Yellowing of the eyes, known medically as jaundice, can be a sign of liver failure. However, there are many potential causes for yellowish discoloration of the eyes and skin. Evaluating the underlying cause is important, as some are more serious than others. Liver failure specifically refers to severe impairment in the liver’s ability to perform its normal functions. Mild or temporary yellowing of the eyes does not necessarily indicate liver failure. But understanding the connection between liver issues and jaundice is helpful when assessing symptoms.
What Causes Jaundice?
Jaundice occurs when there is a buildup of bilirubin in the bloodstream. Bilirubin is a yellowish pigment produced during the normal breakdown of old red blood cells. Typically, the liver filters out bilirubin from the blood and secretes it into bile. Bile travels from the liver to the small intestine, where bilirubin is eliminated from the body in stool. Jaundice develops when this process is disrupted:
- Too much bilirubin is produced
- The liver cannot properly filter bilirubin
- Bilirubin backs up and is not secreted into bile
- Bile with bilirubin cannot flow from the liver to the small intestine
When bilirubin accumulates in the blood, it deposits in tissues like the skin and eyes. This causes a yellowish discoloration. Bilirubin buildup may also make urine appear dark and can cause light-colored stools.
Increased Bilirubin Production
Certain conditions cause the body to produce more bilirubin than normal. These include:
- Hemolytic anemia – excessive destruction of red blood cells
- Internal bleeding – from trauma, surgery, gastrointestinal ulcers, etc.
- Reabsorption of blood from large hematomas or bruises
- Transfusion of incompatible blood
With increased bilirubin production, even a healthy liver may struggle to clear the excess. This can lead to jaundice.
Impaired Bilirubin Processing
Liver disease is a common cause of inadequate bilirubin processing and jaundice. The liver may not be able to effectively filter bilirubin from the bloodstream. Or issues with bile production or flow may prevent bilirubin from being adequately eliminated. Specific liver problems linked to jaundice include:
- Viral hepatitis
- Alcoholic liver disease
- Nonalcoholic fatty liver disease (NAFLD)
- Cirrhosis
- Drug-induced liver injury
- Autoimmune hepatitis
- Biliary obstruction – from gallstones, cancer, etc.
In newborns, jaundice is common as the immature liver adapts to filtering bilirubin after birth. This physiological neonatal jaundice usually resolves without treatment.
Impaired Bile Flow
Even with adequate bilirubin filtering, jaundice can occur if bile containing bilirubin cannot drain properly from the liver. This may result from:
- Gallstones blocking the bile ducts
- Scarring of bile ducts from disease
- Cancers obstructing bile ducts
- Other conditions like cystic fibrosis that cause thick bile
- Rare congenital defects of the bile ducts
When bile cannot flow into the intestine, bilirubin has no way to leave the body. It builds up and causes jaundice.
Is Jaundice Always Related to Liver Issues?
While the liver is the central player in bilirubin processing and jaundice, there are some instances where yellowing of the skin and eyes is not due to liver problems. Examples include:
- Newborn jaundice – as mentioned, this physiological jaundice from the immature newborn liver typically resolves on its own.
- Breastfeeding jaundice – relatively common jaundice in the first week of life due to substances in breast milk that increase bilirubin levels.
- Blood diseases – hemolytic anemias and other disorders that increase red blood cell breakdown.
- Bile duct obstructions – from gallstones, tumors, surgical injury, etc. The liver itself is not diseased.
- Medications – some prescription drugs like antibiotics, NSAIDs, chemotherapy agents, and steroids may cause jaundice.
In these scenarios, treating the underlying problem can resolve jaundice without specific treatment to the liver. However, persistent or severe jaundice warrants liver evaluation even with another known cause.
What Does Jaundice Indicate About Liver Function?
While not all jaundice relates to the liver, the organ plays a central role in bilirubin processing. Yellowish eyes can provide important clues about liver function.
Mild Jaundice
Low-grade jaundice may indicate:
- Early-stage liver disease not yet severe enough to cause dysfunction
- Mild impairment in liver filtration and bile production
- Partial bile duct blockage allowing some bile flow
Mild or early jaundice often causes minimal symptoms. But it still warrants follow-up testing to assess the liver and look for reversible factors.
Moderate to Severe Jaundice
With yellowing clearly visible in the whites of the eyes, moderate to severe jaundice typically indicates:
- Moderate liver cell damage and impairment in bilirubin filtering
- Reduction in bile production and flow
- Partial or complete bile duct obstruction
More visible jaundice requires prompt evaluation to determine the cause. Treating any underlying condition and supporting liver function are important.
Prolonged Jaundice
Jaundice lasting more than 2-3 weeks suggests:
- Chronic, progressive liver disease
- Advanced cirrhosis and loss of functional liver tissue
- Unrelenting bile duct obstruction
Persistent jaundice is a red flag for significant liver damage and multi-system complications. Aggressive treatment is crucial.
Can Jaundice Promptly Progress to Liver Failure?
Rapid onset of severe jaundice may quickly progress to liver failure in certain situations:
- Acetaminophen overdose – damages liver cells and can cause fulminant failure within days.
- Hepatitis virus infection – hepatitis A, B, and E can trigger acute liver failure.
- Autoimmune flare – autoimmune hepatitis exacerbation may rapidly injure liver tissue.
- Toxin exposure – poisonous mushrooms, chemicals, heavy metals can cause acute toxic hepatitis.
- Vascular issues – compromised blood flow from shock can lead to ischemic hepatitis and failure.
In these scenarios, the liver suffers a catastrophic insult, causing fast-developing jaundice as it loses function. Seeking emergency care is crucial for rapid-onset jaundice.
What Liver Tests Help Assess Jaundice?
Various blood tests help evaluate liver issues in someone with jaundice:
- Bilirubin – directly measures levels of circulating bilirubin.
- Liver enzymes – AST, ALT, ALP, GGT enzymes indicate liver cell damage.
- Albumin – produced by the liver, low albumin suggests impaired synthesis.
- PT/INR – assess blood clotting, abnormal in liver failure.
- Ammonia – elevated ammonia occurs with cirrhosis and encephalopathy.
Imaging such as ultrasound, CT, MRI, or MRCP scan also helps evaluate the liver parenchyma and bile ducts. Liver biopsy may be considered if the diagnosis remains uncertain.
How Do You Treat Jaundice Caused by Liver Problems?
Treatment for jaundice aims to:
- Diagnose and address the underlying liver disease or bile obstruction.
- Reduce bilirubin levels through supportive care and medications.
- Prevent complications from severe jaundice.
Key aspects may include:
- Treating infections – antivirals for hepatitis, antibiotics for bacterial infections.
- Addressing autoimmune disease – corticosteroids and immunosuppressants.
- Improving bile flow – through ERCP stenting, surgery, medications to dissolve sludge.
- Discontinuing hepatotoxic drugs – stopping alcohol, cocaine, toxic supplements, certain prescription medications.
- Boosting liver function – IV fluids, vitamin supplements, medications to reduce ammonia.
- Filtration therapy – plasmapheresis, albumin dialysis to remove bilirubin from blood.
- Liver transplant – for end-stage liver failure if jaundice and symptoms do not improve.
Relieving jaundice and restoring adequate liver function are vital. But the optimal treatment depends on the specific cause in each individual.
What Are Complications of Severe Jaundice?
Without treatment, prolonged severe jaundice can lead to major complications:
Bilirubin Encephalopathy
As bilirubin deposits in brain tissue, it causes swelling, damage, and neurological dysfunction. This is called bilirubin encephalopathy or kernicterus. It mainly occurs in newborns but may rarely affect adults. Symptoms include:
- Lethargy and difficulty awakening
- High-pitched crying
- Poor feeding
- Seizures
- Athetoid cerebral palsy
Kernicterus can be fatal. Urgent bilirubin reduction is needed.
Coagulopathy
Liver dysfunction impairs the blood clotting process. This coagulopathy predisposes to bruising and bleeding complications such as:
- Gastrointestinal hemorrhage
- Blood in urine or stool
- Prolonged nosebleeds and bleeding gums
- Heavy menstrual periods
- Bleeding into skin as purplish patches (purpura)
Transfusions of blood products may be required.
Fluid Retention and Ascites
Impaired liver function and low albumin levels cause fluid to leak from blood vessels. This accumulates as peripheral edema and ascites (fluid in the abdominal cavity). Complications include:
- Distended, tense abdomen
- Impaired breathing from fluid pressure
- Increased risk of bacterial peritonitis
- Reduced blood flow to kidneys
Paracentesis or surgical shunting procedures may be utilized to drain fluid. Albumin infusions can help maintain oncotic pressure.
Hepatic Encephalopathy
With advanced liver failure, impaired ammonia processing leads to buildup of ammonia in the bloodstream. This neurotoxic substance causes confusion, altered mental status, and coma known as hepatic encephalopathy.
Kidney Failure
The kidneys and liver work closely together. End-stage liver dysfunction can result in hepatorenal syndrome (kidney failure). Dialysis may be required.
Infection
Advanced liver disease impairs immunity against infection. Bacterial infections are common, including pneumonia, urinary tract infections, and spontaneous bacterial peritonitis.
Without prompt intervention, severe jaundice can trigger this downward spiral of life-threatening complications. Seeking emergency care is critical.
What Is the Prognosis with Liver Failure and Jaundice?
The prognosis depends significantly on the severity of jaundice and extent of liver damage:
- Mild jaundice – Often indicates reversible dysfunction or partial obstruction. Has good prognosis if promptly treated.
- Moderate jaundice – Signifies advanced disease. But still may improve with intensive therapy targeting the cause.
- Severe jaundice – High risk of complications and death without a liver transplant. Even transplantation has 10-15% 1-year mortality.
Rapidly progressive jaundice or jaundice lasting over 2-3 weeks has worse outcomes without urgent intervention. Overall prognosis is highly variable based on the individual clinical situation.
Can Jaundice Be Prevented?
Some key strategies may help reduce the risk of developing jaundice related to liver disease:
- Get vaccinated for hepatitis A and B.
- Avoid alcohol abuse and intravenous drug use to prevent viral hepatitis and cirrhosis.
- Maintain a healthy weight through diet and exercise to prevent nonalcoholic fatty liver disease.
- Avoid exposure to industrial chemicals and toxins.
- Use caution with potentially hepatotoxic drugs like acetaminophen, statins, anabolic steroids.
- Promptly treat infections, autoimmune conditions, and metabolic disorders that could impact the liver.
- Have regular medical check-ups to catch liver abnormalities early.
While not all jaundice can be prevented, minimizing liver disease risk factors improves outcomes. Seeking prompt care for any yellowing can detect reversible causes before liver failure develops.
Summary
In summary, yellowing of the skin and eyes known as jaundice may indicate liver problems but also occurs in some non-liver conditions. Mild jaundice often reflects early disease, while moderate to severe jaundice suggests advanced liver damage or obstruction. Rapid onset of jaundice requires emergency assessment for liver failure. Without treatment, severe prolonged jaundice can lead to catastrophic complications. Improving the underlying liver condition and reducing bilirubin levels are key. The prognosis depends greatly on the severity and specific cause of jaundice. Preventing viral hepatitis and liver injury from toxins and unhealthy lifestyles can reduce jaundice risk. Being aware of yellowing and seeking prompt medical evaluation are essential to detect reversible causes before they progress to liver failure.