Yellow and Black Jaundice: Causes, Signs and Symptoms

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Yellow yellow, unhealthy fellow! Yeah you heard it right… If your skin is gaining yellowish tinge and even the eyes, nails, urine or poop are turning yellow then that doesn’t mean that you are generating elemental gold. It may be a warning sign suggesting that your body is ill, and your life is in grave danger. Now, the body is a complex and coordinated system. What accounts for such signs? Are there any other associated symptoms? What causes such signs to appear? The answers to these questions are important, as what is being talked about is not a disease rather a symptom of an underlying cause.

Jaundice

What is Jaundice?

Jaundice refers to a condition characterized by yellow discoloration of the white part of the eyes and the skin due to decreased excretion and/or increased production of a pigment called bilirubin, in the blood.

Bilirubin, a yellow colored pigment, is formed in the liver due to breakdown of dead red blood cells (RBCs). Under certain conditions, this pigment accumulates excessively in the blood resulting in yellow discoloration of skin, tissues and body fluids. Because of this, jaundice is also known as hyperbilirubinemia.

What Causes Jaundice?

The answer to this lies in basic steps involved in the formation and fate of bilirubin. In fact, this forms one of the bases for classifying jaundice. Moreover, understanding the root cause is an important factor in deciding the treatment plan for jaundice.

1. Prehepatic or Hemolytic Jaundice

This type of jaundice occurs when RBC break down overwhelms the liver’s ability to remove and consequently increase bilirubin in the blood. The two main reasons responsible are:

  • Excessive breakdown of RBCs
  • Excessive production of RBCs that consequently increases the number of RBCs undergoing breakdown naturally

This can be the case in either of the conditions listed below:

Hemolytic disease of the newborn

  • Sickle cell anemia
  • Hemolytic anemia
  • Thalassemia
  • Malaria
  • Spherocytosis
  • Toxin or drug-induced
  • Glucose-6-phosphate dehydrogenase deficiency
  • Autoimmune disorder

2. Hepatic Jaundice

This is named so, because its root cause lies within the liver. This type of jaundice occurs when the ability of the liver to metabolize and excrete bilirubin gets compromised. This can occur in the following conditions:

  • Infection
  • Cancer
  • Hepatitis (Viral or alcohol associated)
  • Liver cirrhosis
  • Drug or toxin-linked liver damage
  • Bacterial infection (leptospirosis or weil’s disease)
  • Gilbert’s syndrome
  • Crigler-Najjar syndrome

Infectious jaundice or weil’s disease is a rare form of jaundice caused by the bacteria (Leptospira icterohaemorrhagiae). It is characterized by the dysfunction of both kidney and liver.

3. Post Hepatic or Obstructive

This is named so, because it is related to the interruption in the normal drainage of bilirubin from liver to intestine in the form of bile via the gallbladder and bile duct. This can occur in the following conditions:

  • Constraints in the bile duct
  • Cancer (gallbladder/bile duct/ pancreatic cancer),
  • Obstruction due to gallstones in the bile duct
  • Inflammation of the bile duct (cholangitis)
  • Birth defects (congenital malformations)
  • Pancreatitis
  • Pregnancy
  • New-borne jaundice

Jaundice is common in newborns, primarily due to the presence of immature liver which is not damaging as it subsides with age. However, under conditions, such as hemolysis due to mother-fetus blood group mismatch (Rh factor), reduced bowel movement due to poor breastfeeding, or due to clot under the scalp of the infant, etc., the increase in bilirubin in newborns is so excessive that if not addressed can cause permanent damage to the brain of the infant (kernicterus).

What are the Signs and Symptoms of Jaundice(Black and Yellow)?

Jaundice itself is a sign of an underlying ailment. The common characteristics of a person with jaundice include:

  • Yellow discoloration of the skin, whites of the eyes, and mucous membranes (yellow jaundice)
  • Dark-colored urine
  • Pale or clay -colored stools
  • Skin itching

Further, in case of extensive obstruction (As in pancreatic cancer, gallbladder cancer), especially in the common bile duct, or during bacterial infections the common features may get intensified. The skin color may change to olive green to dark green due to the oxidized deposits of the pigment and thus, also named ‘black jaundice’.

A black jaundice may be associated with some additional signs and symptoms due to an underlying disease or condition, which may include some of the following:

  • Headache
  • Nausea and vomiting
  • Fever
  • Abdominal pain
  • Fatigue
  • Weakness
  • Confusion
  • Swelling of the legs and abdomen
  • Seizures
  • Disturbed alertness,
  • Anorexia (loss of appetite)
  • Muscular pain
  • Stiffness in neck
  • Coughing
  • Blood in the sputum
  • Bleeding of nose (epistaxis)
  • Bleeding at many sites in the body due to the rupturing of smaller blood vessels, as in nose (epistaxis)
  • Thrombocytopenia (reduce blood platelets)
  • Protein, pus, blood in urine

Is Jaundice Contagious?

Jaundice occurs due to the increased accumulation of bilirubin in blood due to its increased production or reduced elimination. In fact, jaundice is just a sign and itself is non contagious. However, the infections underlying its cause, such as that of viral, and bacterial origin, can be contagious.

Is Jaundice Treatable?

Indeed, it is but, the strategy for the treatment of jaundice is to address the underlying cause of accumulation of the bilirubin-hemolysis, liver damage, obstruction, infection etc. for example antiviral treatment for viral hepatitis, antibiotics for black jaundice, chemotherapy for cancer related jaundice and surgical procedure for obstructive jaundice. Additionally, fluid replacements, dietary restrictions, lubricants and anti-itching lotions etc. may also be prescribed.

Jaundice is not a disease but a sign of an underlying illness. Early recognition and management  of the root cause of jaundice is the best way to deal with it.

References:

  1. https://www.nhp.gov.in/disease/digestive/liver/jaundice
  2. https://www.nhp.gov.in/yarqaan-jaundice_mtl
  3. https://www.ncbi.nlm.nih.gov/books/NBK413/
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