Jaundice

Jaundice is a condition in which the skin and whites of the eyes become yellow and urine is dark yellow. It is a symptom of a medical condition, not a disease.

Jaundice develops when there is too much bilirubin in the blood. Bilirubin is a yellowish pigment found in hemoglobin. Hemoglobin is a protein in red blood cells that carries oxygen and gives blood its red colour. Our bodies constantly make new red blood cells. When old red blood cells break down, they release bilirubin. The liver removes bilirubin from the blood. It concentrates bilirubin into bile, which is stored in the gallbladder. Most bilirubin is removed from the body through feces, or stool, and a small amount is passed out of the body in urine.

There are 3 different types of jaundice. They are based on where the problem with bilirubin starts.

Pre-hepatic jaundice is caused by a problem with the blood before it gets to the liver. If a blood disease or condition causes too many red blood cells to die at once, then there is more bilirubin in the blood than the liver can remove.

Hepatocellular jaundice is caused by a problem with the liver. If the liver tissues are scarred (called cirrhosis) and the liver can’t work properly, it can’t remove bilirubin from the blood.

Obstructive jaundice develops when the bile ducts are blocked or damaged so that bile doesn’t get into the intestine.

Hepatocellular and obstructive jaundice are the types most often found in people with cancer.

The different types of jaundice have different causes. Pre-hepatic jaundice can be caused by malaria (a blood infection caused by mosquitoes), sickle cell disease or thalassemia. Cirrhosis, which can lead to hepatocellular jaundice, can be caused by hepatitis viruses or long-term abuse of alcohol. Obstructive jaundice can develop if a bile duct is blocked by a tumour or gallstones, or if a liver disease (such a primary sclerosing cholangitis) damages a bile duct.

The following types of cancer may cause jaundice:

• a type of liver cancer called hepatocellular carcinoma (HCC)
• pancreatic cancer
• gallbladder cancer
• bile duct cancer
• cancer that has spread to the liver from another part of the body (called liver metastasis)

Symptoms of jaundice may include:

• yellowing of the skin and the whites of the eyes
• pale or light-coloured stools that are unusually foul smelling
• dark yellow or brown urine
• itching (often all over the body)
• abdominal pain or tenderness
• blood in vomit or stool
• fever
• fatigue
• changes in mental alertness, including drowsiness, confusion and agitation

Report symptoms to your doctor or healthcare team as soon as possible.

Your doctor will try to find the cause of jaundice. You may need to have the following tests.

A complete blood count (CBC) is used to check the level of red blood cells and hemoglobin.

Blood chemistry tests, specifically liver function tests, are done to find out how well the liver is working. Other blood chemistry tests are used to check the levels of blood sugar and enzymes.

Ultrasound or CT scan of the abdomen is done to look for a blockage or tumour.

Endoscopic retrograde cholangiopancreatography (ERCP) is used to examine the ducts that drain the pancreas, liver and gallbladder. It may also be used to treat a blockage or obstruction.

Find out more about complete blood count (CBC), blood chemistry tests, ultrasound, CT scan and ERCP.

Once the cause of jaundice is known, your healthcare team can suggest ways to manage it. When jaundice is caused by a tumour or scarring, treatment may include:

• surgery to remove the obstruction
• placing a thin plastic or metal tube (called a stent) to allow the bile to drain around the obstruction

Jaundice can cause itching. You can try applying unscented and hypoallergenic skin lotions and lubricants several times a day to relieve itching. You may want to bathe less often each week. Switching to a mild, hypoallergenic unscented soap and washing with lukewarm water instead of hot water showers or baths may also help. Be sure to pat your skin dry and apply lotion right away. Choose clothing and bedding made of materials that don’t irritate the skin, such as cotton or silk. Use a gentle unscented laundry detergent and double rinse when washing.

Your healthcare team can also suggest anti-itching medicines like antihistamines. In some cases, they may prescribe an antidepressant to help reduce itching.