Jaundice in Adults: Causes and When It Is Urgent

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Jaundice in adults is a yellow color of the skin, the whites of the eyes, or the inside of the mouth, caused by a buildup of bilirubin in the blood. It is not a disease on its own. It is a sign that something is affecting the liver, the bile ducts, the pancreas, or the blood, and new jaundice always deserves prompt medical evaluation. This page is for adults in Arlington, Annandale, and the rest of Northern Virginia who have noticed yellowing in themselves or a family member, or who were told a blood test showed a high bilirubin, and want to understand what it can mean and how quickly to act.

This article is general education, not medical advice. If you have jaundice with fever, chills, confusion, severe abdominal pain, or vomiting blood, go to an emergency department or call 911 rather than waiting for an office visit.

What jaundice in adults is

Bilirubin is a yellow substance made when the body breaks down old red blood cells. MedlinePlus, the National Library of Medicine's health site, explains the normal path: the liver and spleen remove old red blood cells, the liver processes the bilirubin, and it leaves the body through bile and stool. Jaundice appears when that path is disrupted in one of three ways:

• Too much bilirubin is made, because red blood cells are breaking down faster than usual.
• The liver cannot process it, because the liver is inflamed, damaged, or overloaded.
• Bile cannot drain from the liver into the intestine, usually because a bile duct is blocked or narrowed.

MedlinePlus notes that jaundice is often a sign of a problem with the liver, gallbladder, or pancreas. Many healthy newborns have some jaundice in their first week, but jaundice in adults is not expected and should not be watched at home to see whether it fades.

Signs of jaundice in adults

MedlinePlus lists the symptoms that commonly come with jaundice:

• Yellow skin and yellow whites of the eyes, which can look brownish when jaundice is more severe
• A yellow color inside the mouth
• Dark or brown, tea-colored urine
• Pale or clay-colored stools
• Itching, which often accompanies jaundice

Jaundice may appear suddenly or come on slowly. Yellowing is often easiest to see in the whites of the eyes in natural daylight. Dark urine and pale stools together point toward bile that is not reaching the intestine, which is a detail worth reporting.

Yellow skin that is not jaundice

Not every yellow tint is jaundice. MedlinePlus explains that if the skin is yellow but the whites of the eyes are not, it may not be jaundice: eating a lot of beta carotene, the orange pigment in carrots, can turn the skin yellow to orange. That harmless color change does not affect the eyes. Only a clinician and a bilirubin blood test can sort out which is which, so it is still worth asking.

Common causes of jaundice in adults

The American College of Radiology's appropriateness criteria for jaundice state that in the United States, the most common causes of all types of jaundice fall into four groups: hepatitis, alcohol-associated liver disease, blockage of the common bile duct by a gallstone or a tumor, and a toxic reaction to a drug or medicinal herb. A longer list from MedlinePlus adds blood disorders, inherited conditions, cirrhosis, cancer of the pancreas, and a form of jaundice that develops in pregnancy.

Doctors often sort these causes by where the problem sits, because that shapes the next test.

Before the liver: too much bilirubin

When red blood cells break down faster than normal, a process called hemolysis, the liver receives more bilirubin than it can keep up with. The American College of Gastroenterology (ACG) guideline on evaluating abnormal liver chemistries notes that hemolysis infrequently pushes bilirubin above 5 mg/dL unless kidney disease, liver disease, or severe sudden hemolysis is also present. A blood count, reticulocyte count, and related tests help show whether this is happening.

Gilbert syndrome: mild and usually harmless

The most common cause of a high unconjugated (indirect) bilirubin, according to the ACG, is Gilbert syndrome, an inherited difference in how the liver processes bilirubin that affects 3 to 7 percent of the US population. Total bilirubin almost never exceeds 6 mg/dL and is usually below 3. Fasting or a significant illness can raise it two- to threefold, which is why some people notice faint yellowing of the eyes during a cold, a stomach bug, or a long fast.

The ACG says that in a healthy person without symptoms who has mildly high indirect bilirubin, a clinician should rule out medicines that raise bilirubin and evidence of hemolysis and confirm the other liver tests are normal. If all of that checks out, a presumptive diagnosis of Gilbert syndrome can be made and further testing is not routinely needed. Our elevated liver enzymes page covers that lab pattern in more detail.

In the liver: hepatitis, alcohol, medicines, and chronic disease

When the liver itself is inflamed or damaged, it cannot process bilirubin normally. Causes include:

• Viral hepatitis. MedlinePlus names viral hepatitis as the most common infectious cause. The ACG notes that hepatitis A and E cause acute hepatitis, often with nausea, vomiting, fever, and loss of appetite. Hepatitis B and C are covered on our chronic hepatitis B and C page.
• Alcohol-associated hepatitis. New or worsening jaundice in someone who drinks heavily is the hallmark of this serious condition, described on our alcohol-associated liver disease page.
• Medicines and supplements. MedlinePlus lists an overdose of acetaminophen and reactions to other medicines among the causes. See the next section.
• Autoimmune liver disease. Autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis can all cause jaundice; our autoimmune liver disease page explains each.
• Cirrhosis. In advanced scarring of the liver, jaundice can be a sign the liver is struggling. Our cirrhosis page covers what that means.

After the liver: a blocked bile duct

Bile leaves the liver through the bile ducts and empties into the small intestine near the pancreas. If a duct is blocked, bile backs up into the blood. The ACG guideline explains that a high conjugated (direct) bilirubin generally points to liver disease or a bile duct blockage. Common reasons for a blocked duct include:

• A gallstone that has moved out of the gallbladder into the main bile duct. Our gallstones page covers this complication.
• A narrowing of the duct, from inflammation, prior surgery, or primary sclerosing cholangitis.
• A tumor of the pancreas, bile duct, or the area where they meet the intestine.
• Pancreatitis, which can swell the head of the pancreas around the duct. See our pancreatitis page.

Painless jaundice in adults should never be brushed off

Jaundice from a passing gallstone often comes with pain. Jaundice without pain can feel less alarming, but it is one of the patterns gastroenterologists take most seriously, because a slowly growing tumor that presses on the bile duct may cause no pain at first.

The National Cancer Institute explains that pancreatic cancer does not have early signs or symptoms, which makes it very hard to find early. As it grows, the signs it lists include jaundice (yellowing of the skin and eyes, light-colored stools, dark urine, and itching), pain in the upper or middle abdomen and back, weight loss for no known reason, loss of appetite, and fatigue. NCI also notes that new-onset diabetes in someone with no risk factors for it can sometimes be an early sign.

Most people with jaundice do not have cancer, and NCI itself says these symptoms can have less serious causes. The point is timing. Painless jaundice, especially with weight loss, itching, pale stools, or dark urine, should be evaluated within days, not monitored for weeks. If that is your situation, call a physician today, and see our page on unexplained weight loss for the related warning signs.

When jaundice in adults is an emergency

Some patterns of jaundice need same-day or emergency care.

Jaundice with fever and abdominal pain

Fever, pain in the upper right abdomen, and jaundice together are the classic picture of acute cholangitis, a bacterial infection of a blocked bile duct. A 2024 review of acute cholangitis calls it a potentially life-threatening infection associated with mortality rates of up to 15 percent, and notes that this three-symptom pattern, known as Charcot's triad, is not always complete: studies have found only moderate sensitivity, so cholangitis can be present even if one of the three is missing. The American Society for Gastrointestinal Endoscopy (ASGE) describes cholangitis as a GI emergency requiring prompt recognition and treatment, and its 2021 guideline suggests relieving the blockage within 48 hours.

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) gives the same message for gallstones: see a doctor right away for pain lasting several hours, nausea and vomiting, fever (even low-grade) or chills, yellowing of the skin or eyes, and tea-colored urine with light-colored stools, since these can signal a serious infection or inflammation. Chills, confusion, or feeling faint with jaundice are reasons to go to an emergency department.

Jaundice with confusion or easy bleeding

The ACG guideline defines acute liver failure as rapid liver injury with severe loss of liver function, shown by a prolonged clotting time and a change in mental state (hepatic encephalopathy), in someone without known prior liver disease. It says signs of acute liver failure call for immediate hepatology consultation and referral to a liver transplant center. New confusion, unusual sleepiness, or easy bruising or bleeding alongside jaundice belong in the emergency department.

Jaundice after starting a new medicine or supplement

The ACG guideline on drug-induced liver injury names antibiotics and other antimicrobials, herbal and dietary supplements, and some cancer treatments as the most common culprits in the Western world. It states that drug-induced liver injury carries a mortality rate of up to 10 percent when jaundice is present with liver cell injury, and that people whose jaundice keeps worsening should be referred to a specialized center. If jaundice starts after a new prescription, an over-the-counter product, or a supplement, call the prescriber or a physician promptly. Do not stop a prescribed medicine on your own unless a clinician tells you to, but bring every product you take, including teas and powders, to the visit.

How doctors evaluate jaundice in adults

The first steps are a history, an exam, and blood work. The ACG guideline recommends that the doctor take a careful history of medicines, supplements, and alcohol, and, in someone with jaundice and abdominal pain, ask about prior gallstones and inflammatory bowel disease.

Blood tests

MedlinePlus lists the usual tests: a bilirubin level, liver tests, a hepatitis virus panel, a complete blood count, and a prothrombin time (a measure of clotting). The ACG says an elevated total bilirubin should be split into its direct and indirect fractions, because the split tells the doctor where to look next:

• Mostly indirect (unconjugated): points toward hemolysis, Gilbert syndrome, or a medicine effect.
• Mostly direct (conjugated): points toward liver disease or a blocked bile duct, and leads to imaging.

Imaging

The ACG says a right upper quadrant ultrasound should be done in people with elevated direct bilirubin and alkaline phosphatase to look for widened bile ducts, a sign of blockage further down. NCI likewise describes an abdominal ultrasound or CT scan as the usual first imaging step when pancreatic cancer is a concern. If the cause is still unclear, the next tests can include:

• MRCP (magnetic resonance cholangiopancreatography), an MRI that maps the bile and pancreatic ducts without a scope
• CT of the abdomen
• Endoscopic ultrasound (EUS), which uses a scope with an ultrasound tip to look closely at the pancreas and bile duct; see our endoscopic ultrasound page
• ERCP, a scope procedure that can both image the ducts and open a blockage with a stent or stone removal; see our ERCP page

The ACG notes that some duct diseases, such as primary sclerosing cholangitis, may not show on ultrasound and need MRCP or ERCP to see. A liver biopsy may sometimes be needed to confirm a diagnosis. Which tests make sense, and where they are done, depends on the person and is a decision for the treating physicians.

Jaundice in pregnancy

The ACG notes that a pregnancy test is part of the workup for women of childbearing age with a cholestatic pattern, because a condition called intrahepatic cholestasis of pregnancy can cause itching and liver test changes. Anyone who is pregnant and develops itching or yellowing should contact their obstetric clinician promptly.

Treatment of jaundice in adults depends on the cause

There is no single treatment for jaundice, because jaundice is a sign rather than a diagnosis. MedlinePlus says simply that treatment depends on the cause. In broad terms:

• Gilbert syndrome, once confirmed, usually needs no treatment.
• Hepatitis, autoimmune disease, and alcohol-associated hepatitis are treated according to the specific diagnosis, which our condition pages describe.
• A suspected medicine reaction is managed by the prescribing clinician and a specialist, who decide whether to stop the medicine.
• A blocked bile duct is usually relieved with a procedure such as ERCP, followed by treatment of what caused the blockage.

Yellowing can take time to fade even after the cause is treated. The ACG explains that one form of bilirubin binds to the blood protein albumin, which lasts about three weeks in the bloodstream, and this is why jaundice can linger for a while during recovery from hepatitis or a relieved blockage.

Jaundice in adults in Northern Virginia: when to see a gastroenterologist

Outside the emergency situations above, jaundice in adults is still a reason to be seen soon, typically by a primary care physician first and then a gastroenterologist or hepatologist. A gastroenterologist is especially useful when:

• Bilirubin is high on a blood test and the cause is not yet clear
• Jaundice comes with itching, pale stools, dark urine, or weight loss
• Imaging shows widened bile ducts, a mass, or a pancreatic cyst; see our pages on pancreatic cysts and liver lesions
• There is a known liver condition such as fatty liver disease, hepatitis, or hemochromatosis, and jaundice is new
• A mildly high bilirubin keeps showing up and you want to know whether it is Gilbert syndrome

Evaluation for jaundice in Northern Virginia with GC of NoVA

Gastroenterology Center of Northern Virginia sees adults across Arlington, Annandale, and the surrounding communities for liver and bile duct concerns, including jaundice and abnormal bilirubin results. Our five gastroenterologists can review your blood work and imaging, look at your medicines and supplements, order the tests that fit your situation, and coordinate with your primary care physician and any other specialists involved. Our page on your first gastroenterologist visit explains what to bring; prior lab results and a complete list of medicines, supplements, and herbal products are the most helpful items for jaundice.

We see patients at our Arlington office at 1715 N George Mason Drive, adjacent to VHC Health, and our Annandale office at 3299 Woodburn Road in the Woodburn Medical complex. To schedule a visit for new jaundice or a high bilirubin, call Arlington at (703) 522-7476 or Annandale at (703) 560-6106, or learn more at gcofnova.com. If you have jaundice with fever, confusion, or severe pain, go to an emergency department instead.

This article is for general education and is not medical advice. Talk with a qualified gastroenterologist about your symptoms, diagnosis, and treatment options.