Noticing a yellow tint to your skin or seeing the whites of your eyes turn yellow can be a deeply alarming experience. This yellowish discoloration, known as jaundice, is a clear and unmistakable sign that something is wrong within the body. It is crucial to understand that jaundice is not a disease in itself, but rather a visible signal of an underlying medical condition. It is caused by a buildup of a yellow substance called bilirubin in the blood. Because the potential causes of jaundice range from a mild, self-limiting viral infection to a serious blockage of the bile ducts or chronic liver disease, it is a symptom that should never be ignored and always warrants a prompt medical evaluation to determine the root cause.

Jaundice, known medically as icterus, is the yellowish or greenish pigmentation of the skin and the whites of the eyes (the sclera) due to high levels of bilirubin in the blood, a condition called hyperbilirubinemia.

To understand jaundice, it is essential to first understand bilirubin and how the body normally processes it.

• Bilirubin Production: Your body is constantly breaking down old red blood cells as part of a normal recycling process. When the hemoglobin from these old cells is broken down, it creates a yellow, toxic, fat-soluble waste product called unconjugated bilirubin.
• Liver Processing: This unconjugated bilirubin travels through the bloodstream to the liver, which acts as the body’s main processing and waste management plant. Inside the liver, a special enzyme attaches a chemical tag to the bilirubin in a process called conjugation. This makes the bilirubin non-toxic and water-soluble.
• Excretion: This new, “tagged” conjugated bilirubin is then excreted from the liver as a key component of bile. The bile flows through the bile ducts into the small intestine and is then eliminated from the body, primarily in the stool, giving it its characteristic brown color.

A helpful analogy is to think of this system as a sophisticated waste management plant.

• The breakdown of old red blood cells produces a constant stream of greasy, yellow “toxic sludge” (unconjugated bilirubin).
• This sludge is sent to the liver’s processing station. Here, specialized workers “package” the sludge by putting it into water-soluble containers (conjugation).
• This safe, packaged waste (conjugated bilirubin) is then shipped out of the plant through a network of drainage pipes (the bile ducts).
• Jaundice is what happens when this waste management system breaks down at any of its three main stages, causing the yellow bilirubin to back up and spill into the bloodstream, staining the body’s tissues.

In my experience, jaundice often worries patients because of the visible yellowing of the skin and eyes. But it’s a symptom, not a disease in itself.

The causes of jaundice are classified into three main categories based on where the problem in the bilirubin processing pathway occurs: before the liver, within the liver, or after the liver.

1. Pre-Hepatic Jaundice (Before the Liver)

In this type, the problem occurs before the blood gets to the liver. It is caused by any condition that leads to a rapid and massive breakdown of red blood cells (hemolysis). This produces unconjugated bilirubin faster than the healthy liver can keep up with processing it, causing the “toxic sludge” to overwhelm the system.

• Common Causes:
  • Hemolytic Anemias: Genetic disorders like sickle cell disease, thalassemia, and G6PD deficiency.
  • Malaria: The malaria parasite destroys red blood cells.
  • A large hematoma (a collection of clotted blood from an injury) breaking down.

2. Hepatic Jaundice (Within the Liver)

In this type, the problem is with the liver itself. The liver cells are damaged and have lost their ability to properly take up and conjugate the bilirubin.

• Common Causes:
  • Viral Hepatitis: Inflammation of the liver caused by infection with Hepatitis A, B, C, D, or E. This is a major cause of jaundice worldwide.
  • Alcoholic Liver Disease: Long-term, excessive alcohol consumption can cause severe liver inflammation (alcoholic hepatitis) and scarring (cirrhosis).
  • Drug-Induced Liver Injury: A wide range of medications can be toxic to the liver.
  • Autoimmune Hepatitis.
  • Gilbert Syndrome: A common, harmless genetic condition where the UGT enzyme works at a slightly slower pace, causing mild, fluctuating jaundice.

3. Post-Hepatic Jaundice (After the Liver)

In this type, also known as obstructive jaundice, the liver processes the bilirubin correctly, but the “drainage pipes”, the bile ducts, are blocked. This prevents the bile containing the conjugated bilirubin from being excreted.

• Common Causes:
  • Gallstones: A gallstone passing out of the gallbladder can become lodged in the common bile duct, creating a blockage. This is a very common cause.
  • Tumors: A tumor of the pancreas, gallbladder, or bile duct can compress and block the bile duct.
  • Bile Duct Strictures: Scarring and narrowing of the bile ducts, which can be caused by a condition like primary sclerosing cholangitis.

In my experience, in adults, the most common causes are liver dysfunction or biliary obstruction, while in newborns it’s usually due to immature liver function.

A person develops jaundice as a sign of one of the many underlying conditions described above. It is not contagious itself, but some of its primary causes, like viral hepatitis, are.

The risk factors for developing a condition that causes jaundice include:

• Exposure to viral hepatitis through contaminated food or water (Hepatitis A and E) or through infected blood and body fluids (Hepatitis B and C).
• Chronic, heavy alcohol consumption.
• Having risk factors for gallstones, such as being female, being overweight, and being over the age of 40.
• Having a pre-existing inherited blood disorder like sickle cell disease.

In my experience, jaundice develops when there’s excessive production of bilirubin or the liver can’t properly process and excrete it, this can result from liver disease, infections, or blockages.

The primary sign of jaundice is the visible discoloration.

• Yellowing of the skin and, most noticeably, the sclera (the whites of the eyes).

Other associated signs and symptoms can provide important clues to the underlying cause:

• Dark, Tea-Colored Urine: When conjugated (water-soluble) bilirubin builds up in the blood, it is filtered by the kidneys and excreted, making the urine very dark.
• Pale, Clay-Colored Stools: If the bile ducts are blocked (obstructive jaundice), bilirubin cannot reach the intestines to give the stool its normal brown color.
• Pruritus (Itching): Severe, widespread itching is a common symptom of obstructive jaundice, caused by the buildup of bile salts in the skin.
• Accompanying Symptoms of the Underlying Disease:
  • Flu-like symptoms, such as fever, fatigue, and muscle aches, often precede the jaundice in cases of acute viral hepatitis.
  • Severe upper right abdominal pain that comes in waves is characteristic of a gallstone blockage.
  • Unintentional weight loss may suggest an underlying cancer.

A Special Note on Newborn Jaundice

It is very common for newborn babies to develop a mild, transient jaundice a few days after birth. This physiological jaundice occurs because the baby’s immature liver is not yet efficient at processing bilirubin. This is normal and usually resolves on its own or with phototherapy. This is different from the pathological jaundice caused by a more serious condition like HDN or biliary atresia, which appears earlier, is more severe, and requires urgent medical treatment.

Clinically, I look for associated signs like abdominal pain, fever, weight loss, or fatigue, which help guide me toward the underlying diagnosis.

When a person develops jaundice, the entire diagnostic process is focused on finding the underlying cause.

1. Medical History and Physical Exam: A doctor will ask detailed questions about symptoms, medications, alcohol use, and potential exposures. They will perform a physical exam to check for an enlarged or tender liver or other signs of chronic liver disease.
2. Blood Tests: A comprehensive panel of blood tests is the crucial first step in the investigation.
   • Liver Function Tests (LFTs): This panel is essential. It will measure:
     • Total, conjugated, and unconjugated bilirubin levels. The pattern of elevation helps to differentiate the cause. For example, pre-hepatic jaundice will have high unconjugated bilirubin, while post-hepatic jaundice will have high conjugated bilirubin.
     • Liver Enzymes (ALT, AST, ALP): The pattern of enzyme elevation can indicate whether the primary problem is liver cell damage (hepatitis) or bile duct obstruction (cholestasis).
   • Viral Hepatitis Serologies: Blood tests to check for acute or chronic infection with Hepatitis A, B, and C.
   • Complete Blood Count (CBC): To check for anemia, which would suggest a hemolytic cause.
3. Imaging Studies:
   • Abdominal Ultrasound: This is the best initial imaging test for a jaundiced patient. It is non-invasive and excellent for looking for gallstones or a dilation of the bile ducts, which would indicate a blockage. It can also assess the size and texture of the liver.
   • CT Scan or MRCP (Magnetic Resonance Cholangiopancreatography): These more advanced imaging studies may be ordered to get a highly detailed look at the liver, pancreas, and bile ducts if a tumor or a complex blockage is suspected.
4. Liver Biopsy: If the cause of the jaundice remains unclear after blood tests and imaging, a liver biopsy may be performed to obtain a tissue sample for a definitive diagnosis of a specific liver disease.

In my experience, a thorough history including drug use, alcohol intake, and recent travel often offers the best clues for identifying the underlying cause.

Jaundice itself is a symptom and is not treated directly in adults. The treatment is always directed at the specific underlying disease that is causing the high bilirubin level.

The treatment plan will be tailored to the specific diagnosis.

• For Viral Hepatitis: Treatment for Hepatitis A is supportive, as the infection resolves on its own. Chronic Hepatitis B and C are treated with specific antiviral medications.
• For Gallstone Obstruction: The treatment is a procedure called an ERCP (Endoscopic Retrograde Cholangiopancreatography) to endoscopically remove the stone from the bile duct, often followed by surgery to remove the gallbladder.
• For Alcoholic Liver Disease: The cornerstone of treatment is complete abstinence from alcohol and nutritional support.
• For Drug-Induced Liver Injury: The primary treatment is to stop the offending medication.
• For Autoimmune Diseases: Treatment involves immunosuppressive medications.
• For Cancer: Treatment will be managed by an oncologist and may involve surgery, chemotherapy, or radiation.

While the underlying condition is being treated, medications like cholestyramine can sometimes be prescribed to help relieve the severe itching associated with obstructive jaundice.

Clinically, I’ve seen that hydration, rest, and avoiding alcohol or certain medications are often key parts of recovery, especially in viral or drug-induced hepatitis.

Jaundice, the yellowing of the skin and eyes, is a clear and unmistakable sign that the body’s bilirubin processing system is not working correctly. It is not a disease in itself, but rather a powerful warning signal of an underlying problem, which can range from a mild, self-limited viral hepatitis to a serious bile duct blockage or chronic liver disease. Jaundice should never be ignored. A prompt medical evaluation, beginning with blood tests and an abdominal ultrasound, is essential to determine the root cause. Clinically, timely evaluation and targeted therapy are essential to prevent complications especially in obstructive or progressive liver diseases.

1. American Liver Foundation. (n.d.). Jaundice. Retrieved from https://liverfoundation.org/liver-diseases/complications-of-liver-disease/jaundice/
2. The Merck Manual Consumer Version. (2023). Jaundice in Adults. Retrieved from https://www.merckmanuals.com/home/liver-and-gallbladder-disorders/manifestations-of-liver-disease/jaundice-in-adults
3. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). (2024). Liver Function Tests. Retrieved from https://www.niddk.nih.gov/health-information/diagnostic-tests/liver-function-tests