What jaundice is and how it shows up
Jaundice is a yellowing of the skin and the whites of the eyes. It appears when bilirubin builds up in the blood. Bilirubin is a pigment made when red blood cells break down, and the liver normally clears it out in bile. Yellowing often comes with dark urine, pale stools and itchy skin. Jaundice is not a disease in itself but a signal that something is wrong with the liver, the bile ducts or the blood, so it always calls for a doctor. A cause cannot be worked out from a description.
Yellow eyes and skin: how to tell it is jaundice
The whites of the eyes often turn yellow first, and this is easiest to see in natural daylight. If the skin looks a little yellow but the whites of the eyes stay white, there may be another reason, such as eating very large amounts of carrots or other foods rich in carotene. Do not decide this on your own, though: if in doubt, see a doctor.
Jaundice in adults: possible causes
There are several causes, and it helps to sort them by where the problem starts. In the liver: viral hepatitis, including hepatitis A and hepatitis B, alcohol-related liver damage, or a reaction to some medicines and supplements. In the bile ducts: gallstones, inflammation or pressure from a tumor. In the blood: faster than normal breakdown of red cells, for example in some inherited blood diseases. There are also harmless quirks of bilirubin handling that show up during fasting or a cold, but only a doctor can confirm that after testing.
Dark urine, pale stools and itchy skin
Dark urine (the color of strong tea), pale stools and intense itching without a rash suggest that bile is not reaching the bowel properly. This combination is more often linked to the bile ducts or the liver than to the blood, and it is a reason not to delay a visit. If you itch but are not yellow, see Itching. For rashes, see Rash.
Jaundice with abdominal pain, fever and weakness
Jaundice together with pain under the right ribs, fever and chills may point to an inflamed or blocked bile duct, which needs urgent care. If weakness, nausea, loss of appetite and dark urine join the yellowing, acute hepatitis is possible. For pain, see Abdominal pain; for nausea, Nausea and vomiting; for tiredness, Fatigue.
Jaundice in newborns and children
Yellowish skin in newborns during the first days of life is common and usually harmless, but a doctor should assess it: the blood bilirubin level is measured to decide whether treatment is needed. Pay particular attention if the yellowing appears in the first 24 hours, spreads quickly, or the baby is drowsy, feeds poorly or has pale stools. In older children jaundice is more often due to an infection such as hepatitis A, which spreads through contaminated water and food. The first signs of hepatitis A usually appear 2 to 4 weeks after infection.
What you can do before the visit
- Book a visit within the next few days. Do not wait for the yellowing to go away by itself.
- Do not drink alcohol, and do not start new medicines or supplements without a doctor's advice: many of them put extra load on the liver.
- Write down when the yellowing began, whether you changed any medicines, and whether there were trips, tattoos, contact with someone who has hepatitis, pain, fever or itching.
- Bring a list of all medicines and supplements you take, and any earlier test results.
- If hepatitis A is possible, wash your hands with soap after the toilet and before eating, and do not prepare food for others.
How a doctor finds the cause
The doctor asks about symptoms, medicines, alcohol, travel and contacts, and examines the skin, eyes and abdomen. Blood tests usually follow: bilirubin and its fractions, liver enzymes, a blood count and markers of viral hepatitis. If a bile duct problem is suspected, an abdominal ultrasound is done, and a CT, MRI or other tests if needed. Treatment depends on the cause: sometimes rest and monitoring are enough, and sometimes hospital treatment or surgery is needed.