Jaundice

Jaundice is not a disease. Rather, it is a clinical presentation of an underlying problem.  The yellowish colouration of the eyes and skin is caused by a build up of bilirubin in the body tissues.  This is a pigment formed as a natural process when the oxygen carrying component of blood is broken down and decommissioned.  Any disease affecting the liver, bile ducts or break down of red blood cells can cause an excessive inappropriate accumulation of bilirubin leading to jaundice.

There are many causes for jaundice. A patient who develops jaundice must always be seen by a doctor who will take a detailed history, examine the patient and arrange for appropriate investigations.

Here are some of the main causes for Jaundice:

Viral Hepatitis

Hepatitis is inflammation of the liver and can present as jaundice.  This inflammation may be caused by several viruses, most commonly hepatitis A, hepatitis B and hepatitis C. Recently more viruses causing this condition have been discovered but less is known about them.

Symptoms of viral inflammation of the liver vary widely; apart from jaundice patients experience flu like symptoms, fever, headache, aching limbs, tiredness, loss of appetite, nausea and vomiting. Hepatitis A is transmitted through contaminated food and water. The virus is excreted in the faeces of an infected person and can survive for 3-4 hours outside the body.  Transmission of the virus is enhanced in conditions of poor sanitations and overcrowding.  Hepatitis A is generally self-limiting and does not persist in the bloodstream nor in the stools after the illness has resolved.  A vaccine against hepatitis A is available and will prevent 90% of people from getting the disease.

Hepatitis B and C are transmitted in the blood and other body fluids eg semen and breast milk.  Both viruses are very infectious and can be spread by sexual contact.  Other groups at high risk of getting hepatitis B include intravenous drug abusers, homosexuals and health care workers.

Most people with hepatitis B will become ill and their immune system will eventual ameliorate and expel the infection.  However 5-10% will go on to develop chronic hepatitis and another 5-10% will develop a carrier status where an asymptomatic status is present but the ability to infect persists.

The Hepatitis B vaccine is 3 separate injections over a period of 7 months and is 90% effective. 

Hepatitis C is much more likely to be transmitted in blood such as through intravenous drug abuse and blood transfusion. Hepatitis C is treatable is carefully tailored regimes are available after a diagnostic work up.

Gallstones

This is a common problem especially in adult females.  These stones can cause intermittent abdominal pain and can sometimes cause jaundice. This latter symptom occurs when a stone gets stuck in the bile duct system, blocking bilirubin from being excreted via the intestine.  These acute problems can resolve spontaneously and the gall bladder can then be surgically removed non-urgently.  However, sometimes gallstones can lead to infection in the gallbladder or in the bile duct which can sometimes lead to infection spreading throughout the body. This condition is more serious and will require immediate medical and surgical attention. 

Alcoholic Hepatitis

This can be an acute or chronic illness occurring as a result of liver cell damage by inappropriate excessive alcohol intake.  It is a reversible disease but can often go on to cause cirrhosis when the toxic agent is not discontinued.

Symptoms can include jaundice, nausea, loss of appetite, abdominal pain, an enlarged tender liver, fever and mental confusion.  The spectrum ranges from mild infection to serious complications resulting in critical illness and death. 

Malignancy

Cancer is a possible cause of jaundice especially in older people.  Jaundice in this situation can be caused by blockage in the excretion of bilirubin.  A tumour causing the blockage may reside in the liver, bile duct system, gall bladder or pancreas. 

There are also cases where jaundice is caused by excessive breakdown of red blood cells, there might be a malignancy in the blood or spleen.

Medications

Some medications can cause hepatitis as recognised or unrecognised side effects.  The jaundice in this case is usually mild and the illness nearly always resolves once the offending drug is discontinued.

Pregnancy

A rare cause of jaundice.  This can sometimes be associated with morning sickness. The reasons for development of jaundice are not clear but this is usually a mild illness with an excellent outlook.

What tests ?

Blood tests

These tests are very useful in a case of jaundice.  These will usually show abnormal patterns of liver enzymes such as a high bilirubin level.  Depending on the pattern of these enzymes, further tests may be necessary to make an accurate diagnosis

Imaging

An ultrasound scan may be arranged or a CT scan of the abdomen to check for gallstones or other structural abnormalities of the liver, gallbladder or bile ducts.

ERCP

An endoscopic retrograde cholangiopancreatography (ERCP) is an invasive tst requiring sedation.  It involves passing a flexible scope into the bile and pancreatic ducts via the small intestine and can be useful to demonstrate the nature of the blockage allowing delicate surgery and removing or bypass of the blockage removing the necessity for surgery.

Liver Biopsy

Sometimes a sample of liver tissue is required to help reach a diagnosis.  A liver biopsy can be undertaken under local anaesthesia to obtain a small sample of liver for microscopic analysis.  Sometimes this biopsy is undertaken under ultrasound or CT guidance.

Treatment

Treatment lies in diagnosing the underlying cause.  Some causes of jaundice are treatable and some are not.  A very high level of bilirubin can cause severe generalised itching.  There are drugs and topical treatments available to help alleviate itching.

Anyone experiencing a yellow change in skin colour should see a doctor for a diagnosis as specific treatment is often indicated.