What is Jaundice? Symptoms, Causes, Diagnosis & Treatment

Jaundice is a medical condition characterized by yellowing of the skin, eyes (scleral icterus), and mucous membranes due to elevated bilirubin (>2.5 mg/dL or 43 µmol/L) in the blood. Medically termed icterus or hyperbilirubinemia, it signals underlying issues in bilirubin metabolism affecting the liver, bile ducts, gallbladder, or hemolytic processes. Jaundice affects ~60% of term newborns and 10-20% of adults with liver disease in India; early recognition prevents complications like hepatic encephalopathy or cholangitis.

Symptoms vary by cause and severity; mild cases may resolve spontaneously, while obstructive jaundice requires urgent intervention.

What Is Jaundice?

Jaundice (medically called icterus) happens when a yellow pigment called bilirubin builds up in the blood. As the level rises, it stains the skin and the whites of the eyes yellow. Because so many different problems can cause this build-up, jaundice is best thought of as a warning sign that needs a proper diagnosis.

Role of Bilirubin in Jaundice

Bilirubin metabolism involves:

• Production: ~250-350 mg/day from RBC turnover
• Uptake/conjugation: Liver hepatocytes via glucuronidation
• Excretion: Bile → intestine → urobilinogen/stercobilin

Disruptions cause:

• Excess production (prehepatic)
• Impaired conjugation/secretion (hepatic)
• Obstruction (posthepatic)

Types and Stages of Jaundice

Doctors group jaundice by where the problem lies:

Before the Liver (Pre-Hepatic)

Too many red blood cells break down too quickly, producing more bilirubin than the liver can handle. Causes include certain anaemias, malaria, G6PD deficiency, and sickle cell disease. The jaundice is often mild.

In the Liver (Hepatic)

The liver itself is not working properly. Common causes include viral hepatitis (hepatitis A and E are common in India), fatty liver disease, alcohol-related liver damage, cirrhosis, and certain medicines. There may be tenderness over the liver.

After the Liver - a Blockage (Post-Hepatic)

Bile cannot drain because something is blocking the bile ducts - most often gallstones, and less commonly a narrowing or a tumour of the pancreas or bile duct. This type often causes pale stools, dark urine, itching, and upper-abdominal pain.

Causes of Jaundice

Common Causes in Adults and Infants

Adults: Hepatitis (50% cases India), stones (20%), malignancy (10%)
Infants: Physiologic (unconjugated, peaks day 3-5), hemolytic, breastfeeding

Medication-Induced Jaundice

Idiosyncratic hepatotoxicity: Acetaminophen (>4g/day), INH, statins

Liver Diseases, Infections & Blockages

Hepatitis A/E (fecal-oral), autoimmune, HCC, choledocholithiasis

Symptoms of Jaundice

The main symptoms are:

• Yellow skin and eyes — the whites of the eyes often yellow first.
• Dark urine (tea- or cola-coloured).
• Pale, clay-coloured stools (more common when a blockage is the cause).
• Itching of the skin.
• Tiredness and loss of appetite.

Depending on the cause, there may also be fever, abdominal pain (often on the upper right side), nausea, or unexplained weight loss.

When to See a Doctor

Any new jaundice in an adult should be checked by a doctor. Seek urgent medical care if jaundice comes with:

• Fever and chills (possible infection of the bile ducts)
• Severe abdominal pain or persistent vomiting
• Confusion, drowsiness, or unusual behaviour (possible effect on the brain)
• Black or bloody stools, or easy bruising and bleeding
• Jaundice in pregnancy, or in an older or frail person

For newborns: Contact your doctor promptly if -

• Your baby's skin or eyes look more yellow
• If the yellowing spreads to the arms or legs
• If your baby is feeding poorly or is hard to wake
• He has a high-pitched cry, or if jaundice lasts beyond two weeks.

Diagnosis of Jaundice

Overview of Diagnostic Tests

• History/exam: Itch, pain, risk factors
• Labs: Total/direct bilirubin, LFTs (ALT/AST/ALP/GGT), CBC, PT/INR, viral serology
• Imaging: USG (first-line, detects dilatation/stones 90%)
• Advanced: MRCP/ERCP (biliary tree), biopsy

Interpretation of Tests in Relation to Jaundice Symptoms

• Indirect ↑: Hemolysis (normal ALP)
• Direct ↑ + ALP ↑: Obstruction (dilated ducts on USG)
• Transaminases ↑: Hepatocellular

Treatment and Management of Jaundice

Cause-Specific Treatments

• Hepatitis: Supportive (HAV resolves 95%)
• Obstruction: ERCP stenting (90% success choledocholithiasis)
• Alcohol/NAFLD: Abstinence, lifestyle

Symptomatic Relief

• Cholestyramine (pruritus), hydration, nutrition

Hospital-Based Interventions

• Plasmapheresis (rare fulminant cases)

Complications and Risks of Untreated Jaundice

• Cholangitis (mortality 10-30% if septic)
• Cirrhosis, HCC, variceal bleed
• Kernicterus (neonates)

Jaundice in Newborns vs Adults: Key Differences

Feature	Newborns	Adults
Cause	Immature glucuronyltransferase	Hepatitis, obstruction
Severity	Usually mild (peaks 3-5 days)	Often serious
Treatment	Phototherapy (if >15-20 mg/dL)	Cause-specific
Risk	Kernicterus	Liver failure

Prevention of Jaundice

• HAV/HEV vaccination
• Safe water/hygiene
• Alcohol limits (<20g/day women)
• NAFLD screening (ALT/USG)

Home Remedies and Supportive Care (With Medical Caution)

Supportive only:

• Hydration, low-fat diet
• Avoid until cause identified

Frequently Asked Questions

1. What are The Danger Signs of Jaundice in Infants?

In infants with jaundice, you should call your doctor if:

• The skin of your baby turns more yellow
• The sclera of your baby appears yellow
• Your baby is feeding poorly and not gaining weight
• Your baby is crying inconsolably
• Your baby develops some other symptoms that you may be concerned about

2. How Long is Jaundice Recovery?

In general, your body may need a minimum of 6-months to completely recover from jaundice. Meanwhile, your doctor will continue taking routine tests to check liver function.

3. Can Jaundice Be Cured?

In adults, jaundice is not treated, but the underlying condition is. For example - in the case of acute viral hepatitis, jaundice cures as soon as the liver heals. If you have a blockage in your bile duct, you may need surgery to remove the blockage. If your baby develops mild jaundice, it will go away on its own within two to three weeks. Severe infant jaundice cases need longer hospitalisation.

4. Can Jaundice Be Spread?

No, jaundice is not a communicable or contagious condition. However, underlying causes, for example, Hepatitis A, Hepatitis B, Hepatitis C, Hepatitis D, and Hepatitis E, can spread from one person to another.

5. Which Stage of Liver Disease is Jaundice?

The symptoms you may experience with an end-stage liver condition include the following:

• Jaundice
• Reduction in brain function
• Increased risk of bleeding
• Accumulation of fluid in the abdomen

6. Does Jaundice Cause Death?

According to many medical professionals, jaundice is not a health condition in itself but a sign of a health condition that is hampering the metabolic functions of your body. If left untreated, jaundice can lead to minor health complications to life-threatening ones.

7. Is Jaundice Caused By a Virus?

Viruses, such as Hepatitis A, B, C, and infectious mononucleosis (Epstein-Barr virus infection), can cause jaundice.

8. Does Jaundice Mean Liver Failure?

Liver failure means a severe decline in liver function. It occurs when a considerable portion of the organ is damaged because of any liver disorder. The symptoms of liver function may include jaundice, impaired brain function, weakness, fatigue, not feeling well, loss of appetite, etc.

9. What is The Best Diet for Jaundice? 

A jaundice diet includes fruits, vegetables, whole grains, and lean proteins while avoiding fatty, fried foods. Internal medicine teams provide guidance to ensure optimal recovery and liver function.

Disclaimer

This is educational information only, not medical advice. Consult a gastroenterologist/hepatologist for diagnosis/treatment. Emergency for fever/jaundice.

References

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https://physoc.onlinelibrary.wiley.com/doi/full/10.1002/cphy.c210042

2. European Association for the Study of the Liver. (2019). *EASL clinical practice guidelines: Management of cholestatic liver diseases*. *Journal of Hepatology*, 70(1), 182-202. https://www.journal-of-hepatology.eu/article/S0168-8278(18)31963-5/fulltext

3. American Gastroenterological Association. (2021). *AGA clinical practice update on management of hyperbilirubinemia*. *Gastroenterology*, 160(5), 1833-1838.

https://www.gastrojournal.org/article/S0016-5085(21)00245-7/fulltext

4. World Health Organization. (2024). *Hepatitis in India*.
https://www.who.int/india/health-topics/hepatitis

5. Indian Association for the Study of the Liver. (2023). *Consensus guidelines on viral hepatitis*.

https://iasl.org.in

6. Baron, T. H., et al. (2020). *ASGE guideline on the role of endoscopy in the evaluation of suspected choledocholithiasis*. *Gastrointestinal Endoscopy*, 91(1), 1-12.

https://www.giejournal.org/article/S0016-5107(19)32245-2/fulltext