Adult Jaundice: Symptoms, Causes and Treatment

Jaundice in adults is more than just a yellowing of the skin or eyes—it's a visible sign of an underlying health issue, often related to the liver, blood, or bile ducts. Understanding the symptoms, causes, and treatment options is essential for timely diagnosis and management. This article provides a comprehensive, evidence-based overview of adult jaundice, synthesizing current research to help you recognize, understand, and respond to this important clinical sign.

Symptoms of Adult Jaundice

Jaundice often presents subtly at first, but its symptoms can escalate depending on the underlying cause. Recognizing these early signs is crucial for timely medical intervention. While the hallmark is yellowing of the skin and eyes, adult jaundice can be accompanied by a constellation of other symptoms, ranging from fatigue to changes in urine and stool color.

Symptom	Description	Frequency/Significance	Source(s)
Yellow Skin/Eyes	Visible yellowing, especially of sclera and skin	Most common, defining feature	2, 5
Dark Urine	Brownish or tea-colored urine	Indicates conjugated hyperbilirubinemia	2, 5
Pale Stools	Light or clay-colored stools	Suggests obstruction in bile flow	2, 5
Itching	Generalized pruritus	Often in cholestatic jaundice	2, 5
Fatigue	General malaise, tiredness	Non-specific, but common	5
Abdominal Pain	Discomfort or pain, often right upper quadrant	Suggests biliary or hepatic issues	2, 5
Nausea/Vomiting	Gastrointestinal upset	Can accompany liver issues	5
Weight Loss	Unintentional, over time	Associated with malignancy	3

Table 1: Key Symptoms of Adult Jaundice

Yellowing of Skin and Eyes

The most recognizable symptom of jaundice is a yellowish discoloration of the skin and the whites of the eyes (sclera). This occurs due to elevated levels of bilirubin in the bloodstream, a pigment produced during the normal breakdown of red blood cells. When bilirubin builds up—whether due to liver issues, bile duct obstruction, or blood disorders—it accumulates in tissues, causing the yellow hue 2 5.

Changes in Urine and Stool Color

Dark urine is another early sign and is often noticed before skin changes. It results from excess conjugated bilirubin being excreted by the kidneys. Conversely, pale or clay-colored stools indicate that bile is not reaching the intestines, often due to a blockage in the biliary system 2 5.

Itching (Pruritus)

Cholestatic jaundice—caused by reduced bile flow—can result in itching, which may be severe and persistent. This is due to the accumulation of bile salts in the skin 2 5.

Systemic Symptoms

Jaundice can also be accompanied by systemic symptoms such as:

• Fatigue and malaise, which are non-specific but common in liver dysfunction 5
• Nausea and vomiting, often signaling more acute or severe liver injury 5
• Weight loss, particularly if jaundice is due to cancer or chronic disease 3
• Abdominal pain, especially in the upper right quadrant, may point to gallstones, liver inflammation, or tumors 2 5

Additional Signs

Other findings, such as fever (suggestive of infection), or easy bruising/bleeding (due to impaired liver function), can provide important diagnostic clues 2 5. In some cases, jaundice may be mild and only detected via laboratory tests.

Causes of Adult Jaundice

Adult jaundice can arise from a wide spectrum of medical conditions, ranging from relatively benign to life-threatening. Understanding the common causes—and how they're classified—helps guide both diagnosis and treatment.

Cause	Mechanism/Type	Prevalence/Importance	Source(s)
Gallstones	Posthepatic obstruction	Most common benign cause	2, 3
Malignancies	Blockage or infiltration	Significant, ~25% of cases	3, 5
Viral Hepatitis	Hepatocellular injury	Common intrahepatic cause	1, 2, 5
Alcoholic Liver Disease	Hepatocellular	Notable, especially in chronic drinkers	3, 5
Sepsis/Ischemia	Intrahepatic	Leading cause in some settings	1, 4
Drug-Induced Liver Injury (DILI)	Hepatic injury	Less common, but important	1, 2, 5
Hemolysis	Prehepatic	Increased bilirubin production	2, 5
Autoimmune Disorders	Hepatocellular	Less frequent, but serious	2, 5
Bacterial Infections	Variable	Often overlooked	4

Table 2: Key Causes of Adult Jaundice

Classification by Site: Prehepatic, Intrahepatic, and Posthepatic

Prehepatic Causes

These result from increased breakdown of red blood cells (hemolysis) which leads to excess production of unconjugated bilirubin. Common causes include hemolytic anemias and large hematoma resorption 2 5.

Intrahepatic Causes

Intrahepatic (or hepatocellular) jaundice arises from diseases affecting the liver itself:

• Viral hepatitis (A, B, C, etc.): Inflammation and injury to liver cells impair bilirubin processing 1 2 5.
• Alcoholic liver disease: Chronic exposure to alcohol damages hepatocytes 3 5.
• Drug-induced liver injury (DILI): Certain medications, especially acetaminophen in overdose, can cause acute liver failure and jaundice 1 2 5. However, idiosyncratic (unpredictable) DILI is rare 1.
• Autoimmune hepatitis: The body's immune system attacks liver cells 2 5.
• Sepsis/Ischemic liver injury: Severe infections or low blood pressure can compromise liver blood flow, resulting in jaundice 1 4.

Posthepatic (Obstructive) Causes

These occur when bile cannot flow from the liver to the intestine due to obstruction:

• Gallstones (choledocholithiasis): The most common benign cause of obstructive jaundice; stones block the bile duct 2 3 5.
• Malignancies: Tumors of the pancreas, bile ducts (cholangiocarcinoma), or nearby organs can compress or invade the bile ducts, causing jaundice. Cancers account for over a quarter of adult jaundice cases in some studies 3 5.
• Biliary tract infections and pancreatitis: Inflammation and infection can also block bile flow 2 5.

Epidemiological Insights

• In primary care, gallstones are the leading cause, followed by malignancy (~27%), alcoholic liver disease, and viral hepatitis 3.
• Sepsis and ischemic liver injury are the most common causes among hospitalized adults in some settings 1.
• Up to 22% of adult jaundice cases may not have a clear cause recorded in routine practice, highlighting diagnostic challenges 3.

Other Notable Causes

• Bacterial infections, especially with gram-negative organisms, are an underappreciated cause in adults, often overlooked but important to recognize 4.
• Genetic disorders (e.g., Gilbert's syndrome) can cause mild jaundice due to impaired bilirubin conjugation, but are less common in adults 5.

Treatment of Adult Jaundice

The management of adult jaundice is highly individualized and depends on the underlying cause. Rapid identification and treatment are crucial, especially when jaundice signals a potentially life-threatening condition.

Treatment	Approach/Target	Key Considerations	Source(s)
Treat Underlying Cause	Disease-specific	Most important step	2, 5
Supportive Care	Hydration, nutrition, monitoring	General management	5
Surgery/Intervention	Biliary drainage, stone removal	For obstruction/malignancy	2, 3, 5
Antivirals/Antibiotics	For infections	Viral or bacterial cause	2, 5, 4
Discontinue Offending Drugs	DILI	Remove causative agent	1, 2, 5
Herbal/Plant-based Therapies	Adjunct/Alternative	Used in some communities	6, 7, 8, 9, 10

Table 3: Main Treatment Approaches for Adult Jaundice

Treating the Underlying Cause

The cornerstone of jaundice management is to address its root cause:

• Obstructive causes (gallstones, tumors): Endoscopic or surgical procedures may be needed to relieve the obstruction (e.g., ERCP for stone removal, surgery for tumors) 2 3 5.
• Viral hepatitis: Supportive care is the mainstay for most viral hepatitis; some cases (such as hepatitis B or C) may require specific antiviral therapy 5.
• Alcoholic liver disease: Abstinence from alcohol, nutritional support, and in some cases, corticosteroids or other medications 3 5.
• Drug-induced liver injury: Immediate discontinuation of the offending drug, with supportive care as needed. Most cases resolve with withdrawal of the agent, but severe cases may require hospitalization 1 2 5.
• Bacterial infections: Prompt antibiotic therapy, especially in cases of cholangitis or sepsis 4 5.

Supportive Care

Regardless of cause, supportive measures are vital:

• Maintain hydration and electrolyte balance
• Monitor liver and kidney function
• Manage symptoms such as itching
• Provide nutritional support, especially in chronic liver disease 5

Role of Herbal and Plant-Based Therapies

In many parts of the world, traditional medicine plays a significant role in the management of jaundice:

• Numerous medicinal plants, including Boerhavia diffusa, Tinospora cordifolia, Phyllanthus amarus, Andrographis paniculata, Silybum marianum, Terminalia chebula, and others, are widely used and have shown hepatoprotective effects in experimental models 6 7 8 9 10.
• Artemisia capillaris demonstrates favorable effects in animal studies, helping to reduce bilirubin levels and improve liver function through multiple biological pathways 9.
• The use of these herbal remedies is especially prominent in communities with limited access to conventional healthcare 6 10.
• However, while some plant extracts are promising, robust clinical trials in humans are lacking, and safety must be considered before widespread adoption 6 7 8 9 10.

Additional Therapies

• Immunosuppressive therapy: For autoimmune hepatitis or severe inflammatory liver diseases 5.
• Liver transplantation: Reserved for cases of fulminant liver failure or advanced chronic liver disease 5.
• Symptom management: Cholestyramine for itching, vitamin supplementation, and management of complications 5.

Conclusion

Adult jaundice is a key clinical sign that warrants thorough investigation. By recognizing its symptoms, understanding its diverse causes, and knowing the principles of its management, patients and clinicians can work together to ensure timely and effective care.

Key takeaways:

• Jaundice in adults commonly presents as yellowing of the skin and eyes, dark urine, pale stools, and sometimes itching or systemic symptoms.
• The most frequent causes include gallstones, malignancy, viral hepatitis, alcoholic liver disease, and less commonly, drug-induced liver injury or bacterial infection.
• Prompt identification and treatment of the underlying cause is crucial, with supportive care and, where appropriate, surgical or medical intervention.
• Herbal and plant-based therapies are widely used in some cultures and may offer hepatoprotective benefits, but require further scientific validation.
• If you or someone you know develops jaundice, seek medical attention promptly to determine the cause and receive appropriate treatment.

By staying informed and proactive, we can improve outcomes for adults experiencing jaundice and ensure that this visible warning sign leads to effective action.