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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 characterized by the yellowing of the skin and the whites of the eyes, a result of elevated bilirubin levels in the bloodstream.

Bilirubin is a yellow pigment formed by the breakdown of red blood cells, normally processed by the liver and eliminated in bile. When this process is disrupted, due to liver dysfunction, bile duct blockage, or excessive red blood cell breakdown, bilirubin accumulates in the body, leading to the distinctive yellow hue. This symptom can be an indicator of various underlying health issues, making its recognition important in clinical practice.

Causes of Jaundice

Jaundice results from an imbalance in the production and elimination of bilirubin, categorized into pre-hepatic, hepatic, and post-hepatic causes based on the mechanism of disruption.

  • Pre-hepatic Causes
    These are related to excessive production of bilirubin, exceeding the liver’s capacity to process it, often due to:
  • Hemolytic anaemias, where there is an increased breakdown of red blood cells.
  • Genetic conditions like spherocytosis or sickle cell anaemia.
  • Hepatic Causes
    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.
  • Post-hepatic Causes
    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.

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 that is caused by bilirubin deposits in the skin.
  • 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 jaundice involves a combination of physical examinations, blood tests to measure bilirubin levels and assess liver function, and imaging studies like ultrasound or CT scans to visualize the liver and bile ducts. The physical exam focuses on the extent of yellowing and checks for liver enlargement or tenderness.

Laboratory tests can distinguish between the types of jaundice—pre-hepatic, hepatic, or post-hepatic—by evaluating the forms of bilirubin present. Imaging can also identify obstructions in the bile ducts or abnormalities in the liver that may contribute to jaundice.

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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.

Congenital Factors

Liver Resection

This procedure can remove liver tumors or diseased sections that lead to biliary obstruction. By removing the affected portion, liver resection can improve liver function and reduce bilirubin levels in the bloodstream.

Liver Transplant

For patients with end-stage liver disease or liver failure, where the liver can no longer process bilirubin effectively, a transplant provides a new, functioning liver. This addresses the root cause of jaundice by replacing the damaged liver with a healthy one.

Addressing Pancreatic Disorders

Whipple Procedure (Pancreaticoduodenectomy): This surgery can remove a pancreatic tumor that is blocking the bile duct where it passes through the pancreas, causing jaundice. By removing the blockage, bile flow is restored, and bilirubin can be eliminated from the body normally.

Addressing Bile Duct Disorders

  • 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.

Addressing Gallbladder Disorders

Cholecystectomy and common bile duct exploration: Gallstones can block the bile ducts, causing jaundice. Exploration of the common bile duct is required to remove the stones. Subsequent removal of the gallbladder (the source of the stones) prevents new gallstones from forming and blocking the bile ducts.

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.

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 a healthcare provider 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).

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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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