Jaundice in Babies: Causes, Symptoms and Treatment



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Understanding Jaundice: What You Need To Know

When red blood cells die, they leave behind bilirubin, a yellow-orange pigment in the blood. The liver filters bilirubin from the bloodstream to be removed in your stool. If too much is in your system or your liver is overloaded, it causes a buildup known as hyperbilirubinemia. This causes jaundice, where your skin and the whites of your eyes look yellow.

Newborn babies often get it. About 60% have jaundice, also known as icterus, within the first couple of days after birth. Adults can get it, too, although it's less common. See a doctor right away if you think you have jaundice. It could be a symptom of a liver, blood, or gallbladder problem.

If too much bilirubin is left in your system, you can develop hyperbilirubinemia. This can lead to jaundice, which causes your skin and the whites of your eyes to turn yellow. (Photo Credit: Zay Nyi Nyi/Dreamstime)

There are four main types of jaundice, which are grouped by where the bilirubin collects in your body. A blood test can determine which type you have. 

Prehepatic

If bilirubin builds up before blood enters the liver, it's known as prehepatic jaundice. This means you're breaking down red blood cells and creating more bilirubin than your liver can process. 

Hepatic

If your liver isn't able to process bilirubin well, it's called hepatic jaundice.

Posthepatic

Posthepatic jaundice is when bilirubin builds up after passing through the liver and your body can't clear it quickly enough. 

Obstructive jaundice 

This condition is when bile isn't able to drain into your intestines because of a blocked or narrow bile or pancreatic duct. This type of jaundice has a high death rate, so it's important to catch and treat it early.

Jaundice may have no symptoms. Any signs you have may depend on how quickly the condition is getting worse. Well-known symptoms are yellowing of the skin and jaundice eyes (also called scleral icterus). But there are others to watch for, including: 

  • Fever
  • Stomach pain
  • Chills
  • Dark urine
  • Tar- or clay-colored stools
  • Flu-like symptoms
  • Itchy skin
  • Weight loss
  • Feeling unusually irritated
  • Confusion 
  • Abnormal drowsiness
  • Bruising or bleeding easily
  • Bloody vomit
  • How long does jaundice last in adults? 

    How long jaundice lasts depends on what's causing it and the treatment you need. If a medication is causing it, jaundice will fade after you stop taking it. If hepatitis is causing it, medications can be taken to treat the condition. If there is a blocked bile duct or gallstones, surgery may be required. 

    Jaundice in adults is rare, but you can get it for many reasons. These include:

  • Hepatitis: Liver inflammation can be caused by a virus, autoimmune disorder, alcohol or drug use, or chemical exposure. It may be short-lived (acute) or chronic, which means it lasts for at least 6 months. Long-term inflammation can damage the liver, causing jaundice.
  • Alcohol-related liver disease: If you drink heavily over a long period of time – typically 8 to 10 years – you could seriously damage your liver. Two diseases in particular, alcoholic hepatitis and alcoholic cirrhosis, harm the liver.
  • Other liver disease: Cirrhosis can also be caused by autoimmune diseases, genetic conditions that are passed down in your family, and hepatitis. A severe condition known as nonalcoholic steatohepatitis can cause nonalcoholic fatty liver disease. With this kind of liver disease, fat builds up in your liver along with inflammation, which damages it over time. 
  • Blocked bile ducts: These are thin tubes that carry a fluid called bile from your liver and gallbladder to your small intestine. If the tubes are blocked by gallstones, cancer, inflammation, or rare liver diseases, you could get jaundice.
  • Pancreatic cancer:This is the 10th most common cancer in men and the ninth in women. It can block the bile duct, causing jaundice.
  • Certain medicines: Drugs like acetaminophen, penicillin, birth control pills, and steroids have been linked to liver disease.
  • Blood clots: If your body reabsorbs a large blot clot (hematoma) under the skin, it can increase bilirubin levels.
  • Hemolytic anemias: Destroyed blood cells are sometimes removed from the bloodstream too quickly, increasing bilirubin levels. 
  • Your doctor will ask you about your symptoms and medical history. They'll then give you a physical exam to see if there's swelling in your liver. 

    To get more information, your doctor will likely order blood tests to measure bilirubin and cholesterol levels and get a complete blood count (CBC). If you have jaundice, your level of bilirubin will be high. Your doctor may order other tests to find the cause of your jaundice and how severe it is, including:

  • A hepatitis panel, which is a blood test that shows if you have, or have had, hepatitis. It tests for hepatitis A, hepatitis B, and hepatitis C. If there are no hepatitis antibodies in your blood, it means you don't have the condition, or you had it in the past, but your body has cleared it. 
  • Tests to check enzyme levels in the liver to see how well it is functioning. If enzyme levels are higher or lower than normal, it can mean you have disease or damage to the liver or bile ducts. 
  • Imaging, like a CT scan, ultrasound, or magnetic resonance cholangiopancreatography, a type of MRI that checks for blocked ducts near the gallbladder 
  • A liver biopsy, to show if you have damage to, or disease in, your liver. During the test, a small piece of your liver is removed either with a needle inserted into the belly to the liver, through a vein in your neck, or through a cut in your belly.
  • Prothrombin time, which measures how long it takes for blood plasma to clot. Your blood will be taken, and a laboratory will test it to see if it clots faster or slower than the normal range (which is between 10 and 13 seconds). If it clots too slowly, that may mean there are problems with your liver. 
  • In adults, jaundice itself usually isn't treated. But your doctor will treat the condition that's causing it.

    If you have acute viral hepatitis, jaundice will go away on its own as your liver heals. If a blocked bile duct is to blame, your doctor may suggest surgery to open it. If your skin is itching, your doctor can prescribe cholestyramine to be taken by mouth. This medication is used to remove bile acids from your body, which cause itching. 

    Phototherapy for jaundice

    Phototherapy uses a fluorescent white or blue-spectrum light that breaks down bilirubin so it can be released from the body. This treatment is used for newborns, but phototherapy has not been shown to be effective for treating jaundice in adults. 

    You may have a higher risk for jaundice if you drink too much alcohol or have hepatitis. It is also more common in people during middle age. 

    You can reduce your risk of jaundice through lifestyle changes like:

  • Avoid herbal supplements (which can be toxic to the liver) unless recommended by your doctor 
  • Stop smoking
  • Reduce or cut out all alcohol (the CDC recommends no more than two alcoholic drinks per day for men and one daily for women)
  • Don't use intravenous drugs (drugs that go into your vein)
  • Don't take more prescription medication than you are prescribed
  • Get all recommended vaccines before traveling overseas
  • Use safe sex practices
  • Maintain a healthy weight
  • Keep your cholesterol in a healthy range
  • Unlike newborn jaundice, jaundice is not common in adults. It usually goes away on its own, but your doctor may recommend treatment if there is a condition causing it. If you have jaundice symptoms, including yellowish skin or eyes, flu-like symptoms, dark urine, or belly pain, talk to your doctor right away. 

  • Is jaundice very serious? For infants with high neonatal bilirubin levels, or jaundice, it is usually not serious and goes away on its own. But if it lasts more than 2 weeks, your doctor may suggest treatments to lower bilirubin levels or find out if it's caused by another illness. Jaundice is usually not harmful in adults and goes away over time. If you have symptoms, talk to your doctor right away to see if they suggest tests, imaging, or treatment. 
  • How do they fix jaundice? Your doctor will test you to figure out if there is a condition like hepatitis, liver disease, cancer, or blocked bile ducts causing jaundice. If so, that condition will be treated. 
  • What does jaundice in adults feel like? Sometimes there are no symptoms. Or you may feel like you have the flu, a stomachache, or itchy skin.
  • Can adults recover from jaundice? Yes, sometimes without treatment. If a health condition is the cause, that will need to be treated.

  • Liver Problems And Their Causes

    Liver disease is a general term that refers to any condition affecting your liver. These conditions may develop for different reasons, but they can all damage your liver and affect its function.

    Your liver is a vital organ that performs hundreds of tasks related to metabolism, energy storage, and waste filtering. It helps you digest food, convert it to energy, and store the energy until you need it. It also helps filter toxic substances out of your bloodstream.

    Read on to learn about the types, causes, symptoms, and treatment of liver disease.

    Liver disease symptoms vary, depending on the underlying cause. It's also possible for someone to have liver disease and not have any symptoms at all. However, Hepatitis NSW says that a few general symptoms can indicate some kind of severe liver damage.

    These include:

  • yellowish skin and eyes, known as jaundice
  • pale, bloody, or black stools
  • enlarged stomach due to ascites, which may make it uncomfortable to lie down or eat
  • encephalopathy, a brain issue resulting in marked changes in mood, sleep, and cognition
  • Many conditions can affect your liver. Here's a look at some of the main ones.

    Hepatitis

    Hepatitis is defined as an inflammation of the liver. When that inflammation is caused by a virus, it's referred to as viral hepatitis. Hepatitis can cause liver damage, making it difficult for your liver to function as it should.

    Most types of viral hepatitis are contagious, but you can reduce your risk by getting vaccinated for types A and B and by taking other preventive steps, including using a condom during sex and not sharing needles.

    Five types of hepatitis include:

  • Hepatitis A. Hepatitis A is typically spread through contact with contaminated food or water. Symptoms may clear up without treatment, but recovery can take a few weeks.
  • Hepatitis B. This type of viral hepatitis can be acute (short-term) or chronic (long-term). It's spread through bodily fluids, such as blood and semen. While hepatitis B is treatable, there's no cure for it. Early treatment is key to avoiding complications, so it's best to get regular screenings if you're at risk.
  • Hepatitis C. Hepatitis C can also be acute or chronic. It's often spread through contact with blood from someone with hepatitis C. While it often doesn't cause symptoms in its early stages, it can lead to permanent liver damage in its later stages.
  • Hepatitis D. This is a serious form of hepatitis that only develops in people with hepatitis B — it can't be contracted on its own. It can also be either acute or chronic.
  • Hepatitis E. Hepatitis E is usually caused by drinking contaminated water. Generally, it clears up on its own within a few weeks without any lasting complications.
  • Fatty liver disease

    Fat buildup in the liver can lead to fatty liver disease.

    There are two types of fatty liver disease. These two types can manifest alone, or they can overlap:

  • alcoholic fatty liver disease, which is caused by heavy alcohol consumption
  • nonalcoholic fatty liver disease, which is caused by other factors experts are still trying to understand
  • Without management, both types of fatty liver disease can cause liver damage, leading to cirrhosis and liver failure. Diet and other lifestyle changes can often improve symptoms and lower your risk of complications.

    Autoimmune conditions

    Autoimmune conditions involve your immune system mistakenly attacking healthy cells in your body.

    Several autoimmune conditions involve your immune system attacking cells in your liver, including:

  • Autoimmune hepatitis. This condition causes your immune system to attack your liver, resulting in inflammation. Without treatment, it can lead to cirrhosis and liver failure.
  • Primary biliary cirrhosis (PBC). This results from damage to the bile ducts in your liver, causing a buildup of bile. PBC can eventually lead to cirrhosis and liver failure.
  • Primary sclerosing cholangitis. This inflammatory condition causes gradual damage to your bile ducts. They eventually become blocked, causing bile to build up in your liver. This can lead to cirrhosis or liver failure.
  • Genetic conditions

    Several genetic conditions, which you inherit from one of your parents, can also affect your liver:

  • Hemochromatosis causes your body to store more iron than it needs. This iron remains in your organs, including your liver. This can lead to damage over a long period of time if not managed.
  • Wilson's disease causes your liver to absorb copper instead of releasing it into your bile ducts. Eventually, your liver may become too damaged to store more copper, allowing it to travel through your bloodstream and damage other parts of your body, including your brain.
  • Alpha-1 antitrypsin deficiency occurs when your liver can't make enough alpha-1 antitrypsin, a protein that helps prevent enzyme breakdowns throughout your body. This condition can cause lung disease as well as liver disease. There's no cure, but treatment can help.
  • Drug-induced liver disease

    It's possible to damage your liver by overexposing it to certain drugs and supplements, as seen in a 2019 study. Many times, this damage can be reversed once you stop taking the drug. But if it continues, the damage can become chronic.

    Cancer

    Liver cancer first develops in your liver. If cancer starts elsewhere in the body but spreads to the liver, it's called secondary liver cancer.

    The most common type of liver cancer is hepatocellular carcinoma. It tends to develop as several small spots of cancer in your liver, though it can also start as a single tumor.

    Complications of other liver diseases, especially those that aren't treated, may contribute to the development of liver cancer.

    Cirrhosis

    Cirrhosis refers to scarring that results from liver diseases and other causes of liver damage, such as alcohol use disorder. Cystic fibrosis and syphilis may also lead to liver damage and, eventually, cirrhosis — although these two causes are much less common.

    Your liver can regenerate in response to damage, but this process usually results in the development of scar tissue. The more scar tissue that develops, the harder it is for your liver to function properly.

    In its early stages, cirrhosis is often treatable by addressing the underlying cause. But without management, it can lead to other complications and become life threatening.

    Liver failure

    Chronic liver failure typically happens when a significant part of your liver is damaged and can't function properly. Generally, liver failure related to liver disease and cirrhosis happens slowly. You may not have any symptoms at first. But over time, you might start to notice:

  • jaundice
  • diarrhea
  • confusion
  • fatigue and weakness
  • nausea
  • It's a serious condition that requires ongoing management.

    Acute liver failure, on the other hand, happens suddenly, often in response to an overdose or poisoning.

    Certain things can make you more likely to develop certain liver diseases. One of the most well-known risk factors is heavy drinking, which the Centers for Disease Control and Prevention (CDC) defines as more than 8 alcoholic drinks per week for women and more than 15 drinks per week for men.

    Other risk factors include:

  • sharing needles
  • getting a tattoo or body piercing with nonsterile needles
  • having a job where you're exposed to blood and other bodily fluids
  • having sex without using protection against sexually transmitted infections
  • living with diabetes or high cholesterol
  • having a family history of liver disease
  • living with extra weight
  • being exposed to toxins or pesticides
  • taking certain supplements or herbs, especially in large amounts
  • mixing certain medications with alcohol
  • taking more than the recommended dose of certain medications
  • While not all liver disease or damage can be prevented, lifestyle choices can make a big difference when it comes to keeping your liver healthy. Like the risk factors above, many of the methods around prevention involve dietary decisions and physical activity.

    The American Liver Foundation says that you can help prevent liver disease by:

  • eating a nutritious diet that includes lots of fruits, vegetables, lean proteins, and whole grains
  • increasing physical activity
  • limiting alcohol
  • avoiding smoking and using drugs
  • maintaining a moderate weight
  • interacting cautiously with toxic chemicals like aerosol cleaners, bug sprays, and other cleaning products
  • using a condom or other barrier method during sex
  • visiting your doctor for annual physicals, including blood work
  • If you're concerned about liver disease, it's best to make an appointment with a healthcare professional.

    They'll start by looking over your medical history and asking about any family history of liver problems. Next, they'll likely ask you some questions about symptoms you may be experiencing, including when they started and whether certain things make them better or worse.

    Depending on your symptoms, they'll likely ask you about your drinking and eating habits. Make sure to also tell them about any prescription or over-the-counter medications you take, including vitamins and supplements.

    Once they've collected all this information, they may recommend:

  • liver function tests
  • a complete blood count test
  • CT scans, MRIs, or ultrasounds to check for liver damage or tumors
  • a liver biopsy, which involves removing a small sample of your liver and examining it for signs of damage or disease
  • Many liver diseases are chronic, meaning they last for years and may never go away. But even chronic liver diseases can usually be managed.

    For some people, lifestyle changes are enough to control symptoms. These might include:

  • limiting alcohol
  • maintaining a moderate weight
  • drinking more water
  • adopting a liver-friendly diet that includes plenty of fiber while avoiding unhealthy fats, refined sugar, and salt
  • Depending on the specific liver condition you have, your doctor may recommend other dietary changes. For example, people living with Wilson's disease should limit foods containing copper, including shellfish, mushrooms, and nuts.

    Depending on the condition affecting your liver, you may also need medical treatment, such as:

  • antiviral drugs to treat hepatitis
  • steroids to lower liver inflammation
  • blood pressure medication
  • antibiotics
  • medications to target specific symptoms, such as itchy skin
  • vitamins and supplements to boost liver health
  • In some cases, you may need surgery to remove all or part of your liver. Generally, a liver transplant is only done when other options have failed.

    Many liver diseases are manageable if you catch them early. Without treatment, however, they can cause permanent damage.

    The complications of untreated or unmanaged liver disease can lead to cirrhosis, severe scarring that cannot be reversed. If cirrhosis has gone too far, a liver transplant may be your only option.

    Because some liver diseases can develop without symptoms, making it a point to schedule annual physicals, along with the typical physical blood work, can help you and your doctor stay one step ahead.

    Focusing on a nutritious diet, physical exercise, and other healthy lifestyle choices such as limiting alcohol can also help with prevention or management.


    A/G Ratio: Conditions Linked To High Or Low Albumin/Globulin Levels

    Medically reviewed by Steffini Stalos, DO

    The A/G ratio is a test that measures the amount of proteins called albumin and globulin in your blood. The A/G ratio may be performed as part of a routine blood test called the comprehensive metabolic panel (CMP) or ordered if you have certain unusual symptoms like hematuria (blood in the urine) or jaundice (yellowing of the eyes or skin).

    A high A/G ratio may indicate kidney disease, antibody deficiencies, or severe dehydration. A low A/G ratio can also indicate kidney disease as well as liver disease, chronic infections like human immunodeficiency virus (HIV), autoimmune diseases like lupus, and certain cancers.

    This article explains why the A/G ratio test is used and what the ratio of albumin to globulin says about your health. It also describes what you need to do if your test results are high or low.

    Albumin/Globulin Ratio Results: What's Measured

    The A/G ratio describes the amount of albumin compared to the amount of globulin in your blood. Albumin and globulin are major proteins in your blood, called serum proteins. They have different purposes in the human body, as follows:

  • Albumin is the most common serum protein made by the liver. It helps fluids remain inside arteries and veins and prevents them from leaking into your lungs, abdomen, or other parts of your body. A normal albumin range is between 3.4 and 5.4 grams per deciliter (g/dL).

  • Globulins are a group of serum proteins, some of which are produced by the liver and others by the immune system (immunoglobulins). Globulin plays a central role in liver function, blood clotting, and fighting infections. A normal globulin range is between 2.0 and 3.5 g/dL.

  • Under normal circumstances, there is slightly more albumin in your blood than globulin.

    While the reference ranges of values (meaning the range between which test results are normal) can differ by the lab, most consider an A/G ratio between 1.1 and 2.5 as normal.

    Interpretation

    An A/G ratio of 1 means that there is an equal amount of albumin and globulin in the blood, while an A/G ratio of 2 means that there is twice as much albumin in the blood as globulin.

    Related: What Is Microalbuminuria?

    What Do High or Low A/G Ratio Results Mean?

    When your body is functioning normally, the proportion of albumin to globulin will remain relatively consistent. When the proportion changes and the A/G ratio is either high or low, it may be a sign of an infection, disease, or nutritional deficiency.

    Low A/G Ratio

    Generally speaking, your A/G ratio may become low for three reasons:

  • Your albumin is normal, but your globulin is high.

  • Your albumin is low, and your globulin is high.

  • Your globulin is normal, but your albumin is low.

  • High globulin levels are typically a sign of inflammation and the activation of the immune system to fight an infection or disease.

    Low albumin levels (referred to as hypoalbuminemia) are most often due to the excessive excretion of albumin through the kidneys or the reduced production of albumin in the liver. Chronic inflammatory conditions can also contribute to hypoalbuminemia by increasing the permeability of blood vessels, allowing albumin to leak into surrounding tissues.

    Given these dynamics, the possible causes of a low A/G ratio include:

    A low A/G ratio does not cause symptoms per se other than those related to the underlying cause.

    In many cases, a person with a low A/G ratio will have no symptoms, particularly those with chronic kidney disease who can be asymptomatic (symptom-free) for years.

    Even so, your healthcare provider may order an A/G ratio test if you have signs of chronic kidney disease (including difficulty urinating, ankle swelling, and ammonia-smelling breath) or liver disease (including jaundice, dark urine, severe fatigue, and pain in the upper right abdomen).

    Related: What Is Albuminuria in Diabetes?

    High A/G Ratio

    A high A/G ratio is far less common than a low A/G ratio and can occur when:

  • Your albumin is high, and your globulin is normal.

  • Your globulin is low, and your albumin is normal.

  • Your albumin and globulin are both high, but the proportion is abnormal.

  • Globulin levels can drop when your body is not able to produce enough or an excessive amount is eliminated through the kidneys when you urinate.

    The only situation in which albumin can abnormally increase is with severe dehydration. In such cases, albumin will increase in relationship to decreased volumes of blood plasma (the liquid part of the blood).

    Given these dynamics, possible causes of a high A/G ratio include:

  • Severe diarrhea or vomiting (or other causes of severe dehydration)

  • Pregnancy (during which albumin and globulin will increase to support fetal growth)

  • Antibody deficiency disorders (a group of genetic disorders that cause the inadequate production of immunoglobulins)

  • As with a low A/G ratio, a high A/G ratio does not cause a set group of symptoms. In many cases, there may be no symptoms at all.

    However, people with antibody deficiencies are vulnerable to a host of symptoms, including recurrent infections (especially of the ears, sinuses, and lungs) as well as bacterial or viral meningitis and chronic diarrhea.

    Follow-Up for High or Low A/G Test Results

    An A/G ratio cannot diagnose any medical condition on its own, but it can point your healthcare provider in the direction of possible causes. Other tests can help characterize the nature of the problem and help narrow the causes.

    These involve lab tests like:

    Imaging tests and specialist procedures may be also ordered if a gastrointestinal disease or cancer is suspected. These may include:

    Related: When to See a Kidney Doctor

    Summary

    An A/G ratio is a blood test that compares the amount of two proteins (albumin and globulin) in your blood. A normal A/G ratio is between 1.1 and 2.5, although this can vary by lab.

    A low A/G ratio may be due to kidney disease, liver disease, chronic infections, type 2 diabetes, malnutrition, certain autoimmune diseases, and cancers. A high A/G ratio may also be due to kidney disease as well as severe dehydration, pregnancy, and antibody deficiencies.

    Read the original article on Verywell Health.

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