Synonyms
Icterus
Definition jaundice
Jaundice is an unnatural yellowing of the skin or the conjunctiva of the eyes and the mucous membranes, which is caused by an increase in the metabolic product bilirubin. If the level of bilirubin in the body rises above 2 mg/dl, yellowing is triggered.
What is an icterus?
Icterus is the medical term for jaundice. Characteristic for jaundice is a visible discoloration of the skin and eyes or the “eye white”, the so-called sclerae. The cause of jaundice is an increased amount of bilirubin, the breakdown product of the red blood pigment, the so-called haemoglobin. Bilirubin can be divided into a direct form and an indirect form depending on how far the metabolic process has progressed. The reasons for the occurrence of an icterus are manifold and should always be clarified by a doctor.
Forms and causes of jaundice
The metabolic product bilirubin is the breakdown product of the red blood pigment. If transport is disrupted, or if there is an increased attack, bilirubin is released to the surrounding tissue and then stains the skin, mucous membrane and dermis or conjunctiva of the eyes yellowish. In principle, there are three main forms of jaundice (icterus), which are derived from the place of origin.
Papillary carcinomas can also lead to the development of jaundice. Due to the narrowing of the bile ducts by the tumor, jaundice (posthepatic icterus) can develop. The prehepatic icterus usually has its cause outside the liver, in the metabolic area that precedes the liver.
This includes hemolytic anemia, i.e. diseases in which blood components are dissolved. The product that is produced in this process is, among other things, bilirubin, which then colors the skin yellow. But also an ineffective blood production can lead to an increased bilirubin attack and is therefore also counted as prehepatic jaundice.
A special form is the so-called Morbus Hämolyticus Neonatorum (neonatal icterus). A blood incompatibility in newborns. If a mother gives birth to a child with a different rhesus group, she produces antibodies.
When a second child is born, the antibodies are then directed against the second child and attack its blood components. The child becomes conspicuous by jaundice, among other things. Today, this type of jaundice (icterus) has become relatively rare because precise checks on the mother and previous pregnancies are among the standard examinations.
The hepatic icterus has its cause in the liver. This includes all inflammations of the liver tissue, such as infectious hepatitis caused by viruses, bacteria and chronic hepatitis and cirrhosis of the liver, which has its cause either in infections or in excessive alcohol consumption. Diseases that result in increased bilirubin production (familial hyperbilirubinemia), toxin-produced hepatitides caused by alcohol, carbon tetrachloride and tuber leaf fungus poisoning are also among the intrahepatic causes of jaundice.
Since most drugs are metabolized in the liver after intake, it is possible to damage the liver so severely that jaundice results even in the case of overdose (drugs hepatitis, drugs hepatitis). Excessive consumption of alcohol and cirrhosis of the liver can eventually lead to a congested liver with the so-called portal vein hypertension, which hinders the flow of bile acid through the liver. One of the first symptoms of this congested liver (portal vein hypertension) is usually also jaundice.
Numerous other diseases can also cause intrahepatic jaundice. These are rare metabolic diseases, such as Wilson’s disease, in which iron is abnormally stored in the liver, which means that the liver can no longer function properly and is unable to dispose of the blood pigment bilirubin. Scarring of the bile ducts, so-called PSC (primary sclerosing cholangitis) and PBC (primary biliary cirrhosis) are other rare causes of intrahepatic icterus.
Inflammatory changes in the bile ducts after infusion of a chemotherapeutic agent or thrombosis in the liver veins (Budd Chiari syndrome) are also sometimes causes of jaundice. A special form of intrahepatic icterus is idiopathic pregnancy icterus. It is not dangerous for the mother, but if it is not treated, about 10% of children die during birth and 20% of children are born too early.In the case of a familial predisposition, a disturbance of the bile acid outflow with an accompanied increase in bilirubin may occur during pregnancy.
In addition to yellowing, this is usually accompanied by an unpleasant itching of the skin. A posthepatic icterus is a disturbance of the outflow from the outflow tract of the liver and the bile duct system. This can be caused by a gallstone or adhesions after surgery, but also by tumor formation in the bile duct or pancreas.
The icterus (jaundice) is often the first symptom of this malignant disease, but unfortunately the tumor is already well advanced at this time. In newborns, the occurrence of jaundice between the 3-8 days of life is usually considered natural. This usually subsides within 1-2 weeks.
As long as there are red blood cells in the mother’s belly, children still have red blood cells that are slightly different from those of adults and also occur in a much higher number. After birth, these blood cells are increasingly broken down and replaced by new ones, namely the same ones that adults have. The strong attack of decomposition products of the red blood pigment, or bilirubin, is then responsible for the icterus and is generally considered harmless.
Caution should be exercised, however, in the case of a newborn icterus that develops within the first 24 hours of life or lasts longer than 10 days. It is also considered problematic if the concentration of bilirubin exceeds a certain level. In these cases, an immediate medical examination of the child is necessary.
Important information on this topic:
- Newborn jaundice
- Newborn Icterus
Cholestatic jaundice refers to jaundice caused by a disorder of bile formation or secretion or a disorder of bile flow. The disorder of bile outflow can be located in the liver as well as in the bile ducts outside the liver. The bile naturally transports the blood breakdown product bilirubin into the intestine, which can then be excreted in the stool.
If there is an obstruction in the outflow or secretion of bile, the bilirubin cannot be excreted properly. The typical symptoms of icterus then occur. Furthermore, cholestatic jaundice can become noticeable through the appearance of discolored stool, since the bilirubin that normally gives stool its typical brown color is missing.
Alternatively, the body tries to excrete the bilirubin present in the urine, which then turns brownish, as the stool normally does. Another symptom of jaundice can therefore also be brown urine. There are many things that can cause disturbances in the production or secretion of bile, as well as its drainage.
These include causes that are localized in the liver itself, such as inflammation of the liver or liver cirrhosis, i.e. cell death of liver cells, which can have various causes. A tumor of the liver or the bile ducts running through it can also lead to jaundice by blocking the bile flow through the growing tumor tissue. In addition, mechanical obstacles outside the liver can cause flow disturbances, such as gallstones or inflammatory processes in the bile ducts.
In addition, malformations of the bile ducts can obstruct the outflow. Tumors of the pancreas or an inflammation of the pancreas can also lead to jaundice. The reason for this is the anatomical proximity of the pancreas to the bile duct, which leads from the liver and the gall bladder into the intestine.
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