Jaundice

Jaundice (Piliya) occurs when the skin or the whites of the eye turn yellow. It primarily occurs due to elevated bilirubin levels in the body. The condition primarily affects the liver. It occurs in children more commonly and in adults too, due to various underlying causes. This overview will help you to go through the jaundice definition, types, management, diagnosis, key facts and other crucial aspects of the condition, equipping readers with the insights needed to comprehend and curb the management of this condition. 

What is Jaundice (Piliya)?

A medical symptom known as jaundice is the yellowing of the skin, sclerae, and mucous membranes brought on by an excessive buildup of bilirubin, a byproduct of red blood cell breakdown (MedlinePlus,2025). It is a hepatobiliary condition because it mainly affects the liver and biliary system. It is not a contagious condition, but it occurs due to imbalances in the elimination of bilirubin due to underlying conditions.

It often affects newborn babies. About 50% - 60% of newborns develop jaundice, sometimes referred to as icterus, during the first few days of life; while adults can also contract it, it is far less prevalent. 

Jaundice, caused by bilirubin buildup, can be caused by serious conditions like alcohol-related liver disease, gallstones, hepatitis, pancreatitis, or sickle cell disease, with treatments varying depending on the cause. This condition is often a sign of an underlying disease, so prompt diagnosis and good therapy of jaundice depend on an awareness of the causes, transmission, symptoms, and risk factors connected to the condition.

Jaundice can be categorised into four main types, based on where bilirubin accumulates in the body (Stillman, 1990). A blood test can identify the specific type you have.

• Prehepatic: Prehepatic jaundice occurs when bilirubin accumulates before reaching the liver. This indicates that red blood cells are being broken down, producing more bilirubin than your liver is able to handle.
• Hepatic: Hepatic jaundice refers to the condition when your liver is unable to effectively process bilirubin.
• Posthepatic: When bilirubin accumulates after passing through the liver and your body is unable to remove it at a sufficient rate, this is known as posthepatic jaundice.
• Obstructive: Obstructive jaundice itself is not inherently fatal, but underlying causes like pancreatic cancer or delayed treatment can lead to serious outcomes.

Early signs of jaundice include mild yellowing of the sclera, skin, and dark urine; fatigue; abdominal discomfort; and loss of appetite.  In some cases, jaundice may have no symptoms. The most common sign is the yellowing of the sclera, skin and mucous membrane.

General Symptoms are as Follows: 

• Fever 
• Stomach pain 
• Chills 
• Dark urine
• Clay-coloured stools 
• Loss of appetite 
• Weakness 
• Itchy skin 
• Bloody vomit 
• Confusion 
• Drowsiness 
• Weight loss 
• Unusual irritation 
• Bruising and bleeding
• Flu-like symptoms (These are typical in viral hepatitis, a cause of jaundice, not jaundice itself). 

The development of jaundice involves three main stages:

1. Prehepatic Stage (Before the Liver)

In this stage, red blood cells break down naturally after about 120 days or if they are damaged. This breakdown happens in the reticuloendothelial system, mainly in the spleen. When red blood cells break, they release a protein called haemoglobin into the bloodstream.

Haemoglobin is then split into two parts:

• Heme (which contains iron)
• Globin (a protein)

The heme part is broken down further:

• First, it is converted into biliverdin (a green pigment) by an enzyme called heme oxygenase.
• Then, biliverdin is converted into bilirubin (a yellow pigment) by biliverdin reductase.

Most bilirubin in the body is produced this way. A small amount also comes from the breakdown of other proteins that contain heme, like muscle myoglobin and cytochromes. This type of bilirubin is called unconjugated bilirubin, and it is not water-soluble, so it travels in the blood attached to a protein called albumin.

2. Hepatic Stage (In the Liver)

When unconjugated bilirubin reaches the liver, it is processed by an enzyme called glucuronyl transferase. This enzyme converts it into a water-soluble form called conjugated bilirubin (also known as bilirubin diglucuronide).

This conversion is essential because the body can only remove bilirubin once it becomes water-soluble. The liver then releases this conjugated bilirubin into the bile, which is stored in the gallbladder.

3. Posthepatic Stage (After the Liver)

When bile is released into the intestines during digestion, it carries conjugated bilirubin into the gut. In the intestines, natural bacteria act on bilirubin and convert it into a compound called urobilinogen.

From here:

• Most urobilinogen is turned into stercobilin, which gives faeces their brown colour.
• Some urobilinogen is reabsorbed into the bloodstream and returns to the liver.

A small amount is filtered by the kidneys and excreted in urine as urobilin, giving urine its yellow colour.
 

There are multiple causes of jaundice, such as alcoholism, hepatitis, genetic conditions other systemic effects, discussed below in detail. 

• Hepatitis: Liver inflammation, which can result from a virus, an autoimmune illness, alcohol or drug consumption, blood transfusion, or chemical exposure, is known as hepatitis. It could be chronic, which means that it lasts for at least six months, or it could be acute, which means that it doesn't last for very long. Jaundice can result from liver injury caused by prolonged inflammation.
• Alcohol-related liver disease: Consistent heavy drinking over an extended period, usually eight to ten years, can seriously harm your liver. The liver is seriously damaged by two conditions in particular: alcoholic hepatitis and alcoholic cirrhosis, which could lead to jaundice and associated symptoms. 
• Other liver diseases: Hepatitis, autoimmune disorders, and genetic disorders that run in your family can all lead to cirrhosis. Nonalcoholic fatty liver disease can lead to a serious condition called nonalcoholic steatohepatitis. In this sort of liver illness, fat accumulation in the liver is accompanied by inflammation, which causes progressive liver damage.
• Blocked bile ducts: These are narrow tubes that transport bile, a fluid produced by the liver and gallbladder, to the small intestine. You could get jaundice if gallstones, cancer, inflammation, or rare liver disorders obstruct the tubes.
• Pancreatic cancer: It is a prevalent disease among both sexes. It has the potential to obstruct the bile duct, resulting in jaundice.
• Specific medications: Liver illness has been associated with certain drugs, including steroids, birth control tablets, penicillin, and acetaminophen, which could cause liver imbalance and may lead to jaundice.
• Blood clots: Bilirubin levels might rise if your body reabsorbs a big blood clot (haematoma) that occurs beneath the skin, but it is an uncommon condition. 
• Haemolytic anaemia: The body occasionally eliminates damaged blood cells from circulation too quickly, which raises bilirubin levels.
• Gilbert's syndrome and Crigler-Najjar syndrome: As a result of impaired activity of the UGT1A1 enzyme, which is essential for bilirubin conjugation, genetic liver disorders known as Gilbert's syndrome and Crigler-Najjar syndrome result in elevated blood levels of unconjugated bilirubin. Gilbert's syndrome is quite common and generally mild, and it is frequently discovered by chance during routine blood tests. In contrast, Crigler-Najjar syndrome, especially Type I, is a rarer and more severe illness that can lead to dangerously high amounts of jaundice, particularly in infants and newborns. Unlike Gilbert's syndrome, Crigler-Najjar often requires aggressive treatment, such as phototherapy or, in severe cases, liver transplantation.
• G6PD deficiency: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a common enzymatic disorder that can lead to haemolytic jaundice, especially in newborns or after exposure to certain drugs, foods, or infections. Red blood cells rupture prematurely (haemolysis) in individuals with G6PD deficiency, releasing a lot of heme and hence unconjugated bilirubin, which the liver may have trouble processing quickly. This condition can lead to neonatal jaundice right after birth, and it must be treated right away to avoid complications such as kernicterus. 
• Breastfeeding Jaundice and Breast Milk Jaundice: These are two distinct kinds of neonatal jaundice. Breastfeeding jaundice, which is caused by insufficient milk intake that delays bilirubin clearance, typically manifests within the first week of life (CDC, 2024). In contrast, breast milk jaundice appears after the first week and can linger for several weeks. It is believed that some of the substances found in breast milk impede the breakdown of bilirubin. Both of these conditions are usually mild and do not require end-of-life nursing, although they do require monitoring to exclude more serious causes. 

The cause of your jaundice will determine whether or not it occurs. If it is a virus, it may become chronic or spread. However, if your liver is failing due to jaundice, complications from your liver illness might include coma and even death.

• Alcohol Overuse: Too much alcohol may predispose the individual to develop jaundice due to impaired liver function. 
• Viral Infection: Hepatitis, i.e., liver inflammation, may lead to jaundice. 
• Certain Cancers: Cancer of the pancreas, gall bladder, and liver may lead to jaundice. 
• Neonates: Immature bilirubin metabolism may lead to elevated bilirubin levels. 
• Liver Disease: Cirrhosis or other liver conditions may lead to jaundice due to bilirubin accumulation. 
• Genetics: Genetic nonhaemolytic hyperbilirubinaemia (i.e., Gilbert's or Dubin–Johnson syndrome) as the cause.

Who is at risk? 

The newborn infants, patients suffering from sickle cell anaemia, haemolytic anaemia, hepatitis, gallstones, alcoholics, those with autoimmune genetic conditions, and those with pancreatic cancer are at a severe risk of suffering from jaundice. 

• Neurological Dysfunction: Neonates with significant hyperbilirubinaemia run the risk of developing bilirubin-induced neurologic dysfunction (BIND) (Ansong-Assoku et al., 2024).
• Kernicterus: It is the collection and deposition of waste products in blood and brain tissues, which is a severe form of bilirubin encephalopathy in newborns left untreated (Ansong-Assoku et al., 2024).
• Failure of the liver or cirrhosis: It may lead to progressive chronic jaundice.
• Hepatic encephalopathy (HE): A neurological side effect of advanced jaundice and liver failure is hepatic encephalopathy. When the liver cannot eliminate poisons such as ammonia and free bilirubin, these compounds build up and impair brain activity, causing disorientation, bewilderment, or even coma. Elevated bilirubin levels, especially the bilirubin/albumin ratio, have been connected to a greater risk of HE. 
• Hepatorenal Syndrome (HRS): A kind of kidney failure found in people with advanced liver impairment and protracted jaundice is called hepatorenal syndrome. Changes in circulation and vasoconstriction caused by liver failure cause it as a result of decreased blood flow to the kidneys. Usually appearing in advanced cirrhosis or cholestatic jaundice, this condition is distinguished by rapid loss of kidney function without structural kidney damage.  
• If jaundice is not treated promptly, the condition may worsen, lead to the accumulation of bilirubin and cause death or even coma episodes. 

The following are the simple ways that can help avoid the majority of instances of jaundice.  

• Most herbal supplements are harmful to the liver and can result in irreversible liver damage that causes jaundice; thus, avoid them unless you speak with a doctor.
• Refrain from smoking, drinking alcohol, and using intravenous drugs.
• Don't take more than the prescribed dose of any prescription drugs.
• See your physician if you observe yellowish staining on your body tissues.
• Promote safe sex behaviours to prevent hepatitis transmission (CDC, 2024).
• Jaundice due to hepatitis A and B is vaccine-preventable (CDC, 2024).
• Maintain a healthy weight. 
• Create awareness about the disease through mass media, patient counselling, education and IEC (Information, Education and Counselling) activities. 
• Before going to a foreign nation, always make sure to receive the prescribed vaccinations.
• Keep the cholesterol levels in the healthy range. 
• Avoid too many fatty foods, dairy products and cheese. 
• Ensure timely and recommended vaccinations, especially when travelling. 

Diagnosis of jaundice involves a basic physical examination, followed by confirmatory laboratory tests and imaging to confirm the occurrence of jaundice as well as to identify its underlying causes and assess the extent of liver involvement. 

• Physical Examination and Medical History: Usually starting with a careful assessment of your symptoms and medical background is the diagnostic process. Your doctor will enquire about any recent infections, alcohol intake, family history of liver disease, and medication consumption. The doctor will search for yellowing of the skin and eyes as well as probe your belly during the physical examination to determine any swelling or soreness in the liver region.
• Tests for bilirubin levels and blood: Blood tests will most certainly be ordered by your physician to confirm jaundice and assess its degree. Measurements of cholesterol, total and direct bilirubin levels, and a complete blood count (CBC) are included in these tests. Jaundice is marked by high bilirubin levels, which show that the liver is not properly removing or processing bilirubin.
• Hepatitis Panel: This blood test searches for hepatitis A, B, and C (MedlinePlus,2025). If antibodies for these viruses are found, it might mean either ongoing infection or past exposure. Not seeing any antibodies indicates either that you never had the virus or that you had it and your immune system efficiently eliminated it.
• Tests for Liver Enzymes: Liver function is evaluated based on the levels of several enzymes found in the liver, such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and gamma-glutamyl transferase (GGT)(NCBI, 2023). Abnormal levels of these enzymes could indicate liver inflammation, damage, or a bile duct obstruction, all of which can lead to jaundice.
• Scans: Imaging examinations are frequently undertaken to provide a better view of the bile ducts and liver. Imaging is vital in detecting tumours, gallstones, or liver enlargement; it includes ultrasound, CT scans, or magnetic resonance cholangiopancreatography (MRCP), a specialised MRI that checks for structural blockages or narrowing in the gallbladder and bile ducts.
• Biopsy: Your doctor might advise a liver biopsy in certain situations to assess liver tissue under a microscope. A needle inserted through the skin, a vein in the neck, or a surgical incision is used to get a little tissue sample. This test assists in determining the degree of liver damage and offers certain details on liver diseases, including cirrhosis, hepatitis, or cancer.
• Prothrombin Time (PT): A blood test called prothrombin time examines how long your blood clots. A prolonged clotting time could point to impaired liver function since the liver produces most of the proteins needed for blood clotting. Anything slower may indicate reduced liver synthetic activity; the typical PT range is between 10 and 13 seconds.

Generally speaking, jaundice itself is not treated in adults. However, your physician will address the underlying cause by providing symptomatic treatment. 

• Due to Viral Hepatitis: Jaundice will disappear naturally as your liver recovers if you have acute viral hepatitis (MedlinePlus,2025). 
• Due to a blocked Bile Duct: Your doctor may recommend surgery to unclog a blocked bile duct if it is the cause. 
• Itching: Cholestyramine, which may be administered orally, can be prescribed by your physician if your skin is itchy (Paumgartner & Beuers, 2002). This drug helps to eliminate the bile acids that induce itching from your system.
• Medication: Ursodeoxycholic acid may improve serum lipid levels and provides safeguarding of cholangiocytes from the cytotoxicity of hydrophobic bile acids (Paumgartner & Beuers, 2002).

Note: This medication requires proper dosing based on body weight and underlying condition. Regular liver function monitoring is necessary during treatment.

• Phototherapy for Jaundice: Phototherapy employs fluorescent white or blue-spectrum light to break down bilirubin, enabling it to leave the body. Phototherapy is primarily used for neonatal jaundice (Ansong-Assoku et al., 2024).
• Home Remedies: Take home-cooked food, take low-fat food, maintain hygiene, take adequate rest, stay hydrated to eliminate the toxins, consume sugarcane juice and curd, and chew raw sugarcane. 
• Limiting alcohol intake, being vaccinated against hepatitis, and reducing consumption of fatty and dairy foods may also help manage the progression. 

Disclaimer: Home remedies are supportive measures only and do not replace medical treatment. Always consult your healthcare provider before implementing any home care regimen.

Until the symptoms subsides, regularly monitoring liver function, SGOT, SGPT, CBC, medication adherence, a balanced diet, light foods, patient education, limiting alcohol intake, maintaining hygiene to prevent catching infection and a healthy lifestyle. 

Early detection and treatment of jaundice are crucial to prevent the further spread of infection and to effectively manage the condition. 

• Look for medical attention if dark urine, pale stools, abdominal pain, fever, or mental changes persist for more than two weeks.

• Jaundice is caused by elevated bilirubin levels. Bilirubin is the waste product of red blood cells, which is processed by the liver to be excreted. The elevated bilirubin levels cause yellowing of the skin, eyes, and mucous membranes, which is the first indication of the disease. It should be reported to the physician for prompt and timely management. Regular monitoring of the blood counts to keep an eye on the progression of the disease should be done to curb it from causing more discomfort. 
• Sugarcane juice can be an added advantage for maintaining adequate hydration. 
• Once the condition is confirmed, stay hydrated, take rest, and take home-cooked light foods like khichdis, fruits, vegetables, and juices, and chew raw sugarcane. 
• Monitor complete blood counts, bilirubin levels, and swelling or tenderness in the liver region. 
• Timely treatment is needed for newborns to avoid encephalopathy.
• Limit the intake of alcohol and fatty dairy foods. 

Disclaimer: This information is for educational purposes only and should not replace professional medical advice. Always consult with qualified healthcare providers for diagnosis, treatment, and medical decisions regarding jaundice or any other health condition.