What Is Jaundice?
Jaundice (also called icterus) is the yellowing of the skin, whites of the eyes (sclera), and mucous membranes due to elevated bilirubin levels in the blood. Bilirubin is a yellow pigment produced when red blood cells break down. Normally, the liver processes bilirubin and excretes it into bile. When this process is disrupted — anywhere from the bloodstream to the bile duct — bilirubin accumulates, causing the characteristic yellowing.
Jaundice is always a symptom, never a diagnosis. The underlying cause must be identified and treated.
Jaundice in adults is an emergency until proven otherwise.
Do not treat jaundice with home remedies or wait to "see if it improves." Some causes — like cholangitis (bile duct infection), acute liver failure, or cancer — require immediate intervention.
Types and Causes of Jaundice
Pre-Hepatic (Blood-Related)
Excessive breakdown of red blood cells overwhelms the liver's processing capacity.
Causes: Haemolytic anaemia, malaria, sickle cell disease, G6PD deficiency.
Hepatic (Liver-Related)
The liver itself is damaged and cannot process bilirubin.
Causes: Viral hepatitis (A, B, C, E), alcoholic liver disease, cirrhosis, acute liver failure, autoimmune hepatitis, drug toxicity.
Post-Hepatic (Obstructive)
Bile flow from the liver to the intestine is blocked.
Causes: Gallstones in bile duct, pancreatic cancer, cholangiocarcinoma (bile duct cancer), strictures, cholangitis.
Symptoms That Accompany Jaundice
- Dark urine (tea-coloured) — bilirubin excreted through kidneys
- Pale / clay-coloured stools — bile not reaching the intestine (suggests obstruction)
- Itching — bile salts depositing in the skin
- Fever and chills — suggests infection (hepatitis or cholangitis)
- Abdominal pain — upper right (gallstones, hepatitis) or upper middle (pancreatic cancer)
- Weight loss — suggests malignancy
- Confusion or drowsiness — suggests hepatic encephalopathy / liver failure
Diagnosis: How Dr. Srinivas Evaluates Jaundice
A thorough and logical evaluation is essential to identify the cause and plan treatment:
Step 1: Blood Tests
- Total and Direct Bilirubin (to determine type — conjugated vs unconjugated)
- LFT panel: SGPT, SGOT, Alkaline Phosphatase, GGT, Albumin, Total Protein
- PT/INR (clotting function — indicates liver severity)
- CBC (blood count — rules out haemolytic anaemia, infection)
- Hepatitis A, B, C, E serology
- Peripheral blood smear (if haemolytic cause suspected)
Step 2: Imaging
- Ultrasound abdomen: First-line imaging — identifies gallstones, dilated bile ducts, liver texture, and masses
- MRCP (Magnetic Resonance Cholangiopancreatography): Detailed non-invasive imaging of bile ducts — identifies strictures, stones, and tumours
- Contrast CT scan: Identifies tumours, metastases, and vascular involvement
- ERCP (Endoscopic Retrograde Cholangiopancreatography): Diagnostic and therapeutic — can remove bile duct stones and place stents
Step 3: Biopsy (if needed)
Liver biopsy is reserved for uncertain causes — autoimmune hepatitis, unusual drug reactions, or unexplained chronic jaundice.
Treatment Depends on the Cause
- Viral hepatitis: Rest, supportive care for Hepatitis A & E; antiviral therapy (tenofovir, entecavir) for Hepatitis B; DAAs (cure >95%) for Hepatitis C
- Gallstones in bile duct: ERCP to remove stones + laparoscopic cholecystectomy
- Pancreatic cancer: Stenting for palliation; Whipple's Procedure for curative surgery
- Cholangiocarcinoma: Surgical resection or stenting + chemotherapy
- Alcoholic hepatitis: Alcohol cessation, steroids for severe cases, transplant evaluation
- Drug-induced jaundice: Stop the offending drug; supportive care
- Acute liver failure: ICU management + urgent transplant evaluation
For Patients from Outside Bengaluru
Dr. Srinivas Bojanapu reviews reports remotely before your visit. Send your blood test results and ultrasound report on WhatsApp (+91 88846 94233) for a preliminary assessment so you arrive prepared.