Yellow, itchy skin and eyes
When there’s too much bilirubin in the blood you become jaundiced. The skin and the whites of the eyes turn yellow and you may also feel tired, nauseous and have itchy skin. Your urine may also be darker and your poo lighter in colour than normal.
Jaundice can be a sign of serious disease so it always needs to be investigated.
When red blood cells (the ones that carry oxygen) are broken down, the haemoglobin within them is turned into bilirubin. Red blood cells are being made and destroyed continuously (they only last about 4 months), so the body produces a constant stream of bilirubin.
Usually bilirubin is filtered out of the blood in the liver and excreted into the bowel as bile via the bile duct, making faeces (poo) brown.
There are three main types of jaundice:
- Haemolytic jaundice is due to an accelerated breakdown of red blood cells, leading to an increase in production of bilirubin.
- Hepatocellular jaundice occurs as a result of liver disease or injury, reducing the ability of the liver to filter out bilirubin.
- Obstructive jaundice occurs as a result of an obstruction in the bile duct. This prevents bilirubin from leaving the liver
New born babies can also develop jaundice if their liver is not yet fully functioning.
Various conditions cause red blood cells to be broken down more quickly than usual, leading to excess bilirubin in the blood (and often anaemia). The liver gets overloaded and can’t process it all, so excess bilirubin spills over into the blood and tissues, causing jaundice.
The most common diseases which lead to haemolytic jaundice are genetic conditions such as sickle cell disease and thalassaemia where the abnormal shape of the cells means they get trapped and broken down earlier than expected. These conditions are usually diagnosed early in life, either through routine screening or because other members of the family have the problem.
Malaria can also cause jaundice because the parasites destroy the red cells as they develop.
If the liver is malfunctioning or damaged, it can’t process bilirubin properly. The most common causes are infection, poisoning, alcohol and cancer.
Hepatitis is most commonly cause by viruses that can enter the body through food, water, blood, sexual contact and intravenous drug use if contaminated equipment is used. Leptospirosis is a bacterium that cause hepatitis and is transmitted from infected animals via their urine or faeces. Toxins can also cause hepatitis: the two most common types are alcohol (heavy, prolonged consumption) and certain medicines including paracetamol, especially overdoses.
If hepatitis continues for a long time, the liver becomes permanently scarred and develops cirrhosis. Cirrhosis only causes jaundiced when most of the liver is involved, so it’s often not diagnosed until very late stage when treatment options are limited.
Hepatitis and cirrhosis are usually diagnosed with blood tests, scans and sometimes biopsies (samples) of the liver so that it can be examined under the microscope.
Various inherited conditions can also disrupt liver function. These include Gilberts and other syndromes where the enzymes that process bilirubin and bile are faulty.
If the bile duct gets blocked, bile cannot drain out of the liver and bilirubin builds up in the bloodstream. The most common cause is gallstones blocking the duct, causing intense pain as it contracts to try to move the stone along. Click here to read our blog about gallstones.
The bile duct opens into the bowel alongside the pancreas, so pancreatitis (due to infection or inflammation) can also block the duct. Cancer of the bile duct or pancreas can do the same but tends to be painless. Less common causes include Primary Biliary Cirrhosis where the bile ducts don’t form properly.
About 60% of newborn babies, and 80% of premature ones, get a degree of jaundice in the first few days of life. Their turnover of red blood cells is higher than for an adult and their livers are less developed and therefore worse at filtering bilirubin out of the blood. Neonatal jaundice usually settles within a couple of weeks. More severe cases are treated with ultraviolet light and sometimes need a blood transfusion.
Contact Bluezone if:
… you develop yellow skin or eyes, which may or may not be associated with itchy skin, pale faeces and dark urine.