Jaundice in Adults – Liver and Gallbladder Disorders

June 26, 2025
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In jaundice, the skin and whites of the eyes look yellow. Jaundice occurs when there is too much bilirubin (a yellow pigment) in the blood—a condition called hyperbilirubinemia.

(See also Overview of Liver Disease and Jaundice in the Newborn.)

Bilirubin is formed when hemoglobin (the part of red blood cells that carries oxygen) is broken down as part of the normal process of recycling old or damaged red blood cells. Bilirubin is carried in the bloodstream to the liver and is excreted in the bile (the digestive juice produced by the liver). Bilirubin is then moved through the bile ducts into the digestive tract, so that it can be eliminated from the body. Most bilirubin is eliminated in stool, but a small amount is eliminated in urine. If bilirubin cannot be moved through the liver and bile ducts quickly enough, it builds up in the blood and is deposited in the skin. The result is jaundice.

Many people with jaundice also have dark urine and light-colored stool. These changes occur when a blockage or other problem prevents bilirubin from being eliminated in stool, causing more bilirubin to be eliminated in urine.

If bilirubin levels are high, substances formed when bile is broken down may accumulate, causing itching all over the body. But jaundice itself causes few other symptoms in adults. However, in newborns with jaundice high bilirubin levels (hyperbilirubinemia) can cause a form of brain damage called kernicterus.

Also, many disorders that cause jaundice, particularly severe liver disease, cause other symptoms or serious problems. In people with liver disease, these symptoms may include nausea, vomiting and abdominal pain, and small spiderlike blood vessels that are visible in the skin (spider angiomas). Men may have enlarged breasts, shrunken testes, and pubic hair that grows as it does in women.

Serious problems caused by liver disease can include

  • Ascites: Accumulation of fluid within the abdomen

  • Coagulopathy: A tendency to bleed or bruise

  • Hepatic encephalopathy: Deterioration of brain function because the liver malfunctions, allowing toxic substances to build up in the blood, reach the brain, and cause changes in mental function (such as confusion and drowsiness)

  • Portal hypertension: High blood pressure in the veins that bring blood to the liver, which can lead to bleeding in the esophagus and sometimes stomach

If people eat large amounts of food rich in beta-carotene (such as carrots, squash, and some melons), their skin may look slightly yellow, but their eyes do not turn yellow. This condition is not jaundice and is unrelated to liver disease.

Hepatitis is liver inflammation that is usually caused by a virus but can be caused by an autoimmune disorder or use of certain drugs. Hepatitis damages the liver, making it less able to move bilirubin into the bile ducts. Hepatitis may be acute (short-lived) or chronic (lasting at least 6 months). Acute viral hepatitis is a common cause of jaundice, particularly jaundice that occurs in young and otherwise healthy people. When hepatitis is caused by an autoimmune disorder or a drug, it cannot be spread from person to person.

Drinking large amounts of alcohol over a long period of time damages the liver. The amount of alcohol and time required to cause damage varies, but typically, people must drink heavily for at least 8 to 10 years.

Some drugs, toxins, and herbal products can also damage the liver (see table Some Causes and Features of Jaundice).

Less common causes of jaundice include hereditary disorders that interfere with how the body processes bilirubin. They include Gilbert syndrome and other, less common disorders such as Dubin-Johnson syndrome. In Gilbert syndrome, bilirubin levels are slightly increased but usually not enough to cause jaundice. This disorder is most often detected during routine screening tests in young adults. It causes no other symptoms and no problems.

Disorders that cause excessive breakdown of red blood cells (hemolysis) often cause jaundice (see Autoimmune Hemolytic Anemia and Hemolytic Disease of the Newborn).

blood tests, and sometimes other tests.

In people with jaundice, the following symptoms are cause for concern:

  • Severe abdominal pain and tenderness

  • Changes in mental function, such as drowsiness, agitation, or confusion

  • Blood in stool or tarry black stool

  • Blood in vomit

  • Fever

  • A tendency to bruise or to bleed easily, sometimes resulting in a reddish purple rash of tiny dots or larger splotches (which indicate bleeding in the skin)

If people have any warning signs, they should see a doctor as soon as possible. People with no warning signs should see a doctor within a few days.

Doctors first ask questions about the person’s symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause and the tests that may need to be done (see table Some Causes and Features of Jaundice).

Doctors ask when the jaundice started and how long it has been present. They also ask when urine started to look dark (which usually occurs before jaundice develops). People are asked about other symptoms, such as itching, fatigue, changes in stool, and abdominal pain. Doctors are particularly interested in symptoms that suggest a serious cause. For example, sudden loss of appetite, nausea, vomiting, pain in the abdomen, and fever suggest hepatitis, particularly in young people and people with risk factors for hepatitis. Fever and severe, constant pain in the upper right part of the abdomen suggest acute cholangitis (infection of the bile ducts), usually in people with a blockage in a bile duct. Acute cholangitis is considered a medical emergency.

Doctors ask people whether they have had liver disorders, whether they have had surgery that involved the bile ducts, and whether they take any drugs that can cause jaundice (for example, the prescription drugs amoxicillin/clavulanate, chlorpromazine, azathioprine, and oral contraceptives; alcohol; over-the-counter drugs; medicinal herbs; and other herbal products such as teas). Knowing whether family members have also had jaundice or other liver disorders can help doctors identify hereditary liver disorders.