Jaundice is a condition that occurs because of an accumulation of bilirubin in the bloodstream.  Jaundice symptoms are usually minor, but itching can be a major symptom in some people with obstructive jaundice.

First it’s important to differentiate between signs of jaundice and symptoms of jaundice.  Signs are objective physical findings, whereas symptoms are things that a patient feels or notices.  Yellow eyes, called icteris, is a sign of jaundice, whereas itching is a symptom of jaundice.

First let’s review the physical signs of jaundice because these are usually what brings a patient to the doctor, or are the first thing that a physician notices.  Bilirubin is a yellow pigment, and accumulates in the blood stream and the urine.  It tends to stain the skin and the conjunctiva overlying the white sclera of the eyes.   Yellow skin or yellow eyes are the most common presenting signs in a patient with jaundice.  Sometimes very yellow or brown urine is a presenting concern.

Symptoms of jaundice are really very few in most patients.  A high level of bilirubin, especially from obstruction of the outflow of bile, often is associated with intense itching, or pruritis.  This can be very difficult to treat at times, and can be the presenting symptom in some patients who do not notice the yellow eyes or skin.

Other symptoms are more likely related to the underlying conditions that cause jaundice and include nausea, vomiting, abdominal pain especially in the right upper quadrant of the abdomen where the liver is located, weakness, loss of appetite, generalized malaise and fatigue.  These jaundice symptoms are more likely not due to the elevated bilirubin, but from the liver, bile duct, gall bladder, pancreas, or bowel symptoms that cause the problem.

Painless jaundice is an especially worrisome presentation in adults.  Most of the not-too-serious causes of jaundice are associated with pain.  When there is an acute obstruction of the common bile duct like occurs with gall stones pass from the gall bladder into the common bile duct, but get stuck and block the outflow of bile, it is usually painful.  In fact it is often very painful.  Conditions that gradually obstruct the common bile duct, leading to blockage of the outflow of bile and jaundice, are sometimes not painful. Causes of painless jaundice include cancer of the head of the pancreas, cancer of the bile ducts, and metastatic cancer to the liver that obstruct major intrahepatic bile ducts.  By the time these lesions reach a size that causes jaundice they are often far advanced and may not be amenable to curative treatment.

Bilirubin is the pigment that causes jaundice.  Bilirubin is primarily a breakdown product of the hemoglobin in red blood cells.  Another cause of jaundice is rapid breakdown of red blood cells, called hemolysis.  This can occur due to autoimmune disorders that cause antibodies to be produced that lead to red blood cell destruction, due to incompatible blood transfusions, or due to conditions like sickle cell disease or other hemoglobin or red blood cell hereditary disorders like hereditary spherocytosis and glucose-6-phosphate deficiency. Be sure to check out our page on hemoglobin metabolism.

If you notice that you or someone you know is jaundiced you or they need to be seen and evaluated by their physician to find out why they are jaundiced. If a person develops severe itching checking for jaundice is a good idea.  Most of the time the itching will have a cause other than jaundice, but it is simple to look at their eyes to see if there is any abnormal yellow tint  to the sclera.  If there is they need an evaluation for jaundice.

Jaundice with advanced Icteris