Gastroenterology - Jaundice

What is Jaundice?

Jaundice is characterised by the yellow discolouration of the skin, sclera (whites of the eyes) and mucous membranes (e.g. mouth, nasal passages). It is caused by a high build up of a substance called bilirubin in the blood and tissues of the body.

Bilirubin is a potentially toxic compound that is an end product of the breakdown of old blood cells. It is normally passed out of the body in urine or as part of the digestive tract waste. It is bilirubin that gives urine its light yellow colour and stools their dark brown colour.

What causes Jaundice?

Jaundice can be caused by a number of problems and can be classified as one of three types:

Pre-hepatic - before the liver (e.g. excessive breakdown of blood cells)

Intra-hepatic - in the liver (e.g. liver, small biliary ducts diseases)

Post-hepatic - after liver (e.g. large bile ducts, gall bladder, pancreatic diseases)
Gall stones, viral hepatitis and excessive alcohol intake are the most common causes.

Signs and Symptoms

Always seek medical advice if you develop jaundice. It is an important warning sign that something is wrong with the normal processes of the body.

Symptoms that may accompany Jaundice include:
●    Weakness and tiredness
●    Loss of appetite and weight loss
●    Nausea and vomiting
●    Dull pain in the liver region
●    Intense itching
●    Dark urine
●    Pale stools
●    Ankle and abdominal swelling

Red flag symptoms

Always seek immediate medical attention straight away if you experience any of the following:
●    Rigors (an abrupt attack of shivering and a sensation of coldness, accompanied by a rapid rise in body temperature)
●    Pain (usually in the right upper quarter of the abdomen, sometimes radiating into the back)
●    Fever

Investigations

There are a number of investigations that can be used to establish the cause and assess the severity of jaundice.

Blood tests - These are the simplest tests to establish a baseline for further investigations and a lot of information can be gathered from the results. The results will indicate whether the jaundice is related to biliary obstruction, liver diseases or other causes.

Ultrasound scan - This is an excellent test as it is non-invasive and there are no real risks associated with the procedure, but it has its limitations for the assessment of bile ducts and gall bladder. It can show the size of the bile ducts and define the level of the obstruction and also in some cases can identify the cause and give other information related to the disease.

CT (Computerised Tomography) Scan - This may be required if the cause of the obstruction is not apparent. It is a more sophisticated type of x-ray which builds up a 3D picture of the inside of the body. It is a painless procedure but takes longer than a standard x-ray. Sometimes a drink and/or injection is given to allow particular areas to been seen more clearly.

Other diagnostic tests that may be utilised are an ERCP (camera test) or MRCP (magnetic scan).

Results of these tests will guide further therapeutic options.

Treatment

Treatment for jaundice in adults depends on the underlying condition.
 
Looking after yourself
●    Rest as much as you can
●    Try to eat little and often if you can but always aim to drink at regular intervals
●    Avoid alcohol
●    Always take the medication as prescribed by your doctor. Do not take any supplements, herbal or over the counter medicines

If you have any questions please do not hesitate to contact the Gastroenterology Specialist Nurses.

The gastroenterology clinical nurse specialists may contact you, otherwise if you have any questions, please contact the team on:
The Royal Oldham Hospital: 0161 656 1538

This document was produced with thanks to the British Liver Trust (Registered Charity 298858)
www.britishlivertrust.org.uk or phone the Helpline 0800 652 7330