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What is Jaundice?
Jaundice is the medical term used to describe a yellowish discoloration of the skin and the white part of the eyes (the sclera), caused by an elevated level of bilirubin, a pigment naturally found in the blood.
There are many possible underlying causes of jaundice, but in the majority of cases, it is closely linked to the health and proper functioning of the liver, a condition referred to as hepatic jaundice.
It is worth noting that a great many perfectly healthy newborns develop a mild degree of jaundice during their first week of life. This is an extremely common and generally harmless phenomenon that tends to resolve spontaneously and quickly on its own (click here to learn more about newborn jaundice). That said, jaundice can occur at any age, and in some cases it can be a warning sign of a more serious underlying condition, such as:
- blood disorders,
- genetic syndromes,
- liver diseases, such as hepatitis or liver cirrhosis,
- blockage of the bile ducts (cholestasis),
- infections,
- certain medications.
Reaching an accurate diagnosis generally requires laboratory testing, often supported in many cases by imaging studies of the liver and surrounding structures.
As an interesting side note, it is worth mentioning that eating excessive amounts of carrots can cause the skin to take on a yellowish-orange tint, a phenomenon known as carotenemia. This is, however, in no way related to true jaundice and does not involve any change in the color of the eyes.
Understanding Bilirubin
Red blood cells that have become damaged or have simply reached the natural end of their life span are continuously removed from circulation, a process carried out largely by the spleen. During this process, hemoglobin (the molecule within red blood cells responsible for chemically binding and transporting oxygen) is broken down and converted into a waste product, a greenish-yellow pigment known as bilirubin.
This bilirubin is then transported through the bloodstream to the liver, where it undergoes a chemical transformation that prepares it to be excreted into the intestine as part of bile, the digestive fluid produced by the liver. From there, it is ultimately eliminated from the body through the stool, giving normal stool its characteristic brown color.
When bilirubin is not excreted into bile quickly enough, whatever the underlying reason, it begins to accumulate within the bloodstream. From there, it gradually deposits within the skin and other tissues, producing the characteristic yellowish discoloration that defines jaundice.
Causes
Excess bilirubin in the blood can result from a problem occurring at any one of three distinct stages: before the liver has a chance to process the bilirubin, during the liver’s processing of bilirubin, or after this processing has already taken place. This distinction forms the basis for classifying jaundice into three main categories.
Pre-Hepatic Jaundice
This form of jaundice occurs when, for one reason or another, the destruction of red blood cells is accelerated beyond the normal rate, resulting in an increased production and circulation of bilirubin that overwhelms the liver’s normal processing capacity.
Possible causes of this accelerated red blood cell breakdown include:
- malaria (an infection transmitted through mosquito bites),
- sickle cell anemia (a genetic condition that causes red blood cells to develop an abnormal shape and structure),
- thalassemia (Mediterranean anemia) (a similar genetic blood disorder that is relatively common Mediterranean regions).
Hepatic Jaundice
Symptoms of this type of jaundice arise when a condition directly affects the liver itself, impairing its normal ability to effectively process and eliminate bilirubin from the bloodstream.
The most common causes of hepatic jaundice include:
- viral hepatitis
- liver damage resulting from excessive alcohol consumption
- leptospirosis (a bacterial infection)
- infectious mononucleosis
- drug or toxin-induced liver injury, for example from an overdose of acetaminophen (paracetamol)
- Gilbert’s syndrome
- liver cancer
- and several other liver conditions
In Gilbert’s syndrome specifically, bilirubin levels are only mildly elevated above the normal range, usually not high enough to cause visible jaundice under most circumstances. This condition, which in some cases runs in families, is most often diagnosed incidentally in young adults during routine blood testing performed for unrelated reasons. Importantly, Gilbert’s syndrome does not cause any symptoms or health problems and is considered a benign, harmless variation of normal liver function.
Post-Hepatic Jaundice
This category of jaundice occurs when the system responsible for transporting bile out of the liver and into the intestine becomes damaged or obstructed, for example due to:
- gallstones blocking the bile ducts,
- pancreatic cancer or cancer of the gallbladder,
- pancreatitis (inflammation of the pancreas).
Newborn (Neonatal) Jaundice
A particular and very common form of jaundice occurs specifically in newborn babies. Given the unique characteristics and management considerations for this condition, we recommend referring to our dedicated, in-depth article on newborn jaundice for complete information.
Risk Factors
Hepatic and post-hepatic jaundice tend to be more common among middle-aged and older adults, while pre-hepatic jaundice can potentially affect individuals of any age, including children.
Among the recognized risk factors for developing jaundice are:
- being overweight or obese, which increases the risk of fatty liver disease and related liver damage
- excessive alcohol consumption, a well-established risk factor for liver damage and cirrhosis
- behaviors that increase the risk of exposure to and infection with hepatitis viruses, such as unprotected sexual contact or sharing needles
Symptoms
The characteristic yellowish discoloration caused by jaundice primarily affects the skin and the white portion of the eyes (sclera). In addition to this, urine often appears darker than usual, since excess bilirubin circulating in the blood is, in these cases, partly eliminated through the kidneys and excreted in the urine.
Patients with jaundice may also experience:
- itching (pruritus), which typically improves and resolves as the underlying liver condition improves.
- pale, lighter-colored stools than usual, resulting from reduced bilirubin reaching the intestine.
Any additional symptoms that may accompany jaundice largely depend on the specific underlying disease responsible for it. For example:
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tumors affecting the liver, pancreas, or bile ducts may cause fatigue, unexplained weight loss, or, in some cases, may present with no other symptoms at all beyond the jaundice itself.
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hepatitis can cause nausea and vomiting, significant fatigue, and general malaise.
It is worth reiterating an important distinction here: the skin of individuals who consume a diet particularly rich in beta-carotene (a substance found abundantly in carrots, pumpkins, and certain types of melon, which serves as a precursor to vitamin A and is responsible for these foods’ characteristic orange color) can develop a mild yellowish tint to the skin. However, in these cases, the eyes remain completely white and unaffected. This phenomenon, known as carotenemia, is not true jaundice and is not in any way connected to liver problems or elevated bilirubin levels.
When to Call a Doctor
Whenever jaundice is noticed, whether in yourself, your child, or another family member, it is always important to contact a doctor promptly so that the underlying condition responsible for this symptom can be properly and promptly diagnosed. Jaundice should never be ignored or assumed to be harmless without proper medical evaluation, even when it appears mild.
Diagnosis
Since jaundice is a symptom that can potentially be caused by a wide range of quite different underlying conditions, reaching an accurate diagnosis often requires several steps and, in some cases, a range of diagnostic tests before a definitive answer can be established.
Medical history
The first and most essential step in the diagnostic process is a thorough medical history, during which the physician gathers detailed information directly from the patient, including:
- any additional symptoms that may be present alongside the jaundice,
- recent travel to foreign or tropical countries, which may raise suspicion for certain infectious causes,
- consumption of alcohol, medications, dietary supplements, or recreational substances,
- any occupational exposure to potentially hazardous chemicals or toxins.
Physical examination
Following the medical history, a physical examination is performed to identify any additional signs or symptoms that might point toward the underlying condition responsible for the jaundice, such as an enlarged liver or spleen, abdominal tenderness, or other relevant physical findings.
Laboratory and imaging tests
A number of laboratory and imaging tests prove particularly valuable in establishing the correct diagnosis, including:
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blood tests, which of course include direct measurement of bilirubin levels to precisely quantify the extent of the elevation, along with other important markers of liver function, such as liver enzymes (transaminases), as well as markers of inflammation and blood cell counts;
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urine tests, used to measure the amount of urobilinogen present, a breakdown product of bilirubin that can provide useful diagnostic clues about the underlying cause;
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imaging studies, aimed at further evaluating the liver and bile ducts, such as abdominal ultrasound, CT scan, or MRI, which can help identify structural abnormalities such as gallstones, tumors, or bile duct blockages;
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in select cases, a liver biopsy may ultimately be necessary, involving the removal of a small sample of liver tissue for detailed microscopic examination, particularly when the diagnosis remains unclear after other testing or when it is important to assess the extent of liver damage precisely.
Treatment
Because jaundice is fundamentally a symptom rather than a disease in its own right, the treatment approach always depends entirely on identifying and addressing the specific underlying cause responsible for the elevated bilirubin levels.
In more severe cases, particularly those involving very high bilirubin levels, treatment of the underlying condition may need to be accompanied by additional supportive measures, such as a blood transfusion, specifically aimed at removing a portion of the excess circulating bilirubin from the bloodstream. This measure is particularly important in preventing bilirubin from reaching dangerously high levels capable of causing damage to the central nervous system, a serious complication that is of particular concern in severe cases of newborn jaundice.
Beyond this specific supportive measure, treatment is entirely guided by the underlying diagnosis, whether that involves antiviral therapy for hepatitis, surgical removal of gallstones or a tumor obstructing the bile ducts, dietary and lifestyle modifications for alcohol-related liver disease, or specific management of an underlying blood disorder causing accelerated red blood cell destruction.
Frequently Asked Questions
What is jaundice?
Jaundice is a medical symptom characterized by the appearance of a yellowish discoloration of the skin and the white part of the eyes (sclera), caused by elevated levels of bilirubin in the blood.
When should I be worried about jaundice?
Any case of jaundice with an unknown or unclear cause should always be promptly reported to and investigated by a doctor. Among the benign, harmless causes of jaundice is Gilbert’s syndrome, a genetic condition with no meaningful health consequences that can occasionally cause mild jaundice, particularly during periods of illness, stress, or fasting. Excessive consumption of carrots, melon, or pumpkin can also lead to a change in skin color (carotenemia), which is likewise a completely benign phenomenon. Importantly, this condition does not affect the eyes and is in no way related to true jaundice, though it can sometimes be mistaken for it by patients or family members.
I’ve noticed a yellow tint to my skin and eyes. What could be causing this, and what should I do?
A yellow discoloration of the skin and eyes, known as jaundice, can indicate elevated bilirubin levels in the blood, which can result from a variety of underlying conditions, including liver disease or conditions involving increased destruction of red blood cells (hemolysis). It is important to consult a doctor for a proper clinical evaluation, which will likely include blood tests to determine the underlying cause and assess overall liver function.
When should I be concerned about yellow discoloration of my skin or eyes?
Symptoms that suggest a more serious underlying cause of jaundice include fever, severe fatigue, dark urine, pale or light-colored stools, itching, or abdominal pain. If any of these symptoms accompany jaundice, prompt medical evaluation is strongly recommended.
Is jaundice caused by Gilbert’s syndrome something to worry about?
Jaundice caused by Gilbert’s syndrome is generally not a cause for concern. Gilbert’s syndrome is a benign, inherited condition that causes a mild increase in blood bilirubin levels, particularly during periods of stress, fasting, or illness. This can result in a slight yellowish discoloration of the skin and eyes (jaundice), but it does not pose any serious health risks and does not require any specific treatment.
Is it possible for yellow discoloration of the eyes to be normal and not indicate any underlying health problem?
No, yellow discoloration of the eyes (jaundice) is never considered a normal finding, and when present, it almost always indicates elevated bilirubin levels in the blood. That said, jaundice can be caused by a wide range of underlying conditions, many of which are not serious, such as Gilbert’s syndrome. However, it can also indicate more significant problems affecting the liver, bile ducts, or red blood cells, which is why any occurrence of jaundice warrants proper medical evaluation to determine its exact cause.
Sources and Bibliography
- MSD Manuals. Approach to the Patient with Liver Disease: Jaundice
- National Institutes of Health (NIH). Jaundice
- NHS. Jaundice, licensed under the Open Government Licence (OGL)
