What are the different types of jaundice?

Jaundice happens when too much bilirubin builds up in your blood. This makes your skin and the whites of your eyes look strikingly yellowish.

Bilirubin is a yellowish pigment created as hemoglobin — a component of red blood cells — is broken down.

Normally, bilirubin is delivered from the bloodstream into your liver. Then, it passes through tubes called bile ducts. These ducts carry a substance called bile into your small intestine. Eventually, bilirubin is passed out of your body through urine or stool.

Types of jaundice are categorized by where they happen within the liver’s process of taking in and filtering out bilirubin:

  • pre-hepatic: before the liver
  • hepatic: in the liver
  • post-hepatic: after the liver

Pre-hepatic jaundice is caused by conditions that heighten your blood’s rate of hemolysis. This is the process through which red blood cells are broken down, releasing hemoglobin and converting into bilirubin.

Because the liver can only process so much bilirubin at once, bilirubin overflows into bodily tissues.

The most common causes of pre-hepatic jaundice are:

  • malaria, a blood infection caused by a parasite
  • sickle cell anemia, a genetic condition in which red blood cells become crescent-shaped rather than the typical disc shape
  • spherocytosis, a genetic condition of the red blood cell membrane that causes them to be sphere-shaped rather than disc-shaped
  • thalassemia, a genetic condition that causes your body to make an irregular type of hemoglobin that limits the number of healthy red blood cells in your bloodstream

Common symptoms of pre-hepatic jaundice include:

  • abdominal pain
  • fever, including chills or cold sweats
  • abnormal weight loss
  • feeling itchy
  • dark urine or pale stool

Some risk factors for this type of jaundice include:

  • drug use
  • having a family member with a blood disorder
  • traveling to malaria-endemic regions

To diagnose pre-hepatic jaundice, your doctor will likely order the following tests:

Your doctor will likely diagnose you with pre-hepatic jaundice if there aren’t any issues with bilirubin being processed by your liver or within the gallbladder and biliary ducts.

Treatment for pre-hepatic jaundice may include:

For malaria:

  • medications to help destroy the parasite and prevent parasites from reinfecting your liver again

For sickle cell anemia:

  • blood transfusions from a healthy donor
  • rehydrating with intravenous (IV) fluid
  • medications for any infections that can cause a sickle cell crisis

For spherocytosis:

  • folic acid supplements
  • blood transfusions for anemia
  • spleen removal surgery to help increase red blood cell life and lower the chance of gallstones

For thalassemia:

  • blood transfusions
  • bone marrow transplants
  • spleen or gallbladder removal surgery

Hepatic jaundice happens when your liver tissue is scarred (known as cirrhosis), damaged, or dysfunctional. This makes it less effective at filtering out bilirubin from your blood.

Since it can’t be filtered into your digestive system for removal, bilirubin builds up to high levels in your blood.

The most common causes of hepatic jaundice are:

  • liver cirrhosis, which means that liver tissues are scarred by long-term exposure to infections or toxic substances, such as high levels of alcohol
  • viral hepatitis, an inflammation of the liver caused by one of several viruses that can get into your body through infected food, water, blood, stool, or sexual contact
  • primary biliary cirrhosis, which happens when bile ducts are damaged and can’t process bile, causing it to build up in your liver and damage liver tissue
  • alcoholic hepatitis, in which your liver tissues are scarred by the heavy, long-term drinking of alcohol
  • leptospirosis, is a bacterial infection that can be spread by infected animals or infected animal urine or feces
  • liver cancer, in which cancerous cells develop and multiply within liver tissues

Common symptoms of hepatic jaundice include:

  • loss of appetite
  • bloody nose
  • skin itching
  • weakness
  • abnormal weight loss
  • swelling of your abdomen or legs
  • dark urine or pale stool
  • pain in your muscles or joints
  • darkening skin
  • fever
  • feeling sick
  • throwing up

Some risk factors for this type of jaundice include:

  • drug use
  • drinking a lot of alcohol over a long period of time
  • use of medications that can cause liver damage, such as acetaminophen or certain heart medications
  • previous infections that affected your liver

To diagnose hepatic jaundice, your doctor will likely order the following tests:

  • a urinalysis to measure levels of substances in your urine related to your liver function
  • blood tests, such as a complete blood count (CBC) and antibody tests, or liver function tests to measure bilirubin in the blood and levels of substances that indicate that your liver may not be processing bilirubin properly
  • imaging tests, such as an MRI or ultrasound, to examine your liver for damage or for the presence of cancerous cells
  • an endoscopy, which involves inserting a thin, lighted tube into a small incision to look at your liver and take a tissue sample (biopsy) if necessary for analysis for cancer or other conditions

Your doctor will likely diagnose you with hepatic jaundice if they notice liver tissue damage on an imaging test result or see abnormal levels of certain liver substances, such as albumin, or antibodies for infections or cancer.

Treatment for hepatic jaundice can include:

For liver cirrhosis:

For viral hepatitis:

  • antiviral medications
  • hepatitis vaccination
  • plenty of rest and fluids

For primary biliary cirrhosis:

  • bile acids to help with digestion
  • bile-lowering medication
  • antihistamines like diphenhydramine (Benadryl) for itching

For alcoholic hepatitis:

  • quitting alcohol
  • nutrition supplements
  • liver transplant, in severe cases

For leptospirosis:

  • antibiotics for infection
  • ventilator for breathing trouble
  • dialysis for kidney damage

For liver cancer:

  • chemotherapy or radiation to kill cancer cells
  • partial liver resection
  • liver transplant

Post-hepatic, or obstructive jaundice, happens when bilirubin can’t be drained properly into the bile ducts or digestive tract because of a blockage.

The most common causes of post-hepatic jaundice are:

  • gallstones, hard calcium deposits in the gallbladder that can block bile ducts
  • pancreatic cancer, the development and spread of cancer cells in the pancreas, an organ that helps produce digestive substances
  • bile duct cancer, the development and spread of cancer cells in your bile ducts
  • pancreatitis, an inflammation or infection of your pancreas
  • biliary atresia, a genetic condition in which you have narrow or missing bile ducts

Common symptoms of post-hepatic jaundice include:

  • feeling sick
  • throwing up
  • dark urine or pale stool
  • abdominal pain
  • diarrhea
  • abnormal weight loss
  • skin itching
  • abdominal swelling
  • fever

Some risk factors for this type of jaundice include:

  • being overweight
  • eating a high-fat, low-fiber diet
  • having diabetes mellitus
  • having a family history of gallstones
  • being female
  • aging
  • smoking tobacco products
  • drinking a lot of alcohol
  • having a previous pancreas inflammation or infection
  • being exposed to industrial chemicals

To diagnose post-hepatic jaundice, your doctor will likely order the following tests:

  • a urinalysis to measure levels of substances in your urine
  • blood tests, such as a complete blood count (CBC) and antibody tests for cancer, or liver function tests to rule out hepatic jaundice
  • imaging tests, such as an MRI or ultrasound, to examine your liver, gallbladder, and bile ducts for obstructions like gallstones or tumors
  • an endoscopy, which involves inserting a thin, lighted tube down the esophagus to look at your liver, gallbladder, or bile ducts and take a tissue sample if necessary for analysis for cancer or other conditions

If your doctor sees an obstruction on an imaging test result or finds levels of certain antibodies that may indicate infections or cancer, they’ll likely diagnose your jaundice as post-hepatic.

Treatment for post-hepatic jaundice will address the cause. This includes:

For gallstones:

  • changing your diet to stop producing gallstones
  • removing gallstones or your gallbladder entirely
  • taking medications or treatments to dissolve gallstones

For pancreatic cancer:

  • surgery to remove cancerous tissue or your whole pancreas
  • radiation or chemotherapy to destroy cancer cells

For bile duct cancer:

  • surgery to remove bile ducts and parts of your liver and pancreas
  • radiation or chemotherapy to destroy cancer cells
  • liver transplant

For pancreatitis:

  • rest
  • intravenous (IV) fluids or pain medication
  • surgery to remove any causes of inflammation (like gallstones)

For biliary atresia:

  • the Kasai procedure to remove and replace ducts
  • liver transplant

Neonatal jaundice is a common type of jaundice that happens to newborn babies.

Most babies are born with a lot of red blood cells, and because the liver isn’t fully developed yet, bilirubin can’t be processed quickly. As a result, your child may have jaundice symptoms a few days after they’re born.

Types of neonatal jaundice include:

  • Physiological. This happens because the liver isn’t fully formed yet.
  • Prematurity. This results from a baby being born too early and being unable to poop out bilirubin properly.
  • Breastfeeding. Breast milk jaundice occurs from a baby having trouble breastfeeding or not getting enough breast milk.
  • Incompatible blood type. This results from a baby and mother having different blood types, which can cause the mother to make antibodies that break down her baby’s red blood cells.

Neonatal jaundice isn’t usually a cause for concern. But if bilirubin builds up to extremely high levels, your child can experience brain damage (known as kernicterus) from bilirubin getting into brain tissue.

Seek emergency medical attention if you notice that your child has any of the following symptoms:

  • long periods of high-pitched crying
  • arching of their neck and back
  • fever
  • throwing up
  • having trouble feeding

Jaundice clearly means that there’s too much bilirubin in your blood, but the underlying cause can vary widely.

See your doctor right away if you notice yellowing of your skin or the whites of your eyes. Some causes can be treated with a change in your diet or lifestyle, but others may need immediate surgical or long-term treatment.