Bilirubin is a by-product of the breakdown of the red blood cells (RBCs) in the body. The breakdown of RBCs causes it to release the hemoglobin in blood, and the hemoglobin further splits and undergoes chemical changes to produce bilirubin. 
The liver normally excretes the bilirubin in the form of bile. The bile passes through the bile ducts into the small intestine. If the amount of bilirubin released exceeds the liver's excretion capacity, the person develops jaundice.Jaundice is often a common symptom of major liver diseases such as hepatitis, liver cirrhosis or liver cancer. It can also be due to an obstruction of the biliary tract. In addition, some non-liver causes may also be responsible for jaundice.
Causes of Jaundice
• Excessive Breakdown of Red Blood Cells: Normally, the rate of the production and the rate of breakdown of RBCs are balanced and equal. However, numerous conditions may increase the rate of breakdown of the RBCs. If the amount of bilirubin released exceeds the liver''s excretion capacity, the patient develops jaundice.
Conditions causing increased breakdown of red blood cells include malaria, sickle cell anemia, thalassemia, glucose-6-phosphate dehydrogenase (G6PD) deficiency, spherocytosis and drug toxicity.
• Impairment of Liver Cell Function: Impairment of liver function results in inability of the liver to properly metabolize and excrete bilirubin
. Liver conditions that could result in jaundice include
viral and
alcoholic hepatitis, liver cirrhosis, toxicity due to drugs or other toxins, Gilbert's syndrome and liver cancer.
• Blockage of the Bile Ducts: Conditions that block the bile ducts prevent the normal drainage of complexed bilirubin in the form of bile from the liver into the intestines. The cause of obstruction may be within or outside the bile ducts.
Gall stones are the most common cause of obstructive jaundice. Other causes of obstructive jaundice include cancers of the pancreas, gall bladder and bile duct, strictures or inflammation of the bile ducts, congenital malformations, parasite infections and pregnancy.
Symptoms of Jaundice
Jaundice can be a sign of underlying major disease. The general symptoms of jaundice include yellowing of skin, whites of the eyes, and mucous membranes; pale stools; dark-colored urine and itching of skin.
Other symptoms that may be associated with jaundice include nausea and vomiting, loss of appetite, abdominal pain, weakness, fever and headache. Some patients may suffer from confusion and swelling of the legs (ankles) and /or abdomen in more severe cases.
Jaundice in newborns can cause poor feeding, lethargy, changes in muscle tone, high-pitched crying, and in some cases, seizures.
Treatment of Jaundice
Jaundice treatment depends upon the basic condition leading to jaundice and complications associated with it. Treatment may be directed towards attacking the underlying cause and providing symptomatic relief, and may or may not require hospitalization.
• Medical treatment may include administration of intravenous fluids (IV Fluids) in case of dehydration, medications for nausea/vomiting and / or pain, antibiotics, anti-viral medications, and blood transfusions, depending on the patient condition. In certain cases, medications may not be necessary also, and could be managed by rest. Medications are used depending upon the underlying cause of the jaundice.
• If a drug was found to be the cause, it is discontinued.
• In certain cases of newborn jaundice, phototherapy or exchange blood transfusions is used to decrease elevated bilirubin levels.
• Surgical treatment may be required in cases such as cirrhosis or liver cancer. It may also be necessary in conditions such as gallstones, congenital malformationsand other conditions that obstruct the bile ducts. Sometimes, a liver transplant is possibly needed.
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