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Jaundice in Adults

By

Danielle Tholey

, MD, Sidney Kimmel Medical College at Thomas Jefferson University

Last full review/revision Feb 2021| Content last modified Feb 2021
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In jaundice, the skin and whites of the eyes look yellow. Jaundice occurs when there is too much bilirubin (a yellow pigment) in the blood—a condition called hyperbilirubinemia.

Bilirubin is formed when hemoglobin (the part of red blood cells that carries oxygen) is broken down as part of the normal process of recycling old or damaged red blood cells. Bilirubin is carried in the bloodstream to the liver, where it binds with bile (the digestive juice produced by the liver). Bilirubin is then moved through the bile ducts into the digestive tract, so that it can be eliminated from the body. Most bilirubin is eliminated in stool, but a small amount is eliminated in urine. If bilirubin cannot be moved through the liver and bile ducts quickly enough, it builds up in the blood and is deposited in the skin. The result is jaundice.

Many people with jaundice also have dark urine and light-colored stool. These changes occur when a blockage or other problem prevents bilirubin from being eliminated in stool, causing more bilirubin to be eliminated in urine.

If bilirubin levels are high, substances formed when bile is broken down may accumulate, causing itching all over the body. But jaundice itself causes few other symptoms in adults. However, in newborns with jaundice Jaundice in the Newborn Jaundice is a yellow color to the skin and/or eyes caused by an increase in bilirubin in the bloodstream. Bilirubin is a yellow substance formed when hemoglobin (the part of red blood cells... read more Jaundice in the Newborn high bilirubin levels (hyperbilirubinemia) can cause a form of brain damage called kernicterus.

Also, many disorders that cause jaundice, particularly severe liver disease, cause other symptoms or serious problems. In people with liver disease, these symptoms may include nausea, vomiting and abdominal pain, and small spiderlike blood vessels that are visible in the skin (spider angiomas). Men may have enlarged breasts, shrunken testes, and pubic hair that grows as it does in women.

Serious problems caused by liver disease can include

If people eat large amounts of food rich in beta-carotene (such as carrots, squash, and some melons), their skin may look slightly yellow, but their eyes do not turn yellow. This condition is not jaundice and is unrelated to liver disease.

Did You Know...

  • Eating too many carrots can make the skin look yellow, but this effect is not jaundice.

What Causes Jaundice in Adults?

Jaundice in adults has many causes. Most causes involve disorders and drugs that

  • Damage the liver

  • Interfere with the flow of bile

  • Trigger the destruction of red blood cells (hemolysis), thus producing more bilirubin than the liver can handle

View of the Liver and Gallbladder

The portal vein receives blood from the entire intestine and from the spleen, pancreas, and gallbladder and carries that blood to the liver. After entering the liver, the portal vein divides into right and left branches and then into tiny channels that run through the liver. When blood leaves the liver, it flows back into the general circulation through the hepatic vein.

View of the Liver and Gallbladder

The most common causes of jaundice are

Hepatitis

Hepatitis Overview of Hepatitis Hepatitis is inflammation of the liver. (See also Overview of Acute Viral Hepatitis and Overview of Chronic Hepatitis.) Hepatitis is common throughout the world. Hepatitis can be Acute (short-lived) read more is liver inflammation that is usually caused by a virus but can be caused by an autoimmune disorder or use of certain drugs. Hepatitis damages the liver, making it less able to move bilirubin into the bile ducts. Hepatitis may be acute (short-lived) or chronic (lasting at least 6 months). Acute viral hepatitis is a common cause of jaundice, particularly jaundice that occurs in young and otherwise healthy people. When hepatitis is caused by an autoimmune disorder or a drug, it cannot be spread from person to person.

Alcohol-related liver disease

Drinking large amounts of alcohol over a long period of time damages the liver. The amount of alcohol and time required to cause damage varies, but typically, people must drink heavily for at least 8 to 10 years. Other drugs, toxins, and some herbal products can also damage the liver (see table Some Causes and Features of Jaundice Some Causes and Features of Jaundice In jaundice, the skin and whites of the eyes look yellow. Jaundice occurs when there is too much bilirubin (a yellow pigment) in the blood—a condition called hyperbilirubinemia. (See also Overview... read more Some Causes and Features of Jaundice ).

Bile duct obstruction

Other causes of jaundice

Less common causes of jaundice include hereditary disorders that interfere with how the body processes bilirubin. They include Gilbert syndrome and other, less common disorders such as Dubin-Johnson syndrome. In Gilbert syndrome, bilirubin levels are slightly increased but usually not enough to cause jaundice. This disorder is most often detected during routine screening tests in young adults. It causes no other symptoms and no problems.

How Is Jaundice Diagnosed?

Warning signs

In people with jaundice, the following symptoms are cause for concern:

  • Severe abdominal pain and tenderness

  • Changes in mental function, such as drowsiness, agitation, or confusion

  • Blood in stool or tarry black stool

  • Blood in vomit

  • Fever

  • A tendency to bruise or to bleed easily, sometimes resulting in a reddish purple rash of tiny dots or larger splotches (which indicate bleeding in the skin)

When to see a doctor

If people have any warning signs, they should see a doctor as soon as possible. People with no warning signs should see a doctor within a few days.

What the doctor does

Doctors first ask questions about the person's symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause and the tests that may need to be done (see table Some Causes and Features of Jaundice Some Causes and Features of Jaundice In jaundice, the skin and whites of the eyes look yellow. Jaundice occurs when there is too much bilirubin (a yellow pigment) in the blood—a condition called hyperbilirubinemia. (See also Overview... read more Some Causes and Features of Jaundice ).

Doctors ask when the jaundice started and how long it has been present. They also ask when urine started to look dark (which usually occurs before jaundice develops). People are asked about other symptoms, such as itching, fatigue, changes in stool, and abdominal pain. Doctors are particularly interested in symptoms that suggest a serious cause. For example, sudden loss of appetite, nausea, vomiting, pain in the abdomen, and fever suggest hepatitis, particularly in young people and people with risk factors for hepatitis. Fever and severe, constant pain in the upper right part of the abdomen suggest acute cholangitis (infection of the bile ducts), usually in people with a blockage in a bile duct. Acute cholangitis is considered a medical emergency.

Doctors ask people whether they have had liver disorders, whether they have had surgery that involved the bile ducts, and whether they take any drugs that can cause jaundice (for example, the prescription drugs amoxicillin/clavulanate, chlorpromazine, azathioprine, and oral contraceptives; alcohol; over-the-counter drugs; medicinal herbs; and other herbal products such as teas). Knowing whether family members have also had jaundice or other liver disorders can help doctors identify hereditary liver disorders.

  • Working at a day care center

  • Living in or working at an institution with long-term residents, such as a mental health care facility, prison, or long-term care facility

  • Living in or traveling to an area where hepatitis is widespread

  • Participating in anal sex

  • Eating raw shellfish

  • Injecting illegal or recreational drugs

  • Having hemodialysis

  • Sharing razor blades or toothbrushes

  • Getting a tattoo or body piercing

  • Working in a health care facility without being vaccinated against hepatitis

  • Having had a blood transfusion before 1992

  • Having sex with someone who has hepatitis

  • Having been born between 1945 and 1965

During the physical examination, doctors look for signs of serious disorders (such as fever, very low blood pressure, and a rapid heart rate) and for signs that liver function is greatly impaired (such as easy bruising, a rash of tiny dots or splotches, or changes in mental function). They gently press on the abdomen to check for lumps, tenderness, swelling, and other abnormalities, such as an enlarged liver or spleen.

Table
icon

Testing

Tests include the following:

Liver tests Liver Blood Tests Liver tests are blood tests that represent a noninvasive way to screen for the presence of liver disease (for example, hepatitis in donated blood) and to measure the severity and progress of... read more (also called liver enzyme tests) involve measuring blood levels of enzymes and other substances produced by the liver. These tests help doctors determine whether the cause is liver malfunction or a blocked bile duct. If a bile duct is blocked, imaging tests, such as ultrasonography, are usually required.

Other blood tests are done based on the disorder doctors suspect and the results of the examination and the initial tests. They may include

  • Tests to assess the blood's ability to clot (prothrombin time and partial thromboplastin time)

  • Tests to check for hepatitis viruses or abnormal antibodies (due to autoimmune disorders)

  • A complete blood count

  • Blood cultures to check for infection of the bloodstream

  • Examination of a blood sample under a microscope to check for excessive destruction of red blood cells

If imaging is needed, ultrasonography of the abdomen is often done first. It can usually detect blockages in the bile ducts. Alternatively, computed tomography (CT) or magnetic resonance imaging (MRI) may be done.

If ultrasonography shows a blockage in a bile duct, other tests may be needed to determine the cause. Typically, magnetic resonance cholangiopancreatography (MRCP Imaging tests of the liver, gallbladder, and biliary tract include ultrasonography, radionuclide scanning, computed tomography (CT), magnetic resonance imaging (MRI), endoscopic retrograde cholangiopancreatography... read more ) or endoscopic retrograde cholangiopancreatography (ERCP Endoscopic Retrograde Cholangiopancreatography Imaging tests of the liver, gallbladder, and biliary tract include ultrasonography, radionuclide scanning, computed tomography (CT), magnetic resonance imaging (MRI), endoscopic retrograde cholangiopancreatography... read more ) is used. MRCP is MRI of the bile and pancreatic ducts, done with specialized techniques that make the fluid in the ducts appear bright and the surrounding tissues appear dark. Thus, MRCP provides better images of the ducts than conventional MRI. For ERCP, a flexible viewing tube (endoscope) is inserted through the mouth and into the small intestine, and a radiopaque contrast agent is injected through the tube into the bile and pancreatic ducts. Then x-rays are taken. When available, MRCP is usually preferred because it is just as accurate and is safer. But ERCP may be used because it enables doctors to take a biopsy sample, remove a gallstone, or do other procedures.

Occasionally, liver biopsy Biopsy of the Liver Doctors can obtain a sample of liver tissue during exploratory surgery, but more often they obtain a sample by inserting a hollow needle through the person's skin and into the liver. This type... read more is needed. It may be done when certain causes (such as viral hepatitis, use of a drug, or exposure to a toxin) are suspected or when the diagnosis is unclear after doctors have the results of other tests.

Laparoscopy Laparoscopy Laparoscopy is an examination of the abdominal cavity using a fiberoptic instrument inserted through the abdominal wall. This is a surgical procedure done in an operating room. People are given... read more may be done when other tests have not identified why bile flow is blocked. For this procedure, doctors make a small incision just below the navel and insert a viewing tube (laparoscope) to examine the liver and gallbladder directly. Rarely, a larger incision is needed (a procedure called laparotomy).

How Is Jaundice Treated?

Usually, itching gradually disappears as the liver's condition improves. If itching is bothersome, taking cholestyramine by mouth may help. However, cholestyramine is ineffective when a bile duct is completely blocked.

What Does Jaundice Look Like in Older People?

In older people, the disorder causing jaundice may not cause the same symptoms as it typically does in younger people, or the symptoms may be milder or harder to recognize. For example, if older people have acute viral hepatitis, they often have much less abdominal pain than younger people. When older people become confused, doctors may mistakenly diagnose dementia and not realize that the cause is hepatic encephalopathy Hepatic Encephalopathy Hepatic encephalopathy is deterioration of brain function that occurs in people with severe liver disease because toxic substances normally removed by the liver build up in the blood and reach... read more . That is, doctors may not realize that brain function is deteriorating because the liver is unable to remove toxic substances from the blood (as it usually does) and, thus, the toxic substances can reach the brain.

In older people, jaundice usually results from a blockage in the bile ducts, and the blockage is more likely to be cancer. Doctors suspect that the blockage is cancer when older people have lost weight, have only mild itching, have no abdominal pain, and have a lump in the abdomen.

FAQs for Jaundice in Adults

What is jaundice?

Jaundice is a yellow color of the skin and eyes caused by having too much bilirubin in the blood.

What causes jaundice in adults?

How do you get rid of jaundice in adults?

Doctors have to treat whatever is causing the jaundice. There is no specific treatment to make jaundice go away.

How do you treat jaundice in adults?

In addition to treating the cause of the jaundice, doctors may give a drug, cholestyramine, to help the itching caused by jaundice.

Can sunlight help jaundice in adults?

What drugs can cause jaundice in adults?

Many drugs can cause jaundice in adults, including acetaminophen, amiodarone, isoniazid, nonsteroidal anti-inflammatory drugs (NSAIDs), anabolic steroids, and a number of antibiotics.

What are the symptoms of jaundice in adults?

Jaundice causes the skin and the whites of the eyes to turn yellow. The higher the bilirubin level, the yellower the skin. Severe jaundice usually also causes itching.

What level of bilirubin causes jaundice in adults?

In good light, jaundice may be faintly visible in people whose bilirubin levels are between 2 and 3 mg/dL (34 to 51 micromol/L). A bilirubin level of 20 mg/dL (342 micromol/L) can make the skin bright yellow, like a lemon.

Key Points about Jaundice in Adults

  • If damage to the liver is severe, jaundice may be accompanied by serious problems, such as deterioration of brain function and a tendency to bleed or bruise.

  • Acute viral hepatitis is a common cause of jaundice, particularly in young and otherwise healthy people.

  • People should see a doctor promptly if they have jaundice so that the doctor can check for serious causes.

  • Cholestyramine may help relieve itching.

Drugs Mentioned In This Article

Generic Name Select Brand Names
No US brand name
TYLENOL
IMURAN
AMOXIL
CORDARONE
LANIAZID
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