Jaundice

What is jaundice?

Jaundice is yellow discolouration of the skin and whites of the eyes caused by a build up of bilirubin. It is a sign rather than a disease, and the cause can lie before, within or after the liver. New jaundice in an adult always needs prompt assessment, and jaundice in a newborn requires urgent evaluation against age specific thresholds.

Causes

• Increased red cell breakdown, as in haemolysis
• Liver disease including hepatitis and cirrhosis
• Bile duct obstruction from gallstones or tumour
• Alcohol related liver injury
• Medicines and toxins
• Gilbert syndrome, a benign inherited variant
• Physiological newborn jaundice

Symptoms

• Yellowing of the whites of the eyes, often first
• Yellow skin tone
• Dark urine
• Pale or clay coloured stools
• Itching
• Fatigue and abdominal discomfort
• Fever if infection is present

Risk factors

• Excess alcohol use
• Viral hepatitis exposure
• Gallstone disease
• Certain medicines including some antibiotics
• Prematurity in newborns
• Inherited red cell disorders

Diagnosis

• Bilirubin measurement with split into conjugated and unconjugated
• Liver function tests and clotting studies
• Full blood count and haemolysis screen
• Abdominal ultrasound to assess ducts and liver
• Viral hepatitis serology
• MRCP or CT when obstruction is suspected

Treatment

• Directed entirely at the underlying cause
• Endoscopic or surgical relief of bile duct obstruction
• Antiviral treatment for viral hepatitis
• Stopping the causative medicine or alcohol
• Phototherapy for significant newborn jaundice
• Exchange transfusion in severe neonatal cases

Self care

• Do not self treat; jaundice always needs a cause identified
• Stop alcohol completely until assessed
• Avoid paracetamol above recommended doses and check all medicines
• Stay hydrated
• Keep a note of any new medicines or supplements started
• For newborns, feed frequently and follow midwife guidance

When to see a doctor

Book an appointment if:

• Any new yellowing of the skin or eyes in an adult
• Pale stools with dark urine
• Itching without a rash
• Recent travel or new medicines with yellowing
• A newborn still jaundiced after two weeks
• Fatigue with upper abdominal discomfort

Some symptoms need emergency care rather than an appointment. See the warning signs listed above.

Prevention

• Vaccinate against hepatitis A and B
• Limit alcohol
• Do not exceed paracetamol dosing
• Practise safe food and water hygiene when travelling
• Attend newborn checks so jaundice is measured against age thresholds

Outlook

Jaundice is a sign, so outlook depends entirely on its cause. Gilbert syndrome and physiological newborn jaundice are harmless. Gallstone obstruction and drug induced jaundice usually resolve completely once treated. Jaundice from advanced liver disease or malignancy carries a more serious outlook, which is why prompt assessment matters.

Related conditions

Common questions