IntroductionJaundice(JAWN-dis) was once called the "morbus regius" (the regal disease) in the belief that only the touch of a king could cure it.
"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."
When red blood cells are removed from the bloodstream, hemoglobin, the molecule in red cells that carries oxygen, is broken down into bilirubin. The bilirubin is carried to the liver and excreted into the intestine as a component of bile.
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 physiologic jaundice in the newborn (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.
JAUNDICE IN AN INFANT, CHILD, OR ADULT SHOULD ALWAYS BE MEDICALLY EVALUATED.
Newborn jaundice is common and unless associated with an abnormal condition will clear without treatment. Another condition called Gilbert's syndrome is a hereditary condition in which mild jaundice develops during times of stress. This condition, once recognized, requires no further treatment or evaluation. There are also other more rare hereditary causes of elevated bilirubin levels. All other jaundice is the result of an underlying disease, condition, or toxicity.
The liver changes bilirubin so that it can be eliminated from the body. If, however, the liver is functioning poorly, as occurs during some infections, or the tubes which transport the bilirubin to the gut are blocked, this changed bilirubin may accumulate in the blood and also cause jaundice. When this occurs, the changed bilirubin (called conjugated bilirubin), appears in the urine and turns the urine brown. This brown urine is an important clue that the jaundice is not "ordinary". Jaundice due to conjugated bilirubin is always abnormal, frequently serious and needs to be investigated thoroughly and immediately.The feces, which normally eliminate bilirubin from the body, may turn grayish. Itching and abdominal pain may also be present.
Accumulation of bilirubin before it has been changed by the enzyme of the liver may be normal "physiologic jaundice". Physiologic jaundice begins on the 2nd or 3rd day, peaks on the 3rd or 4th day and then begins to disappear. However, there may be other conditions which cause an exaggeration of this type of jaundice, such as a more rapid than normal breakdown of red blood cells.
A yellow-to-orange color may be imparted to the skin by excessive intake of beta carotene, the orange pigment seen in carrots. People who consume large quantities of carrots or carrot juice or take beta carotene tablets may develop a distinctly yellow-orange cast to their skin. This condition is called hypercarotenemia or just carotenemia. Hypercarotenemia is easily distinguished from jaundice in that the whites of the eye (sclera) remain white, while people with true jaundice have a yellow sclera.
Common causes
In children:
- newborn jaundice (physiologic jaundice)
- breastfeeding jaundice
- viral hepatitis (hepatitis A, hepatitis B, hepatitis C, hepatitis D, and hepatitis E)
- hemolytic anemia
- congenital disorders of bilirubin metabolism (Gilbert's syndrome,
- Dubin-Johnson syndrome, Rotor's syndrome, or Crigler-Najjar syndromes)
- biliary atresia
- autoimmune hepatitis
- malaria
In adults:
- obstruction of the bile ducts (by infection, tumor or gallstones)
- viral hepatitis (hepatitis A, hepatitis B, hepatitis C, hepatitis D, and hepatitis E)
- drug-induced cholestasis (bile pools in the gallbladder because of the effects of drugs)
- drug-induced hepatitis (hepatitis triggered by medications, including erythromycin sulfa drugs, antidepressants, anti-cancer drugs, Aldomet, rifampin, steroids, chlorpropamide, tolbutamide, oral contraceptives, testosterone, propylthiouracil)
- biliary stricture
- alcoholic liver disease (alcoholic cirrhosis)
- pancreatic carcinoma (cancer of the pancreas)
- primary biliary cirrhosis
- ischemic hepatocellular jaundice (jaundice caused by inadequate oxygen or inadequate blood flow to the liver)
- intrahepatic cholestasis of pregnancy (bile pools in the gallbladder because of the pressure in the abdomen with pregnancy)
- hemolytic anemia
- congenital disorders of bilirubin metabolism (Gilbert's syndrome, Dubin-Johnson syndrome, Rotor's syndrome, or Crigler-Najjar syndromes)
- chronic active hepatitis
- autoimmune hepatitis
- malaria
