Jaundice (yellowing of skin and eyes): causes and when it is urgent

Bilirubin is a yellow pigment made when old red blood cells are broken down. The liver processes it and sends it into bile, which flows through the bile ducts into the bowel. The NHS says you may get jaundice if bilirubin builds up in your body, and that there are many possible reasons, some of them serious.

Doctors think about three broad mechanisms. Before the liver, too many red cells are breaking down, as in some blood conditions such as sickle cell disease, which the NHS lists. Within the liver, damage prevents it processing bilirubin, as in hepatitis or alcohol-related liver disease. After the liver, a blockage in the bile ducts, such as a gallstone or a tumour, prevents bile draining, which is why pale stools and dark urine are such common companions.

The skin looks yellow, and the white part of the eyes does too. The NHS notes that yellowing of the skin may be less noticeable if you have brown or black skin, but the white part of the eyes will still look yellow. Check in natural daylight, because artificial light can mislead. Yellowing of the palms alone can result from eating large amounts of carotene-rich foods, but this spares the eyes.

Itchy skin, darker pee and paler poo than usual may accompany jaundice, according to the NHS. Newborn jaundice is a separate and usually harmless topic covered by the NHS in its own page and is not discussed here.

Many people with jaundice turn out to have gallstones, a viral hepatitis or alcohol-related damage, but the NHS stresses that some causes are serious and the cause cannot be judged by looking. Medicines, including some antibiotics, and herbal remedies can also injure the liver.

• Ask for an urgent GP appointment or get help from NHS 111 if your skin or the white part of your eyes look yellow; the NHS gives this advice for jaundice alone.

• Call 999 or go to A&E if jaundice comes with sudden severe tummy pain, or pain spreading from the tummy to the back with vomiting, as the NHS gallstones page advises.

• Call 999 or go to A&E if jaundice comes with a very high temperature, or feeling hot, cold or shivery, which can indicate infection of the bile ducts.

• Call 999 or go to A&E if you vomit blood, or have very dark or black stool, both of which the NHS lists as signs of advanced cirrhosis and as emergency symptoms elsewhere.

• Seek emergency help for new confusion, slurred speech or marked drowsiness alongside jaundice, which can signal that the liver is failing.

• Ask for an urgent GP appointment for jaundice with weight loss, loss of appetite or tiredness, which the NHS lists with pancreatic cancer symptoms.

Questions cover how quickly the colour changed, pain, itching, urine and stool colour, fever, weight loss, alcohol intake, medicines and supplements, travel, injecting drug use, tattoos, sexual history, family history of liver disease and any known gallstones. The examination looks at eyes, skin, scratch marks, the tummy for tenderness, a swollen liver or fluid, spider-like blood vessels and blotchy red palms, which the NHS lists among early cirrhosis signs.

The NHS pancreatic cancer page notes that a GP may feel your tummy and arrange a urine sample or blood test, and may arrange urgent referral if cancer could be the cause, which does not mean cancer is certain.

Blood tests usually include liver function tests with bilirubin, a full blood count and a clotting test, and tests for hepatitis viruses where appropriate. An ultrasound scan of the liver and bile ducts is the usual first imaging test; the NHS names ultrasound for gallstones. A CT or MRI scan may follow, and a specialist may use ERCP, a camera procedure that the NHS describes for clearing stones from the common bile duct.

Treatment depends on the cause. For gallstones the NHS describes pain relief and surgery to remove the gallbladder, with ERCP for stones in the bile duct. For cirrhosis it says treatment and lifestyle changes can help stop it getting worse. For infections, alcohol-related disease and medicine-related injury, treatment focuses on removing the cause and supporting the liver.