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Health condition · Clinically reviewed

Jaundice, from split bilirubin to MRCP - and every step in between.

Yellow sclerae are a signal, not a diagnosis. A structured plan uncovers the cause and shapes the right treatment.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE, BSG and peer-reviewed hepatology sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice for split bilirubin testing, MRCP-first imaging and ERCP with stenting.

Key facts

Jaundice at a glance.

The essentials, in plain English - what it is, the three broad categories, and how the split bilirubin points the way.

  • What it is

    Yellow discolouration of the sclerae, skin and mucous membranes caused by a rise in circulating bilirubin.

  • Three broad types

    Pre-hepatic (haemolysis), hepatic (liver injury) and post-hepatic (biliary obstruction) - the split guides everything.

  • Split bilirubin

    Conjugated versus unconjugated fractions on the LFTs are the single most useful piece of the puzzle.

  • Obstructive picture

    Pale stools, dark urine and pruritus point strongly at a blockage in the bile ducts.

  • Painless jaundice

    A key red flag - malignancy of the pancreas, ampulla or bile ducts must be excluded urgently.

  • Neonatal jaundice

    A distinct condition in newborns with its own pathway - covered separately on our infant jaundice guide.

Why this guide matters

A structured plan, not a wait-and-see.

Jaundice covers everything from Gilbert syndrome to acute liver failure. A calm, ordered plan makes sure serious causes are not missed.

  • Pre-hepatic - haemolytic

    Unconjugated bilirubin from red-cell breakdown - haemolysis in G6PD deficiency (see /conditions/glucose-6-phosphate-dehydrogenase-g6pd-deficiency/), hereditary spherocytosis (see /conditions/hereditary-spherocytosis/), sickle cell disease (see /conditions/sickle-cell-disease/), thalassaemia, autoimmune haemolysis, HUS (see /conditions/hemolytic-uremic-syndrome/) or benign Gilbert syndrome.

  • Hepatic - liver injury

    Mixed hyperbilirubinaemia from viral hepatitis, alcohol, drug injury, autoimmune hepatitis (see /conditions/autoimmune-hepatitis/), MASH, cirrhosis, Wilson disease or haemochromatosis (see /conditions/hemochromatosis/) - specialist commissioned.

  • Post-hepatic - obstructive

    Conjugated bilirubin with pale stools, dark urine and pruritus - stones (see /conditions/gallstones/), strictures, cholangiocarcinoma (see /conditions/hilar-cholangiocarcinoma/), pancreatic cancer (see /conditions/pancreatic-cancer/), ampullary tumours, PSC and primary biliary cholangitis. Neonatal jaundice is separate (see /conditions/infant-jaundice/).

How the diagnosis is made

From yellow sclerae to a clear plan.

The steps a UK GP, gastroenterologist or hepatologist will normally follow, in order - so you know what to expect. See our private ultrasound scan for imaging.

  1. 01

    Assessing

    History - alcohol, drugs, travel

    Alcohol intake, prescribed and recreational drug use, herbal remedies, foreign travel and family liver disease all matter.

  2. 02

    Assessing

    Examination for stigmata

    A specialist-commissioned look for palmar erythema, spider naevi, hepatomegaly, splenomegaly and ascites.

  3. 03

    Assessing

    Split bilirubin and full LFTs

    Conjugated versus unconjugated bilirubin, AST, ALT, ALP, GGT and albumin - performed under specialist oversight.

  4. 04

    Confirming

    Haemolysis screen

    FBC, blood film, reticulocytes, Coombs and haptoglobin when pre-hepatic disease is suspected, under specialist guidance.

  5. 05

    Confirming

    Hepatic aetiology panel

    Viral hepatitis serology, autoimmune markers, ferritin, caeruloplasmin and alpha-1 antitrypsin, specialist-commissioned.

  6. 06

    Confirming

    First-line imaging

    Ultrasound of the liver and biliary tree - see our private ultrasound scan - to look for duct dilatation, stones and masses.

  7. 07

    MDT

    MRCP, CT and MDT

    MRCP or contrast CT, ERCP with brush cytology if needed, and hepatobiliary MDT review - all specialist commissioned.

Typical timeline: bloods and ultrasound within days, MRCP and MDT within weeks.

Symptoms

What jaundice actually looks like.

Yellow eyes and skin are only the start - dark urine, pale stools and pruritus are just as important, and hint at where the problem sits.

  • Yellow sclerae and skin

    The classic sign - visible first in the white of the eye, then in the skin as bilirubin rises further.

  • Dark urine

    Cola-coloured urine is a hallmark of conjugated hyperbilirubinaemia and biliary obstruction.

  • Pale stools

    Chalky, pale stools suggest that bile is not reaching the gut - a strong pointer to obstruction.

  • Pruritus

    Persistent itching, worse at night, is common in cholestasis and can be the most distressing symptom.

  • Fatigue and weight loss

    Non-specific but important - especially when painless and progressive alongside jaundice.

  • Hepatomegaly and splenomegaly

    An enlarged liver or spleen points to hepatic or haemolytic causes and needs specialist assessment.

  • Ascites and variceal bleeding

    Signs of decompensated liver disease - see our hepatic encephalopathy guide for the wider picture.

  • Red flag - painless jaundice

    Painless progressive jaundice in an adult needs urgent specialist assessment to rule out malignancy.

Treatment

How jaundice is treated in the UK.

Treat the underlying cause first - then relieve any biliary obstruction, control pruritus and, where needed, consider transplantation.

  • Treat the underlying cause

    Every plan starts with a diagnosis - haemolysis, hepatitis, gallstones and tumours all need different specialist pathways.

  • ERCP and biliary stenting

    For stones, strictures and tumour obstruction - endoscopic decompression is specialist commissioned and often the first step.

  • Surgical resection

    For resectable pancreatic, ampullary or hilar tumours - considered by a hepatopancreatobiliary MDT under specialist care.

  • Antivirals and immunosuppression

    For viral hepatitis and autoimmune hepatitis - see our autoimmune hepatitis guide - under specialist hepatology oversight.

  • Pruritus control

    Cholestyramine, rifampicin and naltrexone can all help itch in cholestatic jaundice - specialist-guided.

  • Liver transplantation

    For end-stage liver disease and selected acute liver failure - see our liver transplant clinic for the pathway.

  • Haematology-led care

    For haemolytic jaundice from G6PD deficiency, hereditary spherocytosis or sickle cell disease - specialist haematology input.

  • MDT and patient support

    A hepatology or HPB MDT coordinates care and the British Liver Trust supports patients throughout treatment.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or hepatologist knows your history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE. Assessment and management of cirrhosis, gallstones and jaundice in adults.

  • British Society of Gastroenterology (BSG). Guidelines on the management of abnormal liver blood tests.

  • European Association for the Study of the Liver (EASL). Clinical practice guidelines on cholestatic liver disease.

  • British Liver Trust. Patient information on jaundice and adult liver disease.

Red flags

When jaundice needs urgent attention.

Most causes are worked up over days to weeks. These are the situations that need same-day or same-week specialist care.

  • Painless progressive jaundice

    Classical for pancreatic, ampullary or hilar cholangiocarcinoma - see our pancreatic cancer and hilar cholangiocarcinoma guides. Urgent specialist referral.

  • Acute liver failure

    Rapidly rising bilirubin with encephalopathy and coagulopathy - see our fulminant liver failure guide - is a specialist-commissioned emergency.

  • Ascending cholangitis

    Fever, jaundice and right upper quadrant pain - Charcot triad - needs immediate admission, antibiotics and specialist biliary drainage.

  • Hepatic encephalopathy

    Confusion, drowsiness or asterixis in a jaundiced patient signals decompensation and needs urgent hepatology review.

  • Suspected paracetamol overdose

    Even a modest overdose can precipitate acute liver failure - a specialist toxicology and hepatology emergency.

  • Haemolytic crisis

    Sudden severe jaundice with anaemia and dark urine - especially in known G6PD deficiency or sickle cell disease - needs urgent haematology care.

  • Wilson disease in a young adult

    Unexplained hepatitis and neuropsychiatric change under 40 - a specialist-commissioned Wilson screen is essential.

  • Iron overload

    A very high ferritin with transferrin saturation raises the possibility of haemochromatosis - see our hemochromatosis guide - and needs specialist input.

  • Pregnancy-related jaundice

    HELLP syndrome, acute fatty liver of pregnancy and intrahepatic cholestasis all need immediate obstetric and hepatology assessment.

Living with it

Manageable, once the cause is clear.

Four things that make the biggest difference day to day - treating the underlying driver, cutting alcohol, controlling itch and keeping follow-up.

A quiet reminder

Yellow eyes deserve a plan, not a wait.

New jaundice in an adult is always worth investigating - the sooner the cause is clear, the sooner treatment can begin.

  1. 01 Cause

    Treat the driver

    Jaundice is a signal, not a disease - the plan follows the cause, whether that is stones, hepatitis, haemolysis or a tumour.

  2. 02 Alcohol

    Alcohol matters

    Whatever the cause, cutting or stopping alcohol reduces further liver injury and helps recovery.

  3. 03 Itch

    Treat the itch early

    Cholestatic pruritus is exhausting - cholestyramine, rifampicin or naltrexone can transform sleep and mood.

  4. 04 Follow-up

    Keep the follow-up

    Repeat LFTs, imaging and MDT review under specialist care are what catch relapse and recurrence early.

Frequently asked

Everything we get asked about jaundice.

Quick answers on the three types, split bilirubin, painless jaundice and how newborn jaundice differs.

  • What is jaundice?

    Jaundice is a yellow discolouration of the sclerae, skin and mucous membranes caused by excess bilirubin in the blood. It is a sign of an underlying problem in the red cells, the liver or the bile ducts and always deserves prompt medical assessment.

  • What are the three main causes of jaundice?

    Pre-hepatic jaundice comes from excess red cell breakdown - haemolysis. Hepatic jaundice comes from liver injury - viral hepatitis, alcohol, drugs, autoimmune hepatitis, MASH or cirrhosis. Post-hepatic jaundice comes from a blockage in the bile ducts, most often gallstones or a tumour.

  • Why do stools go pale and urine go dark?

    When the bile ducts are blocked, conjugated bilirubin cannot reach the gut, so stools lose their normal brown colour and become chalky. Bilirubin is instead excreted through the kidneys, which turns the urine dark. Together with pruritus, this pattern is a strong pointer to obstructive jaundice.

  • Is painless jaundice always serious?

    Painless, progressive jaundice in an adult is a red flag for malignancy of the pancreas, ampulla or bile ducts and needs urgent specialist assessment. Painful jaundice, especially with fever, more often points to gallstones or ascending cholangitis - also urgent, but usually a different pathway.

  • What tests are used to work out the cause?

    Split bilirubin and full LFTs, a haemolysis screen, viral and autoimmune serology, and iron, copper and alpha-1 antitrypsin studies all sit alongside imaging. Ultrasound is usually first, followed by MRCP, CT or ERCP where indicated - all specialist commissioned.

  • Is neonatal jaundice the same condition?

    No - jaundice in newborns has its own physiology, causes and pathway. It is common, often physiological and usually resolves with phototherapy, but it needs specific assessment. See our separate infant jaundice guide for the full picture.

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