What is Jaundice Jaundice refers to yellowish discolouration of the skin and eyes. It occurs when the bilirubin levels in the blood increase. One of the main functions of the liver is to get rid of toxins whether ingested with or without our knowledge. They also get rid of waste products produced by the body. Bilirubin is one such product. What is Bilirubin Red blood cells (RBC) have a life span of around 120 days. Throughout life they are continuously replaced. During the recycling process the old and damaged RBCs are broken down and bilirubin is an end product. The bilirubin thus formed is carried in the bloodstream to the liver where it mixes with bile in a process called conjugation. This conjugated bilirubin is transported with the bile to the gut where it is degraded further and eliminated in the stools. A small amount is also excreted in the urine. Normally the level of bilirubin in the blood is about 1.2 milligrams per deciliter (mg/dL) for adults and about 1 mg/dL for children. When the level in the blood rises to about 3 mg/dL the skin and eyes (conjunctiva) become yellow and jaundice results. Significance of Jaundice: If your bilirubin levels are higher than normal, it’s a sign that either significantly larger number of red blood cells are breaking down or that your liver isn’t functioning properly to clear the bilirubin from your blood. Another reason could be that the excretory pathway from the liver is being blocked so no bilirubin is conjugated or is transported by bile to the gut. Types of Jaundice: • Hemolytic jaundice • Hepatocellular jaundice • Obstructive or post-hepatic jaundice Hemolytic jaundice When there is excessive destruction of RBCs haemolytic jaundice results. This can happen in Sickle cell anaemia, Thalassemia and certain drugs that can cause destruction of red blood cells. Hepatocellular jaundice In hepatocellular jaundice, the liver cells are affected hence conjugation of bilirubin is impaired. The liver cells may be affected in: • Viral infections (Hepatitis A B and C) • Alcohol abuse • Cirrhosis of liver • Autoimmune liver disease • Gilbert syndrome • Drugs eg acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs) • Mushroom poisoning Obstructive (Cholestatic) jaundice In obstructive jaundice, the transport of bilirubin to the intestines is affected due to a blockage of the bile ducts. If blockage is within the liver it is termed intrahepatic cholestasis. If outside (bile duct) it is termed extrahepatic