Jaundice in adults: Why does it happen?

Whether you’re a parent or not, you must have heard of newborns getting jaundice and how it’s pretty normal. But jaundice in adults? How does that even happen, and is it anything serious? 

Yes, I receive a handful of adult patients with jaundice — and unfortunately, jaundice in adults is often a sign of an underlying medical condition which does not improve on its own without serious side effects, unlike neonatal jaundice. Let’s find out all about adult jaundice. 

What is jaundice? 

Jaundice is a yellowing of the skin, mucous membranes and whites of the eyes caused by high levels of bilirubin. Bilirubin is a yellowish waste produced when red blood cells break down every 120 days or so; it is transported from your blood into your liver for excretion by the body’s waste disposal system. Bilirubin also consists of bile from your gallbladder, all of which are excreted from the body through faeces and urine. This explains why your urine is yellow and faeces brown. 

Any interference with this waste disposal process results in jaundice. Please note that jaundice is not exactly a disease per se, but rather a sign of an underlying disease process or medical condition — usually those that affect the body’s metabolism or excretion of bilirubin. 

What causes jaundice in adults? 

In newborns, jaundice occurs due to the liver’s inability to excrete bilirubin properly. This is understandable, as the liver is still immature in the first few days of life. 

In adults, however, the liver should not be malfunctioning in a healthy person. We usually classify jaundice into three main types when diagnosing patients: Hepatocellular jaundice, Haemolytic jaundice and Obstructive jaundice. Sounds confusing? Let me break down these terms for you as simply as possible. 

Hepatocellular jaundice develops when the liver is injured or diseased. 

Haemolytic jaundice develops when the red blood cells break down at an excessive rate. This process is known as hemolysis, which causes a rapid increase in bilirubin levels in the bloodstream, overwhelming the liver’s capability to properly metabolise the bilirubin. Hemolysis is usually caused by conditions such as: 

  • Malaria 
  • Sickle cell disease 
  • Thalassemia 
  • Glucose-6-phosphate dehydrogenase deficiency (G6PD)
  • Autoimmune disorders 

Obstructive jaundice develops when a gallstone passes from the gallbladder into the bile duct, blocking the passage of bile into the intestine. Instead of going into the liver, the bile is absorbed into the bloodstream instead. Without the necessary bile to combine with bilirubin for excretion, bilirubin is thus unable to be excreted as well and remains in the body. 

Whichever the cause, excess bilirubin in the body is something you should be worried about. My biggest concern, however, is obstructive jaundice as it involves the presence of gallstones and may signal serious problems such as inflammation of the gallbladder, gallbladder cancer or a pancreatic tumour. In most cases, gallbladder removal surgery is required to remove the gallstones from your bile duct. If not removed in time, the gallstone may eventually pass into the intestine.

Here’s some myths about gallbladder removal and gallstones that may interest you.

How do I know if I have jaundice? 

Common signs and symptoms of adult jaundice include: 

  • Yellowing of the skin and whites of your eyes 
  • Itchiness 
  • Fever 
  • Flu-like symptoms 
  • Dark urine and light stools 
  • Vomiting 
  • Abdominal pain 

The severity of symptoms will depend on underlying causes and how quickly the disease develops. Adult jaundice caused by infection is usually short term and carries symptoms typical of an illness such as fever and flu. Jaundice caused by pancreatic or biliary tract cancers, on the other hand, usually come with abdominal pain. 

How is adult jaundice diagnosed? 

I usually perform a physical examination to aid me in my diagnosis of jaundice. Besides looking at the skin and whites of the patient’s eyes, I will also look out for any lumps in their abdomen as well as the firmness of their liver. Usually I ask a few questions pertaining to the patient’s lifestyle which might give me a brief idea on whether the patient is at risk of jaundice. For example, 

  • Do they smoke?
  • Do they have a history of drug or alcohol misuse?
  • Do they participate in high-risk sexual activity? 
  • Are they vaccinated for hepatitis? 

From there on I may request that the patient undergo various tests, such as a liver function test, bilirubin test and imaging tests. 

How is adult jaundice treated?

As mentioned, jaundice is not a disease by itself but an indication of an underlying condition. Thus, treatment will involve addressing the root cause that has been diagnosed rather than the jaundice itself. 

Do you have any more questions regarding adult jaundice? Feel free to drop me a message! 

References 

  1. Roche, S. P., & Kobos, R. (2004). Jaundice in the adult patient. American family physician, 69(2), 299–304.
  2. Wang, L., & Yu, W. F. (2014). Obstructive jaundice and perioperative management. Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists, 52(1), 22–29. https://doi.org/10.1016/j.aat.2014.03.002