Jaundice - yellow skin

Definition

Jaundice is a yellow color in the skin, mucus membranes, or eyes. The yellow pigment is from bilirubin, a byproduct of old red blood cells. Jaundice is also a symptom of other disorders.

This article is about jaundice in children and adults.

See also: Newborn jaundice for information about babies

Alternative Names

Yellow skin and eyes; Skin - yellow; Icterus; Eyes - yellow; Jaundice

Considerations

If you?ve ever had a bruise, you may have noticed that the skin went through a series of color changes as it healed. When you saw yellow in the bruise, you were seeing bilirubin.

Normally, about 1% of our red blood cells retire every day, to be replaced by fresh red blood cells. The old ones are handled by the liver. Bilirubin is left after blood cells are disposed of. It leaves the body in the stool.

When too much bilirubin (yellow pigment) builds up in the body, jaundice may result.

Jaundice can be caused by:

• Too many red blood cells retiring for the liver to handle
• The liver being overloaded or damaged
• The bilirubin from the liver is unable to move through the biliary tract to the gut

The skin may turn a yellow-to-orange color if you ingest too much beta carotene, the orange pigment in carrots. In this condition, the whites of the eyes remain white. People with true jaundice often have a yellowish tinge to the eyes. This condition is called hypercarotenemia, or just carotenemia.

Common Causes

Causes seen only in children include:

• Biliary atresia
• Disorders present since birth that cause problems processing bilirubin (Gilbert syndrome, Dubin-Johnson syndrome, Rotor syndrome, or Crigler-Najjar syndrome)

Causes in adults include:

• Alcoholic liver disease (alcoholic cirrhosis)
• Autoimmune hepatitis
• Blocked or narrowed bile ducts (by infection, tumor, stricture, or gallstones)
• Cancer of the pancreas
• Disorders present since birth that cause problems processing bilirubin (Gilbert syndrome, Dubin-Johnson syndrome, Rotor syndrome, or Crigler-Najjar syndrome)
• Drug-induced cholestasis
• Drug-induced hepatitis
• Hemolytic anemia (when the body is destroying too many blood cells)
• Ischemic hepatocellular jaundice (jaundice caused by not enough oxygen or blood to the liver)
• Jaundice of pregnancy (bile may build up in the gallbladder because of pressure in the abdomen during pregnancy)
• Malaria
• Primary biliary cirrhosis
• Viral hepatitis (hepatitis A, hepatitis B, hepatitis C, hepatitis D, and hepatitis E)

See also: Newborn jaundice for information about babies

Home Care

The cause of jaundice must be determined before treatment can be given. Follow prescribed therapy to treat the underlying cause.

Call your health care provider if

All jaundice in a child or adult should be medically evaluated. Always call your doctor if jaundice is present.

What to expect at your health care provider's office

The health care provider will perform a physical examination. To help diagnose the cause of yellow skin, your health care provider will ask medical history questions, such as:

• Is the inside of the mouth (mucus membranes) yellow?
• Are the eyes yellow?
• When did the jaundice start?
• Has the jaundice occurred repeatedly?
• What other symptoms are present?

The following diagnostic tests may be performed:

• Blood serum bilirubin
• Complete blood count
• Liver biopsy
• Liver function tests and cholesterol
• Prothrombin time
• Ultrasound of the abdomen
• Urine and fecal urobilinogen

Prevention

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References

Berk PD, Korenblat KM. Approach to the patient with jaundice or abnormal liver test results. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 150.

Boamah L, Balistreri WF. Manifestations of liver disease. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 352.

Moyer V, Freese DK, Whitington PF, Olson AD, Brewer F, Colletti RB, Heyman MB. Guideline for the evaluation of cholestatic jaundice in infants: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr. 2004;39(2):115-128.

Piazza AJ, Stoll BJ. Digestive system disorders. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 102

This article uses information by permission from Alan Greene, M.D., © Greene Ink, Inc.