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Jaundice

life science Maturity 7-9 Next article →

Jaundice, also called icterus, is a visible sign of physiological changes. It presents as a yellowish or sometimes greenish pigmentation of the skin and the sclera. The sclera is the white part of the eye.

Jaundice
Jaundice

This condition is not a disease itself. Instead, it indicates an underlying issue with bilirubin levels in the body. In healthy individuals, blood bilirubin levels remain below 1.0 mg/dl. When these levels rise above 2 to 3 mg/dl, jaundice becomes apparent.

Heme Breakdown
Heme Breakdown

This pigmentation is often accompanied by intense itchiness, dark urine, and pale feces.

To understand why this happens, we must follow the pathway of heme metabolism. Red blood cells live for about 120 days. When they age or become damaged, they rupture. This process releases hemoglobin into the circulation. Specialized cells called macrophages then ingest this hemoglobin and split it into heme and globin.

Heme Breakdown
Heme Breakdown

An enzyme called heme oxygenase first converts the heme into a green pigment called biliverdin. Then, an enzyme called biliverdin reductase reduces that green pigment into a yellow substance called bilirubin. This initial form is known as unconjugated bilirubin. Because it is not water-soluble, it must travel through the blood attached to a protein called albumin.

Once unconjugated bilirubin reaches the liver, the next stage of metabolism begins. Inside the liver, an enzyme called UDP-glucuronyl transferase performs a process called conjugation. It combines bilirubin with glucuronic acid to create bilirubin diglucuronide. This is known as conjugated bilirubin. Unlike the unconjugated form, conjugated bilirubin is water-soluble. This allows it to be excreted into the gallbladder and eventually into the intestinal tract via bile.

Bilirubin pigment in cholestatic liver 40X
Bilirubin pigment in cholestatic liver 40X

In the intestines, bacteria convert this substance into urobilinogen. Most of this is further processed into stercobilin, which gives feces its brown color. A small amount is reabsorbed and eventually excreted by the kidneys as urobilin, which colors urine yellow.

Medical professionals classify jaundice into three distinct categories based on where the process fails. The first is prehepatic or hemolytic jaundice. This occurs before the liver can process the bilirubin. It is usually caused by an increased rate of erythrocyte hemolysis, or the rapid breakdown of red blood cells. Conditions like sickle-cell anemia or malaria can cause this.

Jaundice-types
Jaundice-types

The second category is hepatic or hepatocellular jaundice. This happens due to damage to the liver cells themselves. This damage can be caused by infections like hepatitis, medications, or genetic conditions like Gilbert's syndrome. In these cases, the liver cannot effectively transport bilirubin.

The third category is posthepatic or cholestatic jaundice. This occurs after the liver has successfully conjugated the bilirubin. It is caused by a physical blockage in the biliary tract that prevents bile from exiting.

Obstructivebiliarydilation
Obstructivebiliarydilation

Common causes include gallstones, known as choledocholithiasis, or pancreatic cancer. Such blockages can lead to visible dilation of the bile ducts.

Obstructivebiliarydilation2
Obstructivebiliarydilation2

When this happens, conjugated bilirubin can leak back into the blood. This results in dark urine because the water-soluble bilirubin is filtered by the kidneys.

Jaundice presents differently depending on a person's age and skin tone. In adults, the yellowing of the sclera is a very reliable sign. While some call this scleral icterus, the more accurate term is conjunctival icterus. This is because the bilirubin actually deposits in the conjunctival membranes.

Jaundice
Jaundice

For people with darker skin, doctors look at the palms, soles, or oral mucosa for signs. In developing children, high bilirubin levels during tooth calcification can cause yellow or green tooth discoloration. This specific dental issue is not seen in adults with liver disease.

Treatment is always focused on the specific underlying cause rather than the color change itself. If a patient has a bile duct blockage, surgery is often required to clear the path. For other causes, medical management is used. This might include treating an infection or stopping a specific medication.

Jaundice-types
Jaundice-types

Newborns are a special case. About 80% of babies experience jaundice in their first week of life. If their bilirubin levels are between 4 and 21 mg/dl, doctors may use phototherapy, which involves special lights, to help the body process the pigment.

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🖼️ Images & Media (6)
File:Jaundice.jpg
Jaundice.jpg
File:Jaundice-types.png
Jaundice-types.png
File:Bilirubin pigment in cholestatic liver 40X.jpg
Bilirubin pigment in cholestatic liver 40X.jpg
File:Heme Breakdown.png
Heme Breakdown.png
File:Obstructivebiliarydilation.png
Obstructivebiliarydilation.png
File:Obstructivebiliarydilation2.png
Obstructivebiliarydilation2.png
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