Brief overview
- Description:Yellowing of the skin, mucous membrane, and sclera of the eyes due to deposited bilirubin. The yellowish-brown pigment is formed as a by-product of the breakdown of old red blood cells.
- Causes: e.g. liver inflammation (hepatitis), liver cirrhosis, liver cancer and liver metastases, gallstones, biliary tumor, sickle cell anemia, artificial heart valves, right heart failure, poisoning, certain medications.
- When to see a doctor? Always – especially if the yellowing of the skin, mucous membranes or eyes is accompanied by other warning signs such as pale stools or fatty stools, dark urine, fatigue, exhaustion, loss of performance, loss of appetite, unwanted weight loss, ascites, fever, confusion, disorientation, strong bad breath.
- Diagnosis: interview to obtain medical history (anamnesis), physical examination, blood test, imaging procedures such as ultrasound.
Jaundice: Description
Jaundice (icterus) is not a disease, but a symptom. It refers to a yellowing of the skin, mucous membrane and eyes. Often, inflammation of the liver (hepatitis) is mistakenly equated with jaundice.
The breakdown of red blood cells (erythrocytes) plays a role in the development of jaundice:
Red blood cells have a lifespan of about 120 days. After that, they are broken down in the liver and spleen. A by-product of this process is bilirubin. This yellowish-brown pigment is insoluble in water. In order for it to be transported with the blood, it is bound to the large protein molecule albumin – physicians then refer to this as indirect bilirubin. In the liver, the bilirubin is released and made water-soluble by binding to glucuronic acid. In this form, it is called direct bilirubin.
Bilirubin deposition in the tissue
The concentration of bilirubin in the blood is normally low. However, certain factors can increase bilirubin levels. If the values rise to more than 2 mg/dl (milligrams per deciliter), the dye is deposited in the tissue. This becomes visible first and foremost in the eyes: the normally white sclera turns yellow. If the bilirubin concentration in the blood continues to rise, the skin and mucous membranes also turn yellow.
In addition to the yellow coloration, itching is characteristic of jaundice. In severe hyperbilirubinemia, even the organs may be discolored yellow.
Jaundice: Causes
The liver plays an important role in the development of jaundice, as bilirubin is chemically processed there and passed on to the gallbladder for further processing. Nevertheless, liver disease need not always be the cause of jaundice. The causes are therefore subdivided according to three aspects:
If the liver fails to break down indirect bilirubin quickly, it is deposited in the tissue – resulting in the typical yellowing of the skin and eyes. Since the cause lies not in the liver itself, but in upstream processes, physicians also refer to this jaundice as “prehepatic.
It is usually caused by blood diseases in which the red blood cells do not live as long as normal and are therefore broken down more frequently. One example of such a disease is sickle cell anemia. However, artificial heart valves, viral infections, toxins and certain medications can also reduce the life span of red blood cells.
2. hepatic icterus
- Viral hepatitis: Hepatitis viruses (hepatitis A, B, C, D or E) often cause acute liver inflammation. Symptoms include fatigue, weight loss, exhaustion, vomiting, nausea, abdominal pain and jaundice. The discoloration of the stool and urine is also typical: the stool is light-colored and the urine dark-colored. If acute hepatitis develops into chronic hepatitis, this can lead to liver cirrhosis and liver cancer. To date, hepatitis B is one of the most common infectious diseases of mankind. Vaccinations against hepatitis A and B can protect against infection.
- Liver cirrhosis: Chronic liver diseases can change the liver surface. This leads to remodeling of the organ with extensive scarring. The liver is less and less able to perform its functions. The main causes of liver cirrhosis are alcohol dependence and viral hepatitis. Symptoms appear very late, but lead to death if left untreated. The only therapy is liver transplantation.
- Liver metastases: The liver is the central organ of the body’s metabolism. Therefore, if a cancerous tumor is located anywhere in the body (e.g., in the intestine), daughter metastases often develop in the liver.
- Poisoning: Eating poisonous mushrooms or toxic chemical substances can severely damage the liver – even causing liver failure.
- Medications: Many medications are processed in the liver and can cause temporary jaundice.
- Pregnancy: Yellow eyes and yellow skin during pregnancy can indicate pregnancy poisoning (gestosis). However, fatty liver may also be behind it.
- Right-sided heart failure: In the case of right-sided heart failure, blood can back up into the liver and damage the cells there. Affected individuals develop mild jaundice with yellow eyes and water retention in the legs and abdomen.
- Yellow fever: In tropical areas, the yellow fever virus transmitted by mosquitoes is widespread. In severe cases, it can lead to liver failure and jaundice, among other things. The disease is then often fatal.
- Congenital elevation of bilirubin levels: Some people have hyperbilirubinemia from birth. This is the case, for example, with the harmless Meulengracht’s disease. Affected individuals produce too little of the liver enzyme responsible for bilirubin processing. The result is jaundice with yellow eyes or yellowish to bronze-colored skin. Otherwise, those affected have no complaints. The disease does not require medical treatment.
3. cholestatic jaundice (posthepatic jaundice):
The following causes can obstruct bile flow:
- Gallstones in gallbladder or bile duct: women over 40 are particularly affected. In addition to icterus, colicky abdominal pain as well as nausea and vomiting are typical symptoms of gallstones. In the long term, gallstones can develop into cholecystitis (inflammation of the gallbladder) or pancreatitis (inflammation of the pancreas).
- Tumors of the gallbladder, duodenum or pancreas can also block the bile duct. In most cases, jaundice occurs before other symptoms develop.
Jaundice: When do you need to see a doctor?
Yellow skin, mucous membranes or eyes are alarming and should always be examined by a doctor. This is especially true if other typical jaundice symptoms are added:
- Tiredness, fatigue, loss of performance are among the uncharacteristic complaints of many liver diseases.
- Loss of appetite, unwanted weight loss.
- Abdominal dropsy (ascites): Increasing abdominal girth in liver cirrhosis or weakness.
- Edema in the legs indicates right heart failure.
- Fever is noticeable in acute inflammatory diseases, such as viral hepatitis and inflammation of the pancreas or gallbladder.
- Fatty stools usually occur as a result of biliary diseases such as gallstones (cholelithiasis).
- Clouding of consciousness, confusion and disorientation may occur in the final stages of liver cirrhosis or liver failure. These symptoms lead to what is known as hepatic coma.
- Strong bad breath. However, this only occurs in acute liver failure.
Note: Icterus without pain and accompanying symptoms may indicate an underlying cancer. Be sure to have this clarified by a physician.
In a personal consultation to obtain your medical history, the doctor will first ask you questions about your lifestyle, your medication consumption, your eating habits and any previous illnesses. Information on stays abroad or pregnancy can also help to track down the cause of jaundice. You should also talk openly about your alcohol consumption. This will enable the doctor to draw important conclusions about the condition of your liver.
Also tell the doctor exactly how long you have had the symptoms, whether you have pain and whether other symptoms accompany the yellowing.
Blood tests are also informative in jaundice:
- If bilirubin is elevated to levels above 2 mg/dl (milligrams per deciliter), this is noticeable by yellow eyes.
- Elevated levels of glutamate pyruvate transaminase (GPT) indicate liver damage.
- Glutamate oxalate transaminase (GOT) can be elevated in liver inflammation and biliary disease, but also in a heart attack. Chronic alcohol abuse is also reflected in elevated levels.
- Gamma-glutamyl transferase (gamma-GT) is a specific liver enzyme. An elevated reading can be caused by chronic alcohol consumption, for example.
- In addition, there are blood values of the pancreas such as alpha-amylase, which is elevated in the case of inflammation.
More complex imaging, such as magnetic resonance imaging (MRI) or computer tomography (CT), is more likely to be used if cancer is suspected.
Complete certainty can be obtained by taking a tissue sample (biopsy). This requires a small surgical procedure.
Note: Once the doctor has found the cause of jaundice, he will initiate appropriate treatment.
Jaundice: What can you do yourself?
If jaundice becomes noticeable through yellow eyes or a yellowish skin color, the only thing that can be done is to go to the doctor. It is necessary to discover the cause and treat jaundice properly. There are no home remedies or other methods against jaundice – the only therapy is treatment of the underlying disease.
However, you can try to prevent jaundice with some measures:
- Protect against hepatitis: By getting vaccinated against hepatitis A and B, you can eliminate two dangers at once.
- Travel smart: Familiarize yourself with the customs and dangers of your destination, especially if it is a hepatitis risk area. Poor hygiene means the hepatitis virus is transmitted particularly quickly through contaminated food. But you should also beware of mosquitoes and tropical diseases. Take into account the country-specific vaccination recommendations. Your doctor can advise you.
- Enjoy alcohol in moderation: For healthy women, a standard glass of alcohol a day (e.g., a glass of wine or a small beer) is considered low risk. For healthy men, twice that amount is medically acceptable.
Frequently asked questions
You can find the answers to the most frequently asked questions about this topic in our article Frequently asked questions about jaundice.
