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Jaundice Treatment In Singapore

Dr Thng Yongxian

Hepatopancreatobiliary & General Surgeon
MBBS • MMed • MRCS (IRE) • FRCSED • FAMS

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What Is Jaundice?

Jaundice is a medical condition characterised by the yellowing of the skin and the whites of the eyes, caused by a build-up of bilirubin levels in the bloodstream.

 

Under normal conditions, the liver processes bilirubin and eliminates it through bile. When this process is disrupted — due to liver dysfunction, bile duct obstruction, or increased red blood cell breakdown — bilirubin levels can rise, leading to visible jaundice. While not a disease itself, jaundice is often a sign of an underlying condition that requires medical attention.

Causes of Jaundice

Jaundice occurs when there is a disruption in the balance between the production and clearance of bilirubin. These disruptions are generally classified into three categories: pre-hepatic, hepatic, and post-hepatic, depending on where the imbalance originates.
  • Pre-hepatic Causes (Before the liver processes bilirubin)
    These are related to an increased breakdown of red blood cells, leading to elevated bilirubin levels beyond the liver’s capacity to process. Common causes include:
  • Hemolytic anaemias, where there is an increased breakdown of red blood cells.
  • Genetic conditions like spherocytosis or sickle cell anaemia.
  • Hepatic Causes (Within the liver, during the production of bilirubin)
    These causes are due to liver dysfunction, affecting its ability to metabolize and excrete bilirubin, including:
  • Hepatitis, inflammation of the liver from viral infections or toxins.

  • Cirrhosis, scarring of the liver tissue affecting its function.
  • Gilbert’s syndrome, a mild genetic disorder impairing bilirubin processing.
  • Fatty liver disease, which affects liver cell function.
  • Post-hepatic Causes (After the production of bilirubin in the liver)
    Also known as obstructive jaundice, these are due to blockages in the bile ducts that impede the flow of bile from the liver to the intestines, such as:
  • Gallstones, which can block the bile ducts.

  • Pancreatic cancer, potentially blocking the bile duct where it passes through the pancreas.
  • Bile duct strictures, narrowing of the bile ducts due to scarring or inflammation.
  • Cholangiocarcinoma, or cancer of the bile ducts

Signs and Symptoms of Jaundice

Jaundice itself is a sign, indicated by the yellowing of the skin, mucous membranes, and the whites of the eyes. However, it may be accompanied by other symptoms depending on the underlying cause, including:
  • Dark urine, resulting from excess bilirubin excreted through the kidneys.
  • Pale or clay-coloured stools, due to a lack of bilirubin reaching the intestines.
  • Itching caused by bilirubin deposits in the skin.
  • Loss of appetite that’s often seen in liver-related conditions, particularly hepatitis or cirrhosis.
  • Fatigue and weight loss are common in chronic liver conditions.
  • Abdominal pain, particularly in cases of gallstones or acute hepatitis.
  • Fever, especially if the jaundice is caused by infection or inflammation.

Diagnosis Of Jaundice

Diagnosing the cause of jaundice involves a combination of clinical assessment, blood investigations, and imaging studies. These help determine the origin of the bilirubin imbalance and guide appropriate management.

  • Physical examination
    Your doctor will examine the skin and eyes for signs of jaundice, and assess the abdomen for tenderness, organ enlargement, or signs of fluid build-up.

  • Blood tests
    Blood investigations provide key information on liver health and potential causes of jaundice:
  • Liver function tests measure enzymes and bilirubin levels to assess liver performance
  • Viral hepatitis screening helps identify infections such as hepatitis B or C
  • Full blood count may reveal signs of haemolysis or infection

  • Imaging tests

    Imaging is essential for evaluating the liver, bile ducts, and surrounding structures:
  • Ultrasound is typically the first-line tool to assess bile duct obstruction or liver abnormalities.
  • CT or MRI scans offer more detailed views to detect masses, strictures, or structural changes.
  • MRCP or ERCP may be used to visualise the bile ducts and assess for blockages or narrowing.

  • Liver biopsy (if required)

    In selected cases, a liver biopsy may be performed to evaluate chronic liver disease, detect inflammation or fibrosis, or rule out malignancy. The decision to proceed with biopsy is based on clinical findings and results from earlier investigations.

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Treating Jaundice

The treatment of jaundice is highly dependent on its underlying cause or disorder, requiring a tailored approach for effective management.

  • Medical management

    Medications and lifestyle changes are often recommended to address underlying liver conditions:
  • Antiviral therapy may be prescribed for chronic hepatitis B or C infections.
  • Corticosteroids are sometimes used in autoimmune hepatitis to reduce liver inflammation.
  • Lifestyle modifications, such as avoiding alcohol or managing weight, are important in conditions like non-alcoholic fatty liver disease (NAFLD).

  • Surgical or interventional treatments

    In cases where jaundice is caused by structural or obstructive issues, procedures may be required to restore bile flow:
  • Endoscopic removal of gallstones using ERCP to relieve blockages.
  • Stent placement in narrowed or obstructed bile ducts.
  • Surgical resection of tumours or strictures causing biliary obstruction.
  • Liver resection to remove diseased liver tissue when appropriate.
  • Liver transplant referral for patients with end-stage liver disease or liver failure.

  • Supportive care

    In addition to addressing the root cause, supportive treatments can help manage symptoms and improve overall well-being:
  • Hydration and nutritional support to assist recovery and liver function.
  • Medications for pruritus, to relieve itching associated with high bilirubin levels.
  • Regular monitoring of bilirubin and liver enzyme levels to track disease progression.

Treating Jaundice Caused By Pancreatic Disorders

Jaundice may occur when a pancreatic tumour compresses the bile duct, obstructing bile flow. Treatment focuses on relieving the obstruction and addressing the underlying pancreatic condition:

  • Surgical resection (Whipple procedure) may be considered for patients with resectable pancreatic tumours. This procedure removes the head of the pancreas along with surrounding structures to restore normal bile drainage.
  • Endoscopic stenting can be performed to relieve bile duct obstruction and improve symptoms in cases where surgery is not immediately suitable.
  • Oncology referral may be necessary for advanced or metastatic disease, where systemic therapy such as chemotherapy is indicated.

Treating Jaundice Caused by Bile Duct Obstruction

When jaundice is due to a blockage in the bile ducts, treatment focuses on restoring normal bile flow to enable proper bilirubin elimination. Several surgical and interventional approaches may be used depending on the location and cause of the obstruction.

  • Biliary bypass: When tumors or strictures block the bile ducts, a bypass can restore the flow of bile from the liver to the intestines, allowing bilirubin to be eliminated from the body, thereby reducing jaundice.

  • Endoscopic Retrograde Cholangiopancreatography (ERCP): This procedure is particularly effective for diagnosing and treating jaundice caused by gallstones or narrowings in the bile ducts. Removing gallstones or placing stents opens up the bile ducts, allowing bilirubin to be properly excreted.

  • Bile duct resection: Removing blocked or diseased sections of the bile duct clears the obstruction, restoring bile flow and addressing the jaundice caused by bile duct conditions.

  • Percutaneous Transhepatic Cholangiography (PTC): Similar to ERCP, PTC can identify and treat blockages in the bile ducts, ensuring that bile and bilirubin can flow normally from the liver to the intestines.

Treating Jaundice Caused by Gallbladder Disorders

Gallstones are a common cause of bile duct obstruction leading to jaundice. Treatment typically involves relieving the blockage and addressing the source of stone formation:
  • Cholecystectomy (gallbladder removal) is often performed laparoscopically to prevent recurrence of gallstones. This is typically recommended once the bile duct has been cleared.
  • Endoscopic Retrograde Cholangiopancreatography (ERCP) may be used to remove stones lodged in the bile duct and restore normal bile flow.
  • Oncological evaluation may be necessary if imaging or biopsy suggests gallbladder cancer, with further treatment guided by surgical or oncology specialists.

Complications Associated with Jaundice

Untreated jaundice, especially when chronic or severe, may lead to significant health complications due to the underlying conditions causing the bilirubin buildup.

  • Chronic Liver Disease
    Ongoing liver dysfunction can progress to cirrhosis, liver failure, or liver cancer, conditions that pose serious health risks and require complex management.
  • Brain Damage
    In severe cases, particularly in newborns with jaundice, high levels of bilirubin can cross the blood-brain barrier, leading to a condition known as kernicterus, which can cause permanent neurological damage.

  • Bile Duct Damage
    In cases of post-hepatic jaundice, prolonged obstruction can cause lasting damage to the bile ducts, leading to biliary cirrhosis.
  • Infection
    Blockages in the bile ducts can predispose individuals to infections, such as cholangitis, a serious condition that requires prompt medical intervention.

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Prevention and Management of Jaundice

While not all causes of jaundice can be prevented, there are strategies to minimize the risk of developing this condition and to manage it effectively when it occurs.

Maintain a Healthy Lifestyle

Regular exercise, a balanced diet, and moderation in alcohol consumption can support liver health and reduce the risk of liver-related causes of jaundice.

Vaccinate Against Hepatitis

Vaccinations for hepatitis A and B can prevent these viral infections that may lead to jaundice.

Use Medications Wisely

Avoid excessive use of alcohol or drugs that can harm the liver. Always consult your doctor before taking new medications, especially if there is a known liver condition.

Practice Safe Blood Transfusions

Ensure blood products are screened for hepatitis viruses and other infections to prevent transfusion-related jaundice.

Screen for Conditions

Regular medical check-ups and screenings for liver function, especially in individuals at higher risk for liver diseases, can detect problems early.

Safe Sexual Practices

Using barrier protection during sexual activity can reduce the risk of hepatitis B and C, both of which can lead to jaundice.

Dr Thng Yongxian

Senior Consultant

HEPATOPANCREATOBILIARY & GENERAL SURGEON

MBBS (SG) • MMed (Surg) • MRCS (Ire) • FRCSEd (Gen) • FAMS (Surg)

Dr Thng Yongxian is a dual fellowship-trained Hepatopancreatobiliary & General Surgeon who has performed over 6000 surgical procedures.

  • Bachelor of Medicine & Bachelor of Surgery
  • National University of Singapore
  • Membership of the Royal College of Surgeons, Ireland
  • Master of Medicine, General Surgery, Singapore
  • Fellow of the Royal College of Surgeons, Edinburgh
  • Fellow of the Academy of Medicine, Singapore

He pursued his subspecialty training in Hepatopancreatobiliary surgery first in the Department of Hepatopancreatobiliary Surgery, Singapore General Hospital. Following this, he completed a clinical fellowship in Minimally Invasive Hepatopancreatobiliary Surgery at Seoul National University Hospital in Bundang, South Korea.


Dr Thng set up and pioneered the Minimally invasive surgery program for his hospital in complex liver and pancreas cases. His surgeries were featured on live national television. His surgical videos have also been presented at international surgical conferences. He also pioneered the use of capsule colonoscopy for colorectal screening.


Dr Thng has served on various committees at hospital, cluster and ministry level. Dr Thng served as a member of the Ministry of Health (MOH) Laparoscopic cholecystectomy Clinician workgroup for value-driven care (VDC).

Frequently Asked Questions About Jaundice

Is jaundice a disease or a symptom?
Jaundice is a symptom, not a disease. It indicates an underlying issue that affects the body’s ability to process or eliminate bilirubin, such as liver disease, bile duct obstruction, or increased red blood cell breakdown.
Jaundice itself is not contagious. However, some causes of jaundice, such as viral hepatitis, can be transmitted through blood or bodily fluids. In such cases, it is the infection, not the jaundice, that is contagious.

Jaundice is generally classified into three types based on its cause:

  • Pre-hepatic: Caused by conditions that increase red blood cell breakdown
  • Hepatic: Due to liver disease or impaired liver function
  • Post-hepatic: Caused by obstruction of bile flow outside the liver
The duration depends on the underlying cause. Some forms of jaundice, such as those from infections, may resolve within weeks, while others related to chronic conditions may require longer-term management.

Yes, jaundice can be a sign of liver cancer, especially if it is caused by a tumour blocking the bile ducts. However, jaundice alone does not confirm cancer. Further evaluation is necessary to determine the cause.

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Our Clinic Locations

Nexus Surgical @ Mt. Alvernia

Nexus Surgical @ Mt. Elizabeth Orchard

Nexus Surgical @ Mt. Elizabeth Novena

Nexus Surgical @ Parkway East

Nexus Surgical @ Gleneagles Medical Centre

Nexus Surgical @ Mt. Alvernia

Nexus Surgical @ Mt. Elizabeth Orchard

Nexus Surgical @ Mt. Elizabeth Novena

Nexus Surgical @ Parkway East

Nexus Surgical @ Gleneagles Medical Centre

Nexus Surgical @ Mt. Alvernia

Nexus Surgical @ Mt. Elizabeth Orchard

Nexus Surgical @ Mt. Elizabeth Novena

Nexus Surgical @ Parkway East

Nexus Surgical @ Gleneagles Medical Centre

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