Go to an emergency department at once if jaundice comes with:
- Fever with chills and tummy pain — this can be an infected, blocked bile duct (cholangitis)
- Confusion, unusual sleepiness, a change in behaviour or reversal of the sleep pattern
- Vomiting blood, black stools or any other bleeding, or a rash of bruises
- Severe persistent vomiting, severe tummy pain, or very little urine
- Pregnancy — hepatitis E in particular can be severe in pregnant women
Jaundice in a person who was well a few days ago, with any of these, can be sudden liver failure, which needs hospital care and sometimes transfer to a liver centre.
What is jaundice?
Jaundice means the yellow pigment bilirubin has built up in the blood. Bilirubin comes from old red blood cells; the liver processes it and sends it out through the bile ducts into the intestine. A problem before the liver, in the liver, or after the liver (a blocked bile duct) can cause it. It becomes visible when the level is roughly three times normal.
- Yellow whites of the eyes are the first and most reliable sign. Yellow skin with white eyes is usually from carotene (carrots, papaya, pumpkin), not jaundice.
- Dark, tea-coloured urine and pale, clay-coloured stools suggest the bile is not reaching the gut.
- Itching all over, without a rash, suggests bile blockage.
Where is the problem? Three patterns
| Pattern | Typical clues | Common causes |
|---|---|---|
| Before the liver (too much bilirubin made) | Mild yellow eyes, normal urine colour, often anaemia; other liver tests normal | Breakdown of red cells (haemolysis); Gilbert syndrome — a harmless, common condition |
| In the liver (hepatocellular) | Fever, nausea and loss of appetite first, then dark urine; SGPT/SGOT (ALT/AST) very high, often in the hundreds or thousands | Hepatitis A and E (contaminated water and food — common in monsoon months), hepatitis B and C, alcohol, drugs and herbal remedies, autoimmune disease, Wilson disease in the young, advanced cirrhosis, and tropical infections such as malaria, leptospirosis, dengue and typhoid |
| After the liver (blocked bile duct) | Pale stools, itching, dark urine; alkaline phosphatase and GGT high; the bile ducts look widened on ultrasound | Stones in the bile duct, growths in the pancreas, bile duct or gallbladder, narrowing after surgery, and chronic pancreatitis |
Many people have more than one problem — for example, a person with cirrhosis can also develop a bile duct stone. After the flood season, jaundice with fever and kidney problems should also prompt a test for leptospirosis.
Painless jaundice in an adult needs prompt evaluation. Gallstones in the bile duct and hepatitis are common causes, but growths of the pancreas, bile duct and gallbladder often present as jaundice without pain. Time matters for these — do not wait for "a few weeks to see if it goes".
How the cause is found
- History and examination: how it started, fever, pain, itching, alcohol, medicines (including painkillers, anti-TB drugs, herbal and traditional remedies), contaminated food or water, travel, and family history.
- Blood tests: bilirubin (total and direct), SGPT/SGOT, alkaline phosphatase, GGT, albumin, INR (shows how well the liver is working), blood count; and, depending on the pattern, hepatitis A and E IgM, hepatitis B and C tests, and malaria or other infection tests.
- Ultrasound of the tummy — the first scan. It shows whether the bile ducts are widened, gallstones, and liver appearance.
- MRCP or endoscopic ultrasound (EUS) if a blockage is suspected — they show the level and cause of the blockage without treatment. EUS can also take a needle sample from a mass.
- CT or MRI if a growth is suspected, to assess its size and spread.
The tumour marker CA 19-9 can be raised by a blocked duct or infection alone, so it is not a stand-alone test for cancer. ERCP is a treatment, not a first test — it is done when a blockage has been found and there is something to treat, such as a stone to remove or a stent to place.
Treatment depends on the cause
| Cause | What is done |
|---|---|
| Hepatitis A or E | Most people recover fully in 2–6 weeks with rest, fluids and a normal balanced diet. There is no specific medicine. Hospital care if there is persistent vomiting, drowsiness, a high INR, or if you are pregnant. |
| Hepatitis B or C | Acute infection is mostly supportive. Chronic hepatitis B needs long-term tablets; hepatitis C can be cured in most people. See liver disease. |
| Drug-induced | The medicine is stopped under medical advice. Do not stop anti-TB medicines on your own — the TB doctor will pause and reintroduce them in a controlled way. Avoid herbal remedies. |
| Alcohol-related hepatitis | Complete alcohol abstinence, nutrition support; selected severe cases are treated with steroids in hospital. |
| Bile duct stones | Removal by ERCP; infected duct is drained urgently. The gallbladder is usually removed afterwards to prevent more stones. |
| Growth blocking the bile duct | Scans and, if needed, an EUS needle biopsy to plan treatment. A stent relieves jaundice and itching. If surgery is planned soon, a stent is not always needed first — the decision is made with the surgeon and oncologist. |
| Gilbert syndrome | No treatment. Mild yellow eyes can appear during fasting, illness or stress. No liver damage results. |
| Itching from bile blockage | Treating the blockage is best. Medicines can ease itching while waiting. |
While you are jaundiced
- Eat normally. Small, frequent, home-cooked meals are enough. A strict fat-free or "no oil, no turmeric" diet is not needed and can cause weakness.
- No alcohol at all until your liver tests are normal.
- Do not self-medicate. Avoid all unnecessary medicines, including paracetamol and other painkillers, while you have jaundice or suspected hepatitis — take only what your doctor advises.
- Do not rely on herbal or traditional remedies for jaundice. They cannot clear a blockage or treat cancer, and some cause liver injury. Delay can cost the time that matters.
- Prevent spread of hepatitis A and E: boiled or filtered water, hand-washing, freshly cooked food. Hepatitis A and B vaccines are available.
Yellow eyes, or abnormal liver tests?
Send your ultrasound, liver function tests and any scan reports on WhatsApp before your visit. Consultations at Hayat Hospital and Apollo Clinic, Ulubari, and at outreach OPDs in Dimapur, Hojai, Tinsukia and Dibrugarh. If you have fever with jaundice, confusion or bleeding, go to an emergency department instead.
When ERCP or EUS is needed
Most jaundice from hepatitis needs neither. A scope is needed when a blockage has been found: ERCP to remove stones, drain an infected duct or place a stent; EUS to see a mass closely, take a biopsy, or check for a small stone that other scans missed. Read more about ERCP and EUS.
Common questions
Is jaundice a disease?
How long does jaundice from hepatitis A or E last?
Is painless jaundice a sign of cancer?
Do I need an ERCP for jaundice?
Can I eat normally with jaundice?
Is jaundice contagious?
My eyes turn yellow when I fast or am unwell, but tests are otherwise normal. Is that serious?
Can traditional or herbal remedies cure jaundice?
What if I am pregnant and have jaundice?
Related
Written and medically reviewed by Dr. Mayank Agarwal, MBBS, MD (Medicine), DM (Gastroenterology) · Assam Medical Council Reg. No. 19633 · Last reviewed:
This page gives general information about jaundice in adults and older children. It does not replace urgent medical care or a consultation — the cause and treatment depend on your own tests. Jaundice in a newborn baby needs a paediatrician and is not covered here. Please do not start or stop any medicine without advice.
Based on:
- Fargo MV, Grogan SP, Saguil A. Evaluation of jaundice in adults. Am Fam Physician 2017;95:164–168.
- Buxbaum JL, et al. ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis. Gastrointest Endosc 2019;89:1075–1105. PMID 30979521.
- Dumonceau JM, et al. Endoscopic biliary stenting: indications, choice of stents, and results — ESGE Clinical Guideline, updated October 2017. Endoscopy 2018;50:910–930.
- Wendon J, et al. EASL Clinical Practical Guidelines on the management of acute (fulminant) liver failure. J Hepatol 2017;66:1047–1081.
- European Association for the Study of the Liver. EASL Clinical Practice Guidelines on hepatitis E virus infection. J Hepatol 2018;68:1256–1271.
- Chalasani NP, et al. ACG Clinical Guideline: Diagnosis and management of idiosyncratic drug-induced liver injury. Am J Gastroenterol 2021;116:878–898.