Yellow staining of the skin and sclerae (the whites of the eyes) by abnormally high blood levels of the bile pigment bilirubin The yellowing extends to other tissues and body fluids. Jaundice was once called the “morbus regius” (the regal disease) in the belief that only the touch of a king could cure it.

Jaundice can indicate liver or gallbladder disease. When the excretion of bilirubin is hindered, excess bilirubin passes into the blood, resulting in jaundice. Inflammation or other abnormalities of liver cells hinder the excretion of bilirubin into bile. Or the bile ducts outside the liver may be blocked by a gallstone or a tumor. Jaundice can also result from the excessive breakdown of red blood cells (a process called haemolysis) and too much bilirubin is released into the bloodstream. This occurs typically in the haemolytic anemias (as opposed to the aplastic anemias in which not enough red cells are produced). Jaundice is common in newborns because there is some hemolysis during labour and delivery and the newborn’s liver is immature and may not be fully up to the task of handling the bilirubin for a few days. In Gilbert syndrome, the blood bilirubin levels are slightly increased, enough to cause mild jaundice. This genetic condition is usually discovered serendipitously during routine screening tests of liver function. It causes no symptoms and no problems.

What Causes Jaundice in Adults?

The most common causes are

  • Hepatitis
  • Alcohol-related liver disease
  • A blockage of a bile duct by a gallstone (usually) or tumor
  • A toxic reaction to a drug or medicinal herb

It can be caused by a problem in any of the three phases in bilirubin production.

Before the production of bilirubin, you may have what’s called unconjugated jaundice due to increased levels of bilirubin caused by:

  • Reabsorption of a large hematoma (a collection of clotted or partially clotted blood under the skin).
  • Haemolytic anaemia (blood cells are destroyed and removed from the bloodstream before their normal lifespan is over).

During production of bilirubin, jaundice can be caused by:

  • Viruses, including Hepatitis A, chronic Hepatitis B and C, and Epstein-Barr virus infection (infectious mononucleosis).
  • Alcohol.
  • Autoimmune disorders.
  • Rare genetic metabolic defects.
  • Medicines, including acetaminophen toxicity, penicillins, oral contraceptives, chlorpromazine (Thorazine®) and estrogenic or anabolic steroids.

After bilirubin is produced, jaundice may be caused by obstruction (blockage) of the bile ducts from:

  • Gallstones.
  • Inflammation (swelling) of the gallbladder.
  • Gallbladder cancer.
  • Pancreatic tumor.

Common symptoms include:

  • A yellow tinge to the skin and the whites of the eyes, normally starting at the head and spreading down the body
  • Pale stools
  • Dark urine
  • Itchiness

Accompanying symptoms of jaundice resulting from low bilirubin levels include:

  • Fatigue
  • Abdominal pain
  • Weight loss
  • Vomiting
  • Fever
  • Pale stools
  • Dark urine

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