Jaundice in Adults: What You Need To Know

Jaundice in adults can be a concerning symptom, often manifesting as a yellowing of the skin and eyes. This occurs when damaged liver cells are unable to process bilirubin. The bilirubin goes into your blood, causing jaundice.

From liver diseases such as hepatitis to blockages in the bile ducts due to gallstones, the causes are diverse and affect the body’s ability to process and remove bilirubin effectively. In this article, we’ll delve into the types, common causes, and treatment options for jaundice in adults.

Types of Jaundice

Jaundice actually falls into three main types, and each one is based on what’s causing bilirubin to build up in the first place:

  • Pre-hepatic Jaundice: Also known as haemolytic jaundice, this occurs when there is excessive breakdown of red blood cells, leading to an increased production of bilirubin that overwhelms the liver’s ability to conjugate and excrete it. Conditions such as sickle cell disease, malaria, and other haemolytic disorders are common causes.
  • Hepatic Jaundice: Arises from intrinsic liver diseases, affecting the liver’s ability to process and excrete bilirubin. Examples include hepatitis, alcoholic liver disease, and cirrhosis. In these conditions, the liver cells are damaged, impairing bilirubin processing.
  • Post-hepatic Jaundice: Obstructive jaundice, also known as post-hepatic jaundice, is caused by blockages in the bile ducts that prevent bilirubin from being transported from the liver into the digestive tract. The dark urine results from excess bilirubin being excreted through the kidneys, while the pale stools occur because bilirubin, which normally colours the stool, cannot pass into the digestive tract due to the obstruction.

Causes of Jaundice

Jaundice can be triggered by a variety of conditions that impact the production, metabolism, or excretion of bilirubin. Let’s take a look at some common triggers for each type of jaundice:

Pre-hepatic Causes

  • Increased Red Blood Cell Destruction: Conditions like haemolytic anaemia and thalassemia increase red blood cell turnover, producing more bilirubin than the liver can handle.
  • Inherited Disorders: Genetic syndromes such as Gilbert’s syndrome can increase susceptibility to jaundice by reducing the liver’s ability to process bilirubin.

Hepatic Causes

  • Liver Diseases: Chronic liver diseases such as hepatitis, cirrhosis, and alcoholic liver disease directly impair the liver’s ability to conjugate and excrete bilirubin.
  • Infections: Viral infections, like hepatitis A, B, and C, can temporarily or permanently damage liver cells and disrupt bilirubin processing.

Post-hepatic Causes

  • Bile Duct Obstruction: Gallstones or tumours may block the bile ducts, preventing bilirubin from being excreted into the gastrointestinal tract.
  • Surgical Complications: Post-surgical scars or strictures in the bile ducts can lead to obstructive jaundice.

Diagnosing Jaundice

The diagnostic process for jaundice is thorough, and designed to pinpoint the specific type and underlying cause of the condition. It typically includes:

Clinical Evaluation

  • Patient History: This includes assessing the patient’s symptoms, medical history, family history of liver disease, alcohol consumption, and exposure to toxins or infections.
  • Physical Examination: A thorough examination is conducted to check for signs of liver disease, such as liver enlargement, tenderness, and other associated symptoms like ascites or spider angiomas.

Laboratory Tests

  • Bilirubin Tests: These measure levels of total, direct, and indirect bilirubin in the blood and help distinguish between the different types of jaundice.
  • Liver Function Tests: These assess the liver’s performance through enzymes such as AST, ALT, alkaline phosphatase, and GGT.
  • Complete Blood Count (CBC): A CBC can help detect signs of anaemia or infection, which may be related to haemolytic jaundice or infectious causes.

Imaging Studies

  • Ultrasound: This is often the first imaging test used to look for blockages in the bile ducts and other structural liver abnormalities.
  • CT Scan and MRI: These provide detailed images of the liver and biliary tract and can help identify obstructive causes of jaundice such as tumours or gallstones.

In some cases, further diagnostic procedures like a liver biopsy may be necessary to obtain more detailed information on liver tissue pathology.

Treatment Options

Treatment for jaundice is tailored to tackle both the symptoms and the underlying causes, based on the type of jaundice diagnosed:

Treatment for Pre-hepatic Jaundice

  • Management of Hemolytic Disorders: Treatments may include immunosuppressive medications for conditions like autoimmune hemolytic anaemia, or disease-specific therapies such as hydroxyurea for sickle cell disease.
  • Blood Transfusions: Used in severe cases to manage symptoms and improve patient stability by increasing blood cell counts.

Treatment for Hepatic Jaundice

  • Antiviral Therapy for Hepatitis: Prescribing antiviral drugs for hepatitis B and C to reduce the viral load and minimise liver damage.
  • Supportive Care for Liver Function: This includes the use of hepatoprotective drugs, programs to help people stop consuming alcohol, and nutritional support to enhance liver recovery and function.

Treatment for Post-hepatic Jaundice

  • Surgical Interventions: Procedures to remove blockages, such as cholecystectomy for gallstones or surgeries to remove tumours causing bile duct obstruction.
  • Endoscopic Procedures: Endoscopic retrograde cholangiopancreatography (ERCP) is frequently utilised not only for diagnostic purposes but also to treat obstructions in the bile ducts.

In all cases, providing thorough supportive care is important. This includes staying hydrated, following a liver-friendly diet, and avoiding substances that could harm liver health. Regular monitoring and follow-up are also essential to adjust treatment plans as needed and address any complications that may arise.

Conclusion

Jaundice in adults can signal various underlying health issues, each needing specific methods for diagnosis and treatment. Knowing whether the jaundice is pre-hepatic, hepatic, or post-hepatic is essential for effective management.

Prompt and appropriate treatment can improve symptoms and also address the root cause, helping to prevent serious complications. It’s important to be aware and seek medical help to effectively handle the causes of jaundice.

If you’re noticing symptoms of jaundice, don’t hesitate to reach out. Our team is ready to assist you. Contact us today to book an appointment and ensure you get the right diagnosis and treatment.