Jaundice Full Details

[Phyliss Berard]

Jaundiceis 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.

Newborn jaundice (producing yellow skin) can have many causes, but the majority of these infants have a condition called physiological jaundice, a natural occurrence in the newborn due to the immature liver. This type of jaundice is short term, generally lasting only a few days. Jaundice should be evaluated by a physician until decreasing or normal levels of bilirubin are measured in the blood.

A chronic liver disease which causes damage to liver tissue, scarring of the liver (fibrosis; nodular regeneration), progressive decrease in liver function, excessive fluid in the abdomen (ascites), bleeding disorders (coagulopathy), increased pressure in the blood vessels (portal hypertension), and brain function disorders (hepatic encephalopathy). Excessive alcohol use is the leading cause of cirrhosis.

Using bili lights is a therapeutic procedure performed on newborn or premature infants to reduce elevated levels of bilirubin. If blood levels of bilirubin become too high, the bilirubin begins to dissolve in the body tissues, producing the characteristic yellow eyes and skin of jaundice. Bilirubin also has an affinity for brain tissue, where it can accumulate and cause permanent brain damage.

A small number of red blood cells in your body die each day, and are replaced by new ones. The liver removes the old blood cells. This creates bilirubin. The liver helps break down bilirubin so that it can be removed by the body through the stool.

Note: If your skin is yellow and the whites of your eyes are not yellow, you may not have jaundice. Your skin can turn a yellow-to-orange color if you eat a lot of beta carotene, the orange pigment in carrots.

Reviewed by: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

When red blood cells die, they leave behind bilirubin, a yellow-orange pigment in the blood. The liver filters bilirubin from the bloodstream to be removed in your stool. If too much is in your system or your liver is overloaded, it causes a buildup known as hyperbilirubinemia. This causes jaundice, where your skin and the whites of your eyes look yellow.

Newborn babies often get it. About 60% have jaundice, also known as icterus, within the first couple of days after birth. Adults can get it, too, although it's less common. See a doctor right away if you think you have jaundice. It could be a symptom of a liver, blood, or gallbladder problem.

This condition is when bile isn't able to drain into your intestines because of a blocked or narrow bile or pancreatic duct. This type of jaundice has a high death rate, so it's important to catch and treat it early.

Jaundice may have no symptoms. Any signs you have may depend on how quickly the condition is getting worse. Well-known symptoms are yellowing of the skin and jaundice eyes (also called scleral icterus). But there are others to watch for, including:

How long jaundice lasts depends on what's causing it and the treatment you need. If a medication is causing it, jaundice will fade after you stop taking it. If hepatitis is causing it, medications can be taken to treat the condition. If there is a blocked bile duct or gallstones, surgery may be required.

To get more information, your doctor will likely order blood tests to measure bilirubin and cholesterol levels and get a complete blood count (CBC). If you have jaundice, your level of bilirubin will be high. Your doctor may order other tests to find the cause of your jaundice and how severe it is, including:

Phototherapy uses a fluorescent white or blue-spectrum light that breaks down bilirubin so it can be released from the body. This treatment is used for newborns, but phototherapy has not been shown to be effective for treating jaundice in adults.

Unlike newborn jaundice, jaundice is not common in adults. It usually goes away on its own, but your doctor may recommend treatment if there is a condition causing it. If you have jaundice symptoms, including yellowish skin or eyes, flu-like symptoms, dark urine, or belly pain, talk to your doctor right away.

Hepatitis A is an inflammation of the liver caused by the hepatitis A virus (HAV). The virus is primarily spread when an uninfected (and unvaccinated) person ingests food or water that is contaminated with the faeces of an infected person. The disease is closely associated with unsafe water or food, inadequate sanitation, poor personal hygiene and oral-anal sex.

Unlike hepatitis B and C, hepatitis A does not cause chronic liver disease but it can cause debilitating symptoms and rarely fulminant hepatitis (acute liver failure), which is often fatal. WHO estimates that in 2016, 7134 persons died from hepatitis A worldwide (accounting for 0.5% of the mortality due to viral hepatitis).

Hepatitis A occurs sporadically and in epidemics worldwide, with a tendency for cyclic recurrences. Epidemics related to contaminated food or water can erupt explosively, such as the epidemic in Shanghai in 1988 that affected about 300 000 people (1). They can also be prolonged, affecting communities for months through person-to-person transmission. Hepatitis A viruses persist in the environment and can withstand food production processes routinely used to inactivate or control bacterial pathogens.

Geographical distribution areas can be characterized as having high, intermediate or low levels of hepatitis A virus infection. However, infection does not always mean disease because infected young children do not experience any noticeable symptoms.

Infection is common in low- and middle-income countries with poor sanitary conditions and hygienic practices, and most children (90%) have been infected with the hepatitis A virus before the age of 10 years, most often without symptoms (2). Infection rates are low in high-income countries with good sanitary and hygienic conditions. Disease may occur among adolescents and adults in high-risk groups, such as persons who inject drugs (PWID), men who have sex with men (MSM), people travelling to areas of high endemicity and in isolated populations, such as closed religious groups. In the United States of America, large outbreaks have been reported among persons experiencing homelessness. In middle-income countries and regions where sanitary conditions are variable, children often escape infection in early childhood and reach adulthood without immunity.

The hepatitis A virus is transmitted primarily by the faecal-oral route; that is when an uninfected person ingests food or water that has been contaminated with the faeces of an infected person. In families, this may happen though dirty hands when an infected person prepares food for family members. Waterborne outbreaks, though infrequent, are usually associated with sewage-contaminated or inadequately treated water.

Symptoms of hepatitis A range from mild to severe and can include fever, malaise, loss of appetite, diarrhoea, nausea, abdominal discomfort, dark-coloured urine and jaundice (a yellowing of the eyes and skin). Not everyone who is infected will have all the symptoms.

Adults have signs and symptoms of illness more often than children. The severity of disease and fatal outcomes are higher in older age groups. Infected children under 6 years of age do not usually experience noticeable symptoms, and only 10% develop jaundice. Hepatitis A sometimes relapses, meaning the person who just recovered falls sick again with another acute episode. This is normally followed by recovery.

Anyone who has not been vaccinated or previously infected can get infected with the hepatitis A virus. In areas where the virus is widespread (high endemicity), most hepatitis A infections occur during early childhood. Risk factors include:

Cases of hepatitis A are not clinically distinguishable from other types of acute viral hepatitis. Specific diagnosis is made by the detection of HAV-specific immunoglobulin G (IgM) antibodies in the blood. Additional tests include reverse transcriptase polymerase chain reaction (RT-PCR) to detect the hepatitis A virus RNA and may require specialized laboratory facilities.

There is no specific treatment for hepatitis A. Recovery from symptoms following infection may be slow and can take several weeks or months. It is important to avoid unnecessary medications that can adversely affect the liver, e.g. acetaminophen, paracetamol.

Hospitalization is unnecessary in the absence of acute liver failure. Therapy is aimed at maintaining comfort and adequate nutritional balance, including replacement of fluids that are lost from vomiting and diarrhoea.

Several injectable inactivated hepatitis A vaccines are available internationally. All provide similar protection from the virus and have comparable side effects. No vaccine is licensed for children younger than 1 year of age. In China, a live attenuated vaccine is also available.

The GHSS recommend shared and disease-specific country actions supported by actions by WHO and partners. They consider the epidemiological, technological, and contextual shifts of previous years, foster learnings across the disease areas, and create opportunities to leverage innovations and new knowledge for effective responses to the diseases. They call to scale up prevention, testing and treatment of viral hepatitis with a focus to reach populations and communities most affected and at risk for each disease, as well as addressing gaps and inequities. They promote synergies under a universal health coverage and primary health care framework and contribute to achieving the goals of the 2030 Agenda for Sustainable Development.

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