Jaundice is defined as ‘yellow discolouration’ of the skin. It can also be recognised by a yellow discolouration of the conjunctiva (whites of the eyes). Patients experience jaundice when they suffer a rise in a liver enzyme called bilirubin, within the blood stream. The normal value for bilirubin is below 20 IU/L but a rise of over 50 will become noticeable by a yellow discolouration of the conjunctiva initially. Other symptoms commonly associated with the onset of jaundice, include skin irritation (itching), nausea, poor appetite, fever and generally feeling unwell. Skin irritation is sometime the first symptom that you will experience, also when jaundice appears it is usual a close friend, partner or relative that may notice it first.
Once diagnosed, patients with jaundice are admitted to hospital for further investigations, which include both routine and specialised blood tests, a standard abdominal ultrasound examination and either a Computed Tomography Scan (CT) or Magnetic Resonance Imaging Scan (MRI); in certain circumstances both of these scans are performed.
What are the causes of Jaundice?
The causes of jaundice can either be as a result of a primary problem with the liver, such as hepatitis or excessive alcohol consumption or more commonly, jaundice is associated with an obstruction of the flow of bile from the liver into the duodenum (bile duct obstruction). Patients with obstructive (also sometimes known as ‘secondary’) jaundice also complain of pale stool (yellow floating stools) and dark urine (pale brown urine).
Secondary causes include:
- Bile duct stones
- Pancreatic cancer
- Bile duct cancer (Cholangiocarcinoma)
- Duodenal cancer
- Ampullary cancer
- Chronic pancreatitis
How is Jaundice best treated?
A primary cause of jaundice is managed by the hepatologists, with the mainstay of treatment being either supportive care or antiviral treatment for hepatitis.
An obstruction of the bile duct requires an Endoscopic Cholangio-Pancreatography (ERCP) to relieve the obstruction, with either extraction of bile duct stones or placement of a plastic stent/ metal stent, if a narrowing is diagnosed possibly as a result of a malignancy. At this time cells can also be taken to try and determine the cause of jaundice.