Jaundice

What is jaundice?

Jaundice is the yellowing of your skin caused by a build-up of a molecule called bilirubin. It’s not a disease itself.

Bilirubin is released when your red blood cells are broken down. Bilirubin is then processed by the liver and sent to your gut where you poo it out, this is what gives poo its brown colour.

What are the symptoms of jaundice?

Having a buildup of bilirubin can cause:

• Yellowing of the skin and the whites of the eyes

• Itchy skin including the palms and soles of the feet

• Dark coloured urine

• Pale coloured stools

You may have other symptoms that may be related to the cause of your jaundice, such as:

• Tummy pain

• Weight loss

• Fever or chills

• Confusion

• Change in bowel habits

What causes jaundice in adults?

There are a few different causes of jaundice which all have different names.

Prehepatic jaundice

This is when your body breaks down red blood cells and makes bilirubin faster than your liver can remove the bilirubin. It may be caused by:

• Gilbert's syndrome – a harmless condition when stress or illness causes mild jaundice

• Haemolytic anaemias – when red blood cells that carry oxygen are broken down releasing too much bilirubin for the liver to process

Intrahepatic jaundice

This happens when damage to your liver means your liver can’t process the bilirubin. Possible causes include:

• Infections from parasites and viruses such as HIV and hepatitis

• Alcohol and drugs

• Cancers of the liver

• Autoimmune conditions

Obstructive jaundice

This is when there’s a blockage in the duct that connects the liver and the gut, which stops the body from discarding the bilirubin. Some causes are:

• Gallstones

• Infections

• Pancreatitis

• Pancreatic cancer or biliary tree cancer

Jaundice in newborn babies

Jaundice in babies is very common. Around 6 in 10 babies have neonatal jaundice. Most of the time, it gets better on its own without treatment.

The signs of jaundice in newborns are similar to those in adults. Babies may have yellowing of the skin and the whites of the eyes, dark pee, and pale poo.

Babies are checked for jaundice within the first 3 days after birth at their newborn physical examination. If your baby develops jaundice after this check-up, talk to a doctor or midwife.

What causes jaundice in newborns?

Babies' red blood cells are broken down and replaced quickly, which releases a lot of bilirubin. Their livers are also still developing and not as good as removing the bilirubin. This is called physiological jaundice.

Physiological jaundice usually disappears on its own by the time your baby is 2 weeks old. It never occurs in the first 24 hours after birth. If your baby develops jaundice within this time, a doctor will look for other causes.

Breastfeeding can increase the risk of your baby developing jaundice. We don’t know why this happens, but you can continue to breastfeed your baby if they are jaundiced as the benefits typically outweigh any risks.

Bilirubin levels can be measured with a blood test or by using a bilirubinometer. If your baby has a high level of bilirubin, they may need treatment, however this is uncommon.

If treatment is necessary, a baby may receive phototherapy to help the liver break down bilirubin or a blood transfusion.

Very rarely, if left untreated the accumulation of bilirubin can cause damage to the brain which is called kernicterus.

How is jaundice diagnosed?

Jaundice is diagnosed with a blood test to measure how much bilirubin is in your blood. You may need further testing like scans to figure out what’s causing the jaundice.

How is jaundice treated?

Jaundice is treated by treating the underlying cause. Sometimes, no treatment is needed at all, but other cases might need medicine or surgery. A doctor will advise you what treatments are recommended.

What else could my yellow skin be?

It is important to be investigated for jaundice if you notice yellowing of the skin. If a doctor has ruled out jaundice, then your yellow skin may be caused by too much beta carotene, the pigment found in carrots, pumpkins as well as other orange foods. If this is the cause, the whites of your eyes will not be yellow.

When should I speak to a doctor?

If you’ve noticed yellowing skin or eyes or any other jaundice symptoms, speak to a doctor urgently. If you have pain in your tummy, jaundice, and a fever you should go to A&E immediately as this can be a sign of a serious infection near your liver.

How can Livi help?

You can book a video appointment with a Livi doctor who can take a look at your skin and eyes and ask you about your symptoms. They can recommend the next steps you should take, which might include a referral to a specialist.