Jaundice

Jaundice, also known as icterus or hyperbilirubinaemia, is a clinical sign or a symptom described as the yellowing of body tissues as a result of the accumulation of bilirubin (Joseph and Samant, 2023). Jaundice occurs when there is a disruption in the metabolism and excretion of bilirubin, usually an indicator of a serious underlying condition that requires urgent investigation. Jaundice usually appears on the skin, eyes (sclera) and mucous membranes.

Bilirubin is a pigment that is produced by the normal breakdown of red blood cells. There are two types of bilirubin – conjugated and unconjugated bilirubin (Table 1). Bilirubin binds to plasma albumin and is then transported to the liver where it is metabolised. It is excreted into the duodenum in bile, providing a distinct yellow colour to the bile, stools and, to a lesser degree, urine (Kalakonda et al, 2023).

Jaundice is the result of increased concentration of bilirubin in the plasma as a result of either increased production or reduced excretion of bilirubin (Taylor et al, 2012). The accumulation of bilirubin in the plasma causes it to move from circulation to the tissues, causing the yellowing symptom to occur (Stevenson and Wong, 2021).

Jaundice is commonly seen in older adults and newborns. The diagnosis of jaundice is based on a comprehensive history and physical examination. Further investigations, such as blood tests and ultrasound, may be required. The person could either be asymptomatic or acutely unwell.

Jaundice may be suspected after consideration of the following:

• duration and previous episodes of jaundice
• dark urine and pale stools
• pain, including consideration of the site, severity and radiation
• itching (pruritus)
• associated symptoms, such as loss of appetite, weight loss, nausea, vomiting, fever, muscle aches and joint pain
• alcohol intake
• family history of inherited anaemias
• travel abroad
• immunisation history
• use of illicit or intravenous drugs
• recently prescribed medicines – potential paracetamol overdose, excessive ingestion of paracetamol or paracetamol-containing medication (Alexiou, 2023)
• blood transfusions
• sexual history
• social history, including tattoos and body piercings
• possibility of pregnancy — jaundice associated with pregnancy is an obstetric emergency (NICE, 2020)

The

The management of jaundice will depend on the type and severity of the underlying condition. A holistic assessment is vital to determine the impact of the disease on the person’s daily life and mental health.

Additional investigations may be required, such as a full blood count and liver function tests (NICE, 2020). Even though the normal plasma concentration of bilirubin is below 21 μmol/litre, clinical jaundice may not appear until the serum bilirubin level is greater than 51 μmol/litre (NICE, 2020). An ultrasound scan is a cost-effective, non-invasive method that may be useful in identifying gallstones, masses and obstruction. Further imaging, such as an abdominal computed tomography scan will determine the level of obstruction.

Assessment of red flags is necessary to determine whether admission should be made to secondary care, including:

• confusion or altered mental state
• vomiting with/without blood
• signs associated with sepsis
• bruising
• abdominal pain
• abnormal renal

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