condition
- Cancer treatment plan
- Removal of the blockage in the liver
Jaundice caused by hepatitis may be prevented by getting the vaccine, as well as by practicing safe sex, and making sure the food eaten is clean.
Berk P, Korenblat K. Approach to the patient with jaundice or abnormal liver tests In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 147.
Wheatley MA, Heilpern KL. Jaundice In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Mosby; 2014:chap 28.