Quick answer
What could jaundice mean?
Jaundice is yellowing of the skin and whites of the eyes caused by high bilirubin — a waste product from broken-down red blood cells. It always needs medical assessment — causes range from harmless gilbert's syndrome to serious liver disease, gallstones blocking bile duct, or pancreatitis. See a GP urgently for jaundice — same-day if also abdominal pain, dark urine, pale stools, or confusion.
Jaundice — yellow skin and eyes
Jaundice (icterus) is yellow discolouration of skin and sclera from accumulation of bilirubin — yellow pigment from haemoglobin breakdown.
It is a sign, not a diagnosis — always warrants medical investigation in adults.
How bilirubin metabolism works
- Red blood cells break down → unconjugated bilirubin
- Liver conjugates bilirubin
- Bile excreted into gut → stool brown colour
Jaundice occurs when:
- too much bilirubin produced (haemolysis)
- liver fails to process (hepatocellular disease)
- bile cannot drain (obstruction)
What jaundice looks like
- yellow sclera — often first visible sign
- yellow skin — more obvious in good light
- itching — especially obstructive causes
- dark urine — tea-coloured — conjugated bilirubin excreted renally
- pale stools — clay-coloured — no bilirubin reaching gut
Check sclera in mirror — harder to see on skin alone in some skin tones.
Common causes
Pre-hepatic — excess bilirubin production
- haemolytic anaemia
- sickle cell crisis
- Gilbert’s syndrome — benign — mild jaundice with fasting or illness
Hepatic — liver cell damage
- viral hepatitis A, B, C, E
- alcohol-related liver disease
- fatty liver disease — advanced
- drug-induced liver injury — paracetamol overdose emergency
- autoimmune hepatitis
- cirrhosis — any cause
- paracetamol toxicity — 999 if overdose
Post-hepatic — bile duct obstruction
- gallstones in common bile duct
- pancreatic cancer — painless jaundice — urgent
- cholangiocarcinoma
- pancreatitis with bile duct compression
- strictures post-surgery
Associated symptoms by cause
| Cause | Clues |
|---|---|
| Gallstone obstruction | Right upper pain, fever if infected (cholangitis) |
| Hepatitis | Flu-like, tender liver, elevated transaminases |
| Alcohol liver disease | History heavy alcohol, ascites |
| Pancreatic cancer | Weight loss, painless progressive jaundice |
| Haemolysis | Anaemia, dark urine, normal ALP |
When urgent — A&E
- jaundice + fever + shaking — cholangitis — sepsis risk
- severe abdominal pain
- confusion — hepatic encephalopathy
- vomiting blood
- paracetamol overdose — any jaundice
Cholangitis triad: jaundice, fever, right upper quadrant pain — Charcot’s triad — emergency.
Investigation pathway
GP same day:
- LFTs — bilirubin direct vs indirect split, ALP, ALT, AST, albumin
- FBC — haemolysis screen
- INR — synthetic function
- hepatitis serology
- ultrasound abdomen — duct dilatation, gallstones, liver texture
Referral:
- 2-week wait if painless jaundice + weight loss — exclude malignancy
- gastroenterology/hepatology for hepatitis
- ERCP if duct stone suspected
Treatment
Depends entirely on cause:
- gallstone — endoscopic removal + cholecystectomy
- hepatitis B/C — antiviral therapy
- alcohol — abstinence, specialist support
- autoimmune — steroids/immunosuppression
- cancer — oncology pathway
No self-treatment — herbal “liver detox” ineffective and may harm.
Neonatal jaundice — note
Common in newborns — immature liver — different pathway — midwife/ paediatric monitoring — kernicterus risk if severe untreated.
This guide focuses on adults — children with jaundice need paediatric assessment.
Yellow eyes are never normal in adults — same-day GP minimum; pain + fever + yellow — A&E.
Common questions
- What causes yellow skin and eyes?
- High bilirubin in blood — from increased red cell breakdown (haemolysis), liver unable to process bilirubin (hepatitis, cirrhosis, fatty liver), or bile duct blockage (gallstones, tumour) preventing bilirubin excretion in stool. GP blood tests and scans determine type.
- Is jaundice always serious?
- Always needs assessment — some causes are mild (Gilbert's syndrome — benign genetic), others urgent (blocked bile duct with infection, acute liver failure). Never assume harmless without medical evaluation.
- What is obstructive jaundice?
- Bile duct blocked — bilirubin backs up — dark urine, pale stools, itchy skin, often pain if gallstone. Needs ultrasound and sometimes ERCP to remove stone. Painless progressive jaundice — exclude pancreatic or biliary cancer — urgent referral.
- Can alcohol cause jaundice?
- Yes — alcoholic hepatitis and cirrhosis cause jaundice — stop alcohol immediately and seek urgent care. Fatty liver with inflammation (NASH) can also cause jaundice in advanced disease.
- What tests are done for jaundice?
- Liver blood tests (ALT, AST, ALP, bilirubin), full blood count, hepatitis B and C serology, ultrasound abdomen — bile ducts and gallbladder. Further CT/MRI/ERCP depending on findings. Coagulation tests assess liver synthetic function.
- Does jaundice cause itching?
- Yes — bile salts deposit in skin — itching often worse at night in obstructive jaundice. Treat underlying cause; cholestyramine sometimes helps symptom relief.