Jaundice, or yellowing of tissues, is a symptom of an underlying disease process. Due to the elevations of bilirubin, a breakdown product of red blood cells, jaundice is often associated with liver disease, red blood cell disorders and gallbladder disease, or cholecystitis.
Jaundice and Bilirubin
Bilirubin is the breakdown product of heme, or hemoglobin, the iron-carrying compound that helps transport oxygen in red blood cells. Typically red blood cell destruction in the liver causes the release of heme, where it is converted to one of two types of bilirubin. If the body is not able to rid itself of the bilirubin, it can accumulate in the blood, leading to its deposition in tissues such as the skin and the sclera, or white parts of the eyes. This deposition is called jaundice.
Cholecystitis Identified
Cholecystitis is the inflammation of the gallbladder caused by infection or the accumulation of gallstones. The gallbladder stores bilirubin as a portion of bile from the liver to be used in digestion once emptied into the small intestine. Cholecystitis occurs when either infection causes inflammation or a gallstone blocks the duct, preventing adequate emptying of the bile. A blocked duct allows bilirubin to back up into the liver and bloodstream, resulting in jaundice.
Red Blood Cell Disorders
Red blood cell disorders can also lead to an abnormal accumulation of bilirubin in the bloodstream, resulting in jaundice. A variety of conditions, including hemolytic anemia, a process where red blood cells spontaneously rupture or are destroyed inappropriately, lead to abnormal elevations of hemoglobin in the blood. Elevated hemoglobin is converted to bilirubin and subsequently deposited in the tissues if levels exceed the threshold for excretion or elimination.
Liver Disease
Liver conditions such as cirrhosis and hepatitis also cause inappropriate elevations in bilirubin, resulting in jaundice. Cirrhosis, a chronic scarring disease of the liver often associated with alcohol abuse, prevents the liver from eliminating the bilirubin, allowing it to accumulate in the bloodstream. Hepatitis, or inflammation of the liver, often due to viral infections, medications or even gallbladder disease, can also stunt the liver's ability to eliminate bilirubin, allowing it to be ultimately deposited in the tissues.
Infant Jaundice
Infant jaundice, also known as physiologic jaundice, is seen in newborns approximately 2 to 4 days old; it is more common in premature infants and is considered normal. Due to the immaturity of the liver and the rapid formation and breakdown of red blood cells, infants accumulate bilirubin. Enzyme deficiencies, viral infections, underlying liver disease and hemolytic anemia are a few of the serious causes of jaundice in a newborn.
References
- "Harrison's Principles of Internal Medicine";Daniel S. Pratt, Marshall M. Kaplan;2009
- MayoClinic.com: Infant Jaundice
