How many Types of Jaundice are There?

Jaundice is a condition where the skin, the mucous membranes and the white portion of the eyes of the patient turn yellow. Jaundice is more of a symptom of an underlying condition than a disease. Jaundice usually occurs when bilirubin is not excreted efficiently from the body.

Depending on the bilirubin metabolism, there are three different types of Jaundice. They include the following:

1. Prehepatic Jaundice: Prehepatic Jaundice occurs when the production of bilirubin is higher than the capacity of the liver to conjugate it. This leads to unconjugated hyperbilirubinemia, with a high level of conjugated bilirubin. 
2. Intrahepatic Jaundice: Intrahepatic Jaundice is also called hepatocellulaJaundicece, which occurs when hepatic cells don't function properly. In intrahepatiJaundicece, the ability to effectively filter out bilirubin is less. As a result of intrahepatiJaundicece, the levels of both unconjugated and conjugated bilirubin may increase in the blood. 
3. Post-hepatic Jaundice: Post-hepatic Jaundice usually occurs when there is an issue in bilirubin drainage into the bile ducts or the biliary system. It is otherwise also called obstructive Jaundice, which most commonly occurs due to blockage in the bile duct. In post-hepatiJaundicece, the levels of conjugated bilirubin in the blood are extremely high.

The causative reasons differ depending upon the type of jaundice. These include:

Causes of Prehepatic Jaundice

The various causes of prehepatic jaundice include the following:

1. Hemolytic anaemia 
2. Dyserythropoiesis 
3. Blood Extravasation in tissues 
4. Estrogen 
5. Gilbert syndrome 
6. Crigler–Najjar syndrome type 1 and 2 
7. Hyperthyroidism 
8. Malaria 
9. Sickle cell anaemia 
10. Thalassemia 

Causes of Intrahepatic Jaundice or hepatocellular jaundice

The various reasons that may lead to hepatocellular jaundice include the following:

1. Congenital disabilities
2. Reduced hepatic uptake of bilirubin
3. Infections caused by viruses
4. Liver cancer 
5. Alcoholic liver disease (cirrhosis) 
6. Autoimmune liver disease
7. Certain medicines
8. Gallstones
9. Intrahepatic cholestasis

Causes of Post-hepatic Jaundice

The various causes of Post hepatic jaundice include the following:

1. Biliary obstruction is caused by a stone in the bile duct (gallstones) 
2. Pancreatic cancer 
3. Gallbladder Cancer
4. Inflammation of the pancreas (pancreatitis)
5. Biliary atresia 

Depending upon the type of jaundice, the associated signs and symptoms differ. However, some of the common signs and symptoms are seen in different types of jaundice include the following:

1. A yellowish discolouration on the skin
2. Yellowish colour on the white portion of the eyes and the mucous membrane 
3. Pain in the abdomen 
4. Fever 
5. Weakness 
6. Itching 
7. Unexplained loss of weight 
8. A dark-coloured urine 
9. Pale coloured stools 
10. A sick feeling like wanting to throw up
11. Vomiting 

The healthcare provider conducts a few tests to diagnose and confirm jaundice. The various diagnostic tests include the following:

1. Physical examination 
2. Imaging tests: These include, Magnetic resonance imaging (MRI) scan, HIDA (hepatobiliary iminodiacetic acid) scan, ultrasound, and computerised tomography (CT) scan to check the liver and bile ducts, and gallbladder for cancer, blockages, stones or to see the bile flow through the liver, etc.
3. Urinalysis: It is performed to examine the urine for the presence of substances like bilirubin and measure their levels (bilirubin test)
4. Blood test includes liver function tests and a complete blood count test (CBC).
5. Endoscopy: Endoscopic retrograde cholangiopancreatography (ERCP) may also be performed to view the liver, gallbladder, and bile ducts and take samples for examination for cancer, fluid leakages, infections, blockages, or stones.

The treatment approach for jaundice is inclined more toward treating the causes of jaundice and the complications that may arise. For example, in patients with pre-hepatic jaundice, treatment is given according to the causes, like:

1. Hemolytic anaemia can be treated by providing blood transfusions, medications (like corticosteroids, immunosuppressants, and anticoagulants), spleen removal surgery or bone marrow transplantation. 
2. Malaria is treated using antimalarial medications.
3. Sickle cell anaemia treatment is focused on providing symptomatic relief and prevention of complications using medicines, blood transfusions or stem cell transplantation. 
4. Thalassemia can be treated with chelation therapy, blood transfusion and stem cell transplantation in severe cases. 
5. Hyperthyroidism can be treated using medicines like antithyroid drugs, beta-blockers, radioactive iodine or surgery. 

Similarly, in patients with hepatocellular jaundice, the treatment will be as follows:

1. Liver cancer can be treated through surgery, chemotherapy, radiation therapy, targeted drug therapy or immunotherapy. 
2. Gallstones can be removed surgically.
3. Infections caused by viruses can be treated using antiviral medications.

Whereas patients with post hepatic jaundice can be treated by providing treatment for conditions like:

1. Acute pancreatitis may require hospitalization and treatment with antibiotics, painkillers and IV fluids. Whereas, in the case of chronic pancreatitis, surgery may be performed. 
2. Liver or pancreatic cancer can be treated using surgery, radiation therapy, chemotherapy, targeted drug therapy or immunotherapy. 

There are various reasons for developing jaundice, so there is no particular preventive measure. However, some regular practices can help decrease the risk of developing jaundice. These tips include the following:

1. Getting vaccinated for Hepatitis A and B 
2. Following measures that can help in contracting hepatitis infection
3. Maintaining a healthy lifestyle by exercising regularly and eating a well-balanced, healthy diet
4. Limiting alcohol intake or getting treated in case of chronic alcohol consumption habit
5. Staying hydrated

Jaundice is a widespread problem in newborn babies and is also known as neonatal Jaundice. Jaundice in babies is usually caused due to excessive accumulation of bilirubin in the baby's blood. 

In most instances, neonatal Jaundice goes away independently and does not require any treatment. However, it is essential to get the baby checked by a healthcare provider, as Jaundice can become a severe problem and may cause potential damage to the brain.

Types of Jaundice occurring in neonates/ infants based on their causes

Neonatal Jaundice and its types can be differentiated based on the reason for Jaundice. Based on the grounds, different types of neonatal Jaundice include the following:

1. Neonatal Jaundice as a result of hepatic immaturity: This type of Jaundice in neonates occurs when the baby is prematurely born (born too soon). It can also happen when the baby cannot metabolise or excrete bilirubin effectively. 
2. Physiological Jaundice in neonates: When a baby is born, its liver is often immature or underdeveloped; hence, getting rid of the bilirubin from their bodies is complex. This leads to the accumulation of excessive bilirubin in the blood, which results in a condition called physiological Jaundice. This type of Jaundice is usually seen when the infant is 2 to 3 days old. 
3. Breastfeeding Jaundice: Breastfeeding jaundice or suboptimal intake usually occurs in newborns in the first week after their birth when they don't receive optimal amounts of breastmilk or have issues in breastfeeding. This lack of proper breast milk causes an elevation in the bilirubin levels in the infant's blood. 
4. Breast milk Jaundice: Breast milk jaundice and breastfeeding jaundice are two different types of Jaundice occurring in newborns. In some cases, there might be certain substances n the mother's milk that may be causing bilirubin accumulation in the baby's blood. 
5. Jaundice due to Blood type incompatibility: Blood type incompatibility jaundice occurs when the baby's blood type differs from that of the baby. This may cause the red blood cells from the mother's body during pregnancy to cross the placenta. As a result, the red blood cells from the mother's body may develop antibodies that can cause the breaking down of the red blood cells in the baby's body and eventually build Jaundice. 

Signs and Symptoms of Jaundice in Neonates  

The various signs and symptoms that usually indicate jaundice in neonates include the following:

1. Yellowish discolouration on the baby's skin
2. Yellowing on the whites of the baby's eyes
3. Crying continuously for longer times at a high pitch
4. Feeding problems 
5. Fever 

Neonatal jaundice is usually mild and doesn't require treatment. It usually goes away on its own as the liver gradually develops. Breastfeeding the baby also improves jaundice by promoting the excretion of bilirubin through faeces (pooping). 

If the baby's condition doesn't improve and the bilirubin level continues to escalate, then the doctor might suggest the following treatments,  

1. Phototherapy: Phototherapy is a treatment where the baby is exposed to a particular type of blue light, which helps remove excessive bilirubin levels. 
2. Exchange transfusion: When phototherapy fails, an exchange transfusion is done in infants. It is a treatment method where the baby's complete blood is transfused, i.e., the baby's blood is replaced with that of the donor. The process of blood removal and replacement takes place simultaneously.

Jaundice refers to the yellowing of the skin and the mucous membranes covering the eyes and other body parts. It can affect both newborns and adults. The type of jaundice that affects newborn babies is also called neonatal jaundice. 

It usually resolves on its own unless it occurs due to an underlying pathology which is relatively uncommon. Jaundice in adults often occurs due to an underlying cause, and treating the cause resolves the problem of jaundice.

The three different types of jaundice include prehepatic jaundice, hepatocellular jaundice (intrahepatic jaundice), and posthepatic jaundice. The symptoms, causes, and treatment differ depending on the type of jaundice. 

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