Jaundice and Viral Hepatitis

Symptom Seen in Some Cases of Acute Infection

Jaundice is an abnormal symptom characterized by the yellowing of the skin and/or the whites of the eyes (sclera). It is associated with a condition known as hyperbilirubinemia in which there is too much of a natural substance called bilirubin in the body.

Jaundice is most commonly associated with liver diseases, including viral hepatitis, but can also be caused by alcohol abuse, medication overuse, and certain autoimmune disorders.

Close up of an eye with jaundice
Media Production / Getty Images

How Jaundice Develops

Jaundice is the consequence of having too much bilirubin in the blood. Bilirubin is a yellow-pigmented substance derived from metabolized red blood cells. As old red blood cells enter the spleen, they are broken down and formed into bilirubins which the liver uses to create bile.

The body avoids the accumulation of bilirubin by excreting any excess through urine or in stools. However, if the system is disrupted, there may be more bilirubin in the blood than the body can handle. If this happens, the accumulation can saturate cells and manifest with the yellowing we recognize as jaundice.

Hyperbilirubinemia may be caused by the excessive production and breakdown of red blood cells (as can happen with newborns) or when the ducts of the liver become obstructed and are less capable of processing bilirubin. In this latter case, viral hepatitis and advanced liver disease (such as cirrhosis or liver cancer) are the two top conditions a doctor would explore.

And for good reason. According to statistics from the Centers for Disease Control and Prevention, as many as 5.7 million Americans may be chronically infected with hepatitis B and C, while 3.9 million are believed to be suffering from some form of chronic liver disease.

Diagnosing Jaundice

The most obvious way to diagnose jaundice is by physical appearance. While it may be more noticeable in some people than others, most will recognize the subtle—and sometimes not-so-subtle—changes in their skin or eye color. Moreover, the yellowing will often be accompanied by extreme exhaustion as well as darkened urine (often described as "coca-cola colored") and pale, clay-colored stools.

Jaundice is sometimes difficult to see in the sclera and may require inspection under fluorescent lights. The yellowing also tends to be more visible in the tissue beneath the tongue.

Hyperbilirubinism can be confirmed with a simple test that measures the volume of bilirubin in a sample of blood. High levels (typically anything over 7.0 mg/dL) are a strong indication of some sort of liver disease.

Viral hepatitis can be confirmed using an antibody test for hepatitis A, an antigen test for hepatitis B, and an antibody test for hepatitis C. Liver function tests (LFTs) can help evaluate the status of the liver or pinpoint the causes of a liver disorder not related to viral hepatitis. Imaging tests and biopsies may be ordered.

Treatment of Jaundice

In most cases, the appearance of jaundice, while distressing, is not considered an emergency situation. Even with advanced (decompensated) cirrhosis or liver cancer, jaundice is more an indication of disease progression rather than an "emergency" event.

The treatment of jaundice is typically focused on resolving or minimizing the underlying cause. With acute hepatitis, this usually means a strict period of bed rest with no physical exertion. Depending on the viral type, the symptoms may take two weeks to a month or longer to resolve. During this time, the liver function will gradually normalize and lead to the clearance of bilirubin from the body.

Following the resolution of symptoms, persons in whom the infection persists may be prescribed chronic medications to either reduce the risk of complications (as with hepatitis B) or ideally cure the disease (as with hepatitis C).

5 Sources
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  2. Kumar S. Overview of acute viral hepatitis. Merk Manual.

  3. Herrine SK. Jaundice in adults. Merck Manual.

  4. Centers for Disease Control and Prevention. Viral hepatitis surveillance—United States. Atlanta, Georgia.

  5. Cleveland Clinic. Adult jaundice: management and treatment.

By Charles Daniel
 Charles Daniel, MPH, CHES is an infectious disease epidemiologist, specializing in hepatitis.