Adult Jaundice Meaning
Bilirubin is a yellow chemical in hemoglobin, the substance that carries oxygen in your red blood cells. As red blood cells break down, your body builds new cells to replace them. The old ones are processed by the liver.
If the liver cannot handle the blood cells as they break down, bilirubin builds up in the body and your skin may look yellow. Jaundice has many causes, including hepatitis, gallstones, and tumors. In adults, jaundice usually does not need to be treated, however, the causes and complications can be treated.
Facts About Jaundice
The term” jaundice” is derived from the French word “jaune”, which means yellow.
- Jaundice is not a disease per se, but rather a visible sign of an underlying disease process.
- Jaundice is typically seen when the level of bilirubin in the blood exceeds 2.5-3 mg/dL (milligrams per deciliter).
- Jaundice in adults can be caused by a variety of medical conditions, some of which are serious and potentially life-threatening.
- Any adult who develops jaundice needs to undergo a comprehensive medical evaluation in order to determine its cause.
- Neonatal jaundice, a condition seen in newborns, is most often a benign condition that improves without serious after effects).
How common is jaundice in Adults? Who gets it?
The risk factors for developing jaundice vary based upon the underlying cause.
- Certain people with hereditary conditions (for example, thalassemia or hereditary spherocytosis) are at an increased risk of developing jaundice from hemolysis.
- People who consume alcohol heavily are at an increased risk of developing alcoholic hepatitis, pancreatitis, and cirrhosis leading to jaundice.
- People who are at an increased risk of exposure to the different types of viral hepatitis (for example, hepatitis B and hepatitis C) are at risk of developing jaundice at the time of infection or subsequently, if the liver disease occurs or if liver cancer develops later.
- Other risk factors include:
- Eating raw shellfish
- Drug injections of other substances
- Birth between 1945 and 1965
- Being an unvaccinated (for hepatitis)
- Healthcare professionals
- Participating in high-risk sexual activity
Adult Jaundice Causes | What Causes Adult Jaundice?
Jaundice is rare in adults, but you can get it for many reasons. Jaundice can be caused by a problem in any of the three phases in bilirubin production.
1). Before the production of bilirubin, you may have what is called unconjugated jaundice due to increased levels of bilirubin caused by:
- Reabsorption of a large hematoma. This is a collection of clotted or partially clotted blood under the skin.
- Hemolytic anemias. This is when the blood cells are destroyed and removed from the bloodstream before their normal lifespan is over.
2). During the production of bilirubin, jaundice can be caused by:
- Viruses, including Hepatitis A, chronic Hepatitis B and C, and Epstein-Barr virus infection (infectious mononucleosis)
- Autoimmune disorders.
- Rare genetic metabolic defects.
- Medicines, including acetaminophen toxicity, penicillins, oral contraceptives, chlorpromazine (Thorazine) and estrogenic or anabolic steroids.
3). After bilirubin is produced, jaundice may be caused by an obstruction (blockage) of the bile ducts from:
- Inflammation (swelling) of the gallbladder
- Gallbladder cancer.
- Pancreatic tumor.
What causes Jaundice during the hepatic phase in Adults?
Jaundice caused during the hepatic phase can arise from abnormalities in the metabolism and/or excretion of bilirubin. This can lead to an increase in both unconjugated and/or conjugated bilirubin levels. Conditions with a hepatic cause of jaundice include:
- Acute or chronic hepatitis (commonly viral [Hepatitis A, B, C, D, E] or alcohol-related)
- Cirrhosis (caused by various conditions including alcohol toxicity)
- Drugs or other toxins
- Crigler-Najjar syndrome
- Autoimmune disorders
- Gilbert’s syndrome
- Liver cancer
What are the post-hepatic causes of Jaundice in Adults?
Jaundice from a post-hepatic cause arises from a disruption (an obstruction) in the normal drainage and excretion of conjugated bilirubin in the form of bile from the liver into the intestine. This leads to increased levels of conjugated bilirubin in the bloodstream. Conditions that can cause post-hepatic jaundice include
- Cancer (pancreatic cancer, gallbladder cancer, and bile duct cancer),
- Strictures of the bile ducts,
- Pancreatitis, and
- Parasites (for example, liver flukes).
Adult Jaundice Symptoms
In Jaundice, sometimes the person may not have symptoms of jaundice, and the condition may be found accidentally. The severity of symptoms depends on the underlying causes and how quickly or slowly the disease develops.
If you have a short-term case of jaundice (usually caused by infection), you may have the following symptoms and signs:
- Abdominal pain
- Flu-like symptoms
- Change in skin color
- Dark-colored urine and/or clay-colored stool.
If jaundice is not caused by an infection, you may have symptoms such as weight loss or itchy skin (pruritus). If the jaundice is caused by pancreatic or biliary tract cancers, the most common symptom is abdominal pain. Sometimes, you may have jaundice occurring with liver disease if you have:
- Chronic hepatitis or inflammation of the liver
- Pyoderma gangrenosum (a type of skin disease)
- Acute hepatitis A, B or C
- Polyarthralgias (inflammation of the joints)
Adult Jaundice Diagnosis
Doctors diagnose jaundice by checking for signs of liver disease such as:
- Bruising of the skin
- Spider angiomas (abnormal collection of blood vessels near the surface of the skin)
- Palmar erythema (red coloration of the palms and fingertips)
Urinalysis (urine testing) that is positive for bilirubin shows that the patient has conjugated jaundice. The findings of urinalysis should be confirmed by serum testing. The serum testing will include a complete blood count (CBC) and bilirubin levels.
Your doctor will also do an exam to determine the size and tenderness of your liver. He or she may use imaging (ultrasonography and computer tomographic (CT) scanning) and liver biopsy (taking a sample of the liver) to further confirm the diagnosis.
What tests and procedures diagnose Jaundice in Adults?
The presence of jaundice requires a comprehensive medical evaluation to determine the cause. Initially, your health-care professional will take a detailed history of your illness and perform a physical exam, which can sometimes determine the cause of jaundice. Initial blood testing will also be undertaken, with special attention being given to your:
- Liver blood tests
- Complete blood count (CBC)
- Electrolyte panel
- Lipase levels
Blood testing for exposure to hepatitis may also be ordered. Additional blood testing may be ordered based on the initial results. A urinalysis will likely also be ordered.
Depending on the results of initial blood tests, further studies may be needed to help diagnose the underlying disease process. In certain cases, imaging studies will need to be obtained in order to evaluate for any abnormalities of the liver, gallbladder, and pancreas. These imaging studies may include:
- Abdominal ultrasound
- Computerized tomography (CT) scan
- Magnetic resonance imaging (MRI)
- Cholescintigraphy (HIDA scan)
Occasionally, people will need further invasive testing to determine the cause of jaundice. Procedures that may be ordered include endoscopic retrograde cholangiopancreatography (ERCP) or a liver biopsy.
Adult Jaundice Treatment
Jaundice usually does not require treatment in adults (it is a more severe problem in infants). The causes and complications of jaundice can be treated. For instance, if itching is bothersome, it may be eased by cholestyramine (Questran).
What is the treatment for jaundice in adults?
The treatment for jaundice depends entirely on the underlying cause. Once a diagnosis has been established, the appropriate course of treatment can then be initiated. Certain patients will require hospitalization, whereas others may be managed as outpatients at home.
- In certain individuals with jaundice, the treatment will consist of supportive care and can be managed at home. For example, most cases of mild viral hepatitis can be managed at home with watchful waiting and close monitoring by your doctor (expectant management). Novel medications for hepatitis C now can offer a cure for this condition.
- Alcohol cessation is necessary for patients with cirrhosis, alcoholic hepatitis, or acute pancreatitis secondary to alcohol use.
- Jaundice caused by drugs/medications/toxins requires discontinuation of the offending agent. In cases of intentional or unintentional acetaminophen (Tylenol) overdose, the antidote N-acetylcysteine (Mucomyst) may be required.
- Various medications may be used to treat the conditions leading to jaundice, such as steroids in the treatment of some autoimmune disorders. Certain patients with cirrhosis, for example, may require treatment with diuretics and lactulose.
- Antibiotics may be required for infectious causes of jaundice, or for the complications associated with certain conditions leading to jaundice (for example, cholangitis).
- Blood transfusions may be required in individuals with anemia from hemolysis or as a result of bleeding.
- Individuals with cancer leading to jaundice will require consultation with an oncologist, and the treatment will vary depending on the type and extent (staging) of cancer.
- Surgery and various invasive procedures may be required for certain patients with jaundice. For example, certain patients with gallstones may require surgery. Other individuals with liver failure/cirrhosis may require a liver transplant.
Adult Jaundice Complications
The type of complication and the severity of complications vary with the underlying cause leading to jaundice. Certain individuals will not suffer any long-term after effects and will have a full recovery, while for others the appearance of jaundice will be the first indication of a life-threatening condition. A few of the potential complications include:
- Electrolyte abnormalities
- Chronic hepatitis
- Liver failure
- Kidney failure
- Hepatic encephalopathy (brain dysfunction)
Adult Jaundice Treatment Side Effects
- Stomach pain
- Upset stomach
Adult Jaundice Prognosis
Some of the frequently asked questions about Adult Jaundice are; What is the prognosis for an adult with jaundice? Can it be cured? Is it fatal?
The prognosis for individuals with jaundice depends on the underlying cause of the condition. There are certain conditions that carry an excellent prognosis with individuals making a full recovery. However, more serious causes of jaundice can sometimes be fatal despite medical or surgical intervention.
The development and severity of complications will also determine an individual’s prognosis, as well as a patient’s underlying health and comorbidities (presence of other diseases). Therefore, a case-by-case assessment by your health care professional is necessary in order to determine a more accurate prognosis.
Adult Jaundice Prevention
Can Jaundice in adults be prevented?
Certain conditions leading to jaundice can be prevented, whereas others may be less preventable. However, there are certain measures that can be taken in order to decrease the risk of developing jaundice.
- Take medications as instructed in order to prevent potential liver damage or unintentional overdose. Individuals with certain medical conditions (for example, G6PD deficiency or cirrhosis) should avoid certain medications altogether. Discuss medications with your health care professional.
- Avoid high-risk behaviors such as unprotected intercourse or intravenous drug use, and implement universal precautions when working with blood products and needles. This can decrease your risk of developing hepatitis B or hepatitis C.
- Consider being vaccinated against hepatitis A and hepatitis B. There is currently no available vaccine against hepatitis C.
- Avoid potentially contaminated food products or unsanitary water, as this may decrease your risk of developing hepatitis A.
- When traveling to areas where malaria is endemic, take the recommended precautions and prophylactic medications in order to prevent the development of malaria.
- Consume alcohol responsibly and only in moderation. This can prevent alcoholic hepatitis, alcoholic cirrhosis, and pancreatitis, among other conditions. Certain individuals will need to avoid alcohol altogether.
- Avoid smoking, as it is a risk factor for the development of pancreatic cancer, as well as many other malignancies.
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