Jaundice, a yellowish discoloration of the skin and whites of the eyes, can affect adults. While commonly associated with newborns, its appearance in adults often signals an underlying health issue. This condition arises from an accumulation of bilirubin, a yellow pigment, in the bloodstream.
Jaundice Explained
Bilirubin is a natural byproduct formed when old red blood cells break down. Hemoglobin, the oxygen-carrying component of red blood cells, is metabolized into unconjugated bilirubin. This unconjugated bilirubin is not water-soluble and travels through the bloodstream bound to albumin until it reaches the liver. Once in the liver, the unconjugated bilirubin undergoes conjugation, where it combines with a sugar molecule to become conjugated bilirubin, making it water-soluble. The liver then excretes this conjugated bilirubin as part of bile into the digestive system, where it is largely eliminated in stool, contributing to its brown color. Jaundice occurs when there is an excess of bilirubin in the blood because the liver cannot process or excrete it efficiently.
Common Causes in Adults
Jaundice in adults stems from problems occurring at different stages of bilirubin processing, categorized as pre-hepatic, hepatic, or post-hepatic. Each category indicates distinct underlying conditions that disrupt the normal bilirubin pathway.
Pre-hepatic Causes
Pre-hepatic causes involve conditions that lead to an excessive breakdown of red blood cells, producing more bilirubin than the liver can handle. Hemolytic anemia, where red blood cells are destroyed prematurely, is a common example. Other conditions like sickle cell anemia, thalassemia, or the reabsorption of a large bruise can increase bilirubin production.
Hepatic Causes
Hepatic causes relate to the liver’s impaired ability to process bilirubin effectively. Liver inflammation from viral hepatitis (A, B, or C), autoimmune disorders, or alcohol-induced hepatitis can damage liver cells. Conditions such as cirrhosis, where healthy liver tissue is replaced by scar tissue, or liver damage from certain medications, also fall into this category.
Post-hepatic Causes
Post-hepatic causes occur when there is an obstruction preventing the normal flow of conjugated bilirubin from the liver into the intestines. This blockage can happen in the bile ducts, which carry bile. Common culprits include gallstones, tumors in the pancreas or bile ducts, or inflammation of the pancreas (pancreatitis).
Identifying Jaundice Symptoms
The most noticeable sign of jaundice is the yellowing of the skin and the whites of the eyes, known as scleral icterus. This discoloration becomes apparent when bilirubin levels in the blood exceed approximately 2.5 to 3 milligrams per deciliter. The intensity of the yellowing can vary based on skin tone and the severity of bilirubin elevation. Beyond the visual changes, other symptoms can accompany jaundice, offering clues about the underlying cause. Individuals often experience dark, tea-colored urine and pale or clay-colored stools, resulting from bilirubin being improperly excreted. Generalized itching, medically termed pruritus, is also common due to the accumulation of bile salts in the skin. Other non-specific symptoms can include fatigue, nausea, vomiting, loss of appetite, and abdominal pain.
Seeking Medical Attention
Any yellowing of the skin or eyes in an adult warrants prompt medical evaluation. Jaundice is a symptom, not a disease itself, and often indicates a serious underlying medical condition that requires accurate diagnosis and treatment. Delaying medical attention can lead to complications, particularly if liver damage is involved. A medical professional will begin with a physical examination, inquire about symptoms and medical history, and order blood tests to measure bilirubin levels and assess liver function. Depending on these results, imaging tests such as ultrasound, CT scans, or MRI may visualize the liver, gallbladder, and bile ducts for abnormalities or blockages, which is essential for guiding effective treatment and preventing further health issues.