If too much bilirubin is produced or the liver cannot clear it, jaundice can develop.
Jaundice is not dangerous, but the underlying cause can be.
Causes range from relatively benign conditions likeGilbert syndrometo potentially fatal ones likeliver cancer.
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This article describes the causes, symptoms, and diagnosis of jaundice in adults and children.
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Prehepatic Jaundice
Red blood cells have a life span of around 120 days.
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They are broken down by the body and replaced by new ones.
Prehepatic jaundice is caused when hemolysis is increased, overwhelming the liver with more bilirubin than it can handle.
Hepatic jaundice is caused when liver cells involved in this process, calledhepatocytes, are damaged.
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Posthepatic jaundice takes place if there is an obstruction in the pathway from the liver to the small intestine.
This causes bile to back up into the liver, where bilirubin can escape.
This breakdown causes the release of more bilirubin than a newborn’s liver can clear.
On rare occasions, neonatal jaundice is not normal.
Another relatively benign cause of jaundice is “breastfeeding jaundice,” a casual term for suboptimal intake jaundice.
This usually occurs in the second week of life when a newborn is not getting enough nutrition.
Breast milk is also thought to contain substances that can impair the conjugation of bilirubin in the liver.
Increased breastfeeding or supplementation with bottled formula will almost invariably help handle the condition.
Depending on the cause, the symptoms can be transient and barely noticeable or long-lasting and severe.
Jaundice symptoms can also differ in newborns.
Reproduced with permission from DermNet and Te Whatu Oradermnetnz.org2023.
Common Symptoms
On its own, jaundice does not cause anything other than yellowish discoloration.
Jaundice in adults and children is typically pathologic, meaning it is related to a disease.
If other symptoms accompany jaundice, it is due to the underlying disease.
These symptoms can vary by whether the condition is hepatic, posthepatic, or prehepatic.
However, in some newborns, jaundice may be pathologic.
With neonatal jaundice, the timeline is more consistent.
In formula-fed babies, jaundice typically clears within two weeks.
In breastfed babies, jaundice may last two to three weeks, sometimes longer.
Aliver biopsymay also be performed to obtain a sample of liver tissue for evaluation in the lab.
Neonatal jaundice is monitored with blood tests that measure bilirubin in milligrams per deciliter of blood (mg/dL).
The treatment varies by the cause.
In all other cases, the treatment is largely medical.
Home phototherapy machines allow home treatment outside of the hospital.
In severe cases, a procedure called an exchange transfusion can counteract the effects of kernicterus.
While potentially lifesaving, risks include blood clots, severe changes in blood chemistry, andshock.
Autoimmune hepatitis and acute hepatitis A and B have also been known to cause acute liver failure.
Another concern is complications of hemolytic anemia, one of the most common causes of prehepatic jaundice.
Severe cases have been known to cause life-threateningarrhythmia(irregular heartbeats),heart failure, and even death.
When to Contact a Healthcare Provider
No amount of jaundice is considered “normal.”
Early intervention can help you avoid potentially serious complications.
Bilirubin is a byproduct of the breakdown of red blood cells.
Neonatal jaundice in newborns is usually normal but can become life-threatening if bilirubin levels are persistently high.
Jaundice is diagnosed with blood tests and will usually clear once the underlying condition is resolved.
Infants with very high bilirubin levels may benefit from phototherapy or an exchange transfusion.
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