Let's talk about jaundice

My aunt was admitted yesterday for “jaundice”. Apparently, my uncle noticed that she had been turning yellow over the past few weeks. What is jaundice? Is it dangerous?

Jaundice is not a disease but a symptom of several diseases. Jaundice manifests as a yellow discolouration of the sclera of the eye (the white part of the eye), and the skin.

It is caused by high levels of bilirubin in blood. If the level of bilirubin becomes very high, the yellow tinge on the skin may turn into brown.

What is bilirubin?

When red blood cells become old, they are destroyed. The part that makes red blood cells “red” is called haemoglobin. So when haemoglobin is broken down, a waste product called bilirubin is formed. Bilirubin is converted to a water-soluble form by the liver so that it can be excreted into bile. From the bile, it goes into the gut, and then is excreted via the faeces.

In fact, bilirubin is what gives faeces its brown colour!

Bilirubin can be divided into unconjugated bilirubin or conjugated bilirubin. The unconjugated form is the type that is not water soluble. The conjugated type is the one that has already been made by the liver to be water-soluble.

Lab tests can differentiate between these two types, because the type of bilirubin that is causing jaundice is very important in diagnosing the disease that is causing the raised bilirubin.

So what types of diseases cause jaundice?

Jaundice can occur when:

·There is so much bilirubin being produced that the liver cannot cope. This occurs when a large number of red blood cells are broken down – such as in the case of haemolytic anaemias where immune and other forces attack red blood cells en masse. This also happens when you have bled a lot internally into the tissues, like in the case of an internal haematoma (collection of blood outside the blood vessels).

·The liver is diseased, and cannot convert bilirubin or secrete it into bile. Very commonly, in this part of the world, when a person has hepatitis, it can really interfere with the liver’s ability to do its job. That’s why patients with hepatitis (B,C, A or any other type) develop jaundice.

·The bile duct is blocked. When this happens, bile cannot flow out and the bilirubin must “escape” into the blood. This is often due to a gallstone or a cancer blocking the common bile duct and obstructing outflow of bile.

Is jaundice dangerous in itself? Is it permanent? Will my aunt be yellow forever?

Jaundice by itself is not dangerous. But some of the diseases that cause it can be dangerous, such as cancer of the pancreas and the haemolytic anaemias.