Types of Jaundice
1. Pre-Hepatic (Haemolytic) Jaundice
Caused by excessive breakdown of red blood cells (haemolysis), producing more bilirubin
than the liver can process. The liver itself is typically healthy.
Common causes:
- Sickle cell anaemia
- Thalassemia
- Autoimmune haemolytic anaemia
- Malaria
2. Hepatic (Liver) Jaundice
The most common type seen at a liver specialist clinic — caused by damage or disease
within the liver itself that impairs its ability to process bilirubin.
Common causes:
- Acute viral hepatitis (Hepatitis A, B, C, D,
E)
- Alcoholic hepatitis
- Non-alcoholic steatohepatitis (NASH)
- Drug-induced liver injury (DILI) — paracetamol
overdose, anti-tuberculosis drugs, herbal remedies
- Autoimmune hepatitis
- Liver cirrhosis from any cause
- Acute liver failure
3. Post-Hepatic (Obstructive) Jaundice
Caused by blockage of the bile ducts outside the liver, preventing bile — and the
bilirubin it contains — from draining into the intestine. This is a serious cause that
often requires procedural or surgical intervention.
Common causes:
- Gallstones (choledocholithiasis) — stones
blocking the common bile duct
- Pancreatic cancer — tumour compressing the
bile duct
- Cholangiocarcinoma (bile duct cancer)
- Strictures (narrowing) of the bile duct
- Pancreatic head tumours and periampullary
cancers
4. Neonatal Jaundice
Extremely common in newborns, typically due to the immature liver's inability to process
bilirubin rapidly enough. Most cases resolve without treatment. However, persistent or
severe neonatal jaundice — particularly with pale stools — requires urgent paediatric
liver evaluation to rule out biliary atresia.
Symptoms Associated With Jaundice
The yellow discolouration itself is the defining feature of jaundice, but accompanying
symptoms provide important clues about the underlying cause:
Symptoms Suggesting Liver Cause
- Fatigue and weakness
- Nausea and loss of appetite
- Fever — suggests acute hepatitis
- Tender liver (on examination)
- Dark urine, pale stools
- Recent alcohol use or medication
changes
- History of hepatitis exposure
Symptoms Suggesting Bile Duct Blockage
- Very dark urine (tea or cola-coloured)
- Pale or clay-coloured stools
- Severe itching (pruritus) — bile salts in
skin
- Pain in upper right or upper middle
abdomen
- Fever with chills (Charcot's triad — suggests
cholangitis)
- Recent onset with no prior liver
disease
- Weight loss (if cancer is the cause)
When to Seek Urgent Care:
If jaundice is accompanied by high fever, severe abdominal pain, confusion, or signs of
bleeding, seek emergency specialist care immediately. These can indicate acute liver
failure or ascending cholangitis — both potentially life-threatening.
How We Diagnose the Cause of Jaundice
Identifying the precise cause of jaundice is essential — because the treatment is
entirely determined by the underlying diagnosis. Our systematic diagnostic approach
leaves nothing to chance.
Blood Tests
- Total and direct bilirubin
levels — distinguishes between types of jaundice
- Liver function tests (ALT,
AST, ALP, GGT, albumin, INR)
- Full blood count — detects
haemolysis or infection
- Viral hepatitis panel
(Hepatitis A, B, C, D, E antibodies and antigens)
- Autoimmune markers (ANA,
ASMA, AMA) if autoimmune hepatitis is suspected
Imaging
- Ultrasound abdomen —
first-line imaging; detects dilated bile ducts, gallstones, liver texture
changes
- MRCP (Magnetic Resonance
Cholangiopancreatography) — gold standard for visualising bile duct
anatomy without invasive procedures
- CT scan — useful for
detecting tumours, lymph nodes, and liver lesions
- ERCP (Endoscopic Retrograde
Cholangiopancreatography) — used both for diagnosis and treatment
of bile duct obstructions
Additional Tests When Needed
- FibroScan — assesses degree
of liver fibrosis
- Liver biopsy — when a tissue
diagnosis is required
- Tumour markers (CA 19-9, CEA,
AFP) — when cancer is suspected
Treatment for Jaundice — By Cause
Viral Hepatitis
Acute viral hepatitis (especially A and E) is usually self-limiting and
managed with supportive care: rest, hydration, and avoidance of alcohol and liver-toxic
drugs. Chronic Hepatitis B and C require antiviral therapies — see our
hepatitis treatment page for details.
Alcoholic Hepatitis
Total alcohol abstinence is the most important. Treatment can include
corticosteroids, nutritional supplements, and monitoring, depending on severity (Maddrey
or MELD score). Severe cases with liver failure require transplant evaluation.
Drug-Induced Liver Injury (DILI)
Immediate withdrawal of the offending medication is essential. Recovery
is typical within weeks. Anti-tuberculosis drug-induced jaundice is
common in India and needs specialized care.
Obstructive Jaundice — Bile Duct Blockage
- Gallstones: ERCP for stone removal, and laparoscopic
cholecystectomy to prevent recurrence.
- Bile duct strictures: Endoscopic dilation and stenting, or surgical
reconstruction (hepaticojejunostomy).
- Pancreatic or bile duct cancer: Surgical removal if feasible
(Whipple or other), or palliative stenting if not.
Cirrhosis-Related Jaundice
Jaundice due to cirrhosis means worsening liver function. Management includes
controlling fluid buildup (ascites), preventing/treating variceal bleeding and
encephalopathy, and considering transplant evaluation for eligible patients.
Acute Liver Failure
Acute liver failure with jaundice is a medical emergency — requiring immediate hospital
admission to a specialized Liver ICU. Supportive care is provided while the cause is
treated; emergency transplantation may be life-saving.
