Jaundice, commonly known as yellowing of the skin or the whites of the eyes, is one of those symptoms that is hard to ignore. It is visible. It is striking. And in Nigeria, it tends to set off a familiar chain of reactions: malaria test, hepatitis screen, herbal remedies — often in that order.
But jaundice is not a diagnosis. It is a symptom. And the range of conditions that can cause it in adults is broader and more serious than most people realise. Some causes pf jaundice in adults are manageable with medication. Others require specialist intervention — and delay can be genuinely dangerous.
This article explains what jaundice actually is, why it happens, and what the different causes mean for your health and your next steps.
What Is Jaundice?
Jaundice is the yellowish discolouration of the skin, the whites of the eyes (sclerae), and sometimes the mucous membranes. This is caused by a build-up of bilirubin in the blood. Bilirubin is a yellow-orange pigment produced when red blood cells are broken down at the end of their natural lifespan.
Under normal circumstances, bilirubin is processed by the liver, secreted into bile, and eventually excreted from the body in the stool, which is why healthy stool has its characteristic brown colour. When this process is disrupted at any point, whether because too much bilirubin is being produced, because the liver cannot process it properly, or because something is blocking its flow — bilirubin accumulates in the tissues and causes jaundice.
Understanding where in this process the disruption occurs is the key to identifying the cause.
The Three Categories of Jaundice
1. Pre-Hepatic Jaundice (Before the Liver)
This occurs when red blood cells are being destroyed faster than the liver can process the resulting bilirubin. The liver itself may be perfectly healthy — the problem is upstream.
In Nigeria, the most common cause of pre-hepatic jaundice is haemolytic anaemia — including sickle cell disease, malaria-induced haemolysis, and G6PD deficiency. The jaundice in these cases is usually mild, and the bilirubin produced is unconjugated (not yet processed by the liver).
2. Hepatic (Liver) Jaundice
Hepatic jaundice in adults occurs when the liver itself is damaged or diseased and cannot process bilirubin normally. This is the category most commonly associated with liver disease in Nigeria. Causes include:
- Viral hepatitis: Hepatitis A (usually acute and self-limiting), hepatitis B (endemic in Nigeria, a major cause of chronic liver disease and cirrhosis), and hepatitis C.
- Alcoholic liver disease: Chronic heavy alcohol use causes progressive liver damage, culminating in cirrhosis.
- Cirrhosis: Advanced scarring of the liver from any chronic cause — hepatitis B, alcohol, fatty liver disease — impairs bilirubin processing.
- Liver cancer (hepatocellular carcinoma): Nigeria has one of the highest incidences of liver cancer globally, driven largely by hepatitis B rates. Jaundice is a feature of advanced disease.
- Drug-induced liver injury: Certain medications and herbal preparations can damage the liver.
3. Post-Hepatic (Obstructive) Jaundice
This is the form of jaundice in adults that is most directly relevant to gastroenterology and to procedures like ERCP. Post-hepatic jaundice occurs when the flow of bile from the liver to the small intestine is physically obstructed — preventing bilirubin from being excreted normally.
This obstruction can occur at any point along the biliary tree — the network of ducts that carry bile from the liver through the gallbladder and into the duodenum. Common causes include:
- Gallstones in the common bile duct (choledocholithiasis): A stone that has migrated from the gallbladder into the bile duct can completely block bile flow. This is one of the most common causes of obstructive jaundice and is highly treatable with Endoscopic Retrograde Cholangiopancreatography (ERCP).
- Pancreatic cancer: A tumour at the head of the pancreas — the part closest to the bile duct — can compress and obstruct the duct from the outside as it grows. Painless progressive jaundice in an older adult should always raise suspicion for this.
- Cholangiocarcinoma (bile duct cancer): Cancer arising from the bile duct itself causes progressive obstruction and jaundice.
- Acute cholangitis: Infection of the bile ducts, usually triggered by obstruction, causes jaundice alongside fever and right-sided abdominal pain — a triad known as Charcot’s triad. This is a medical emergency.
- Primary sclerosing cholangitis (PSC): A chronic inflammatory condition causing progressive scarring and narrowing of the bile ducts.
- Strictures: Scar tissue narrowing the bile duct following prior surgery or inflammation.
How to Recognise Obstructive Jaundice
Obstructive jaundice in adults has a distinctive pattern that differs from the jaundice of liver disease or haemolysis. The combination of the following symptoms should prompt urgent investigation:
- Progressive yellowing of the skin and eyes
- Dark, tea-coloured urine — bile excreted by the kidneys
- Pale or clay-coloured stools — bile absent from the gut
- Itching (pruritus) — bile salts depositing in the skin
- Right upper abdominal pain or discomfort — especially with gallstone-related obstruction
- Fever and chills — if infection (cholangitis) has developed
This constellation of symptoms — particularly the dark urine and pale stools alongside yellowing — is a strong indicator of a bile duct problem, and it warrants urgent specialist assessment.
Jaundice in Nigeria: Why the Cause Is Often Missed
Because hepatitis B and malaria are both extremely common in Nigeria and both can cause jaundice in adults, they tend to be the first — and sometimes the only — conditions considered when a patient presents with yellowing. This leads to under-investigation of obstructive causes, particularly gallstone-related bile duct obstruction and pancreatic cancer.
The consequences can be significant. A gallstone blocking the common bile duct can cause cholangitis — a potentially life-threatening bile duct infection — if not treated promptly. Pancreatic cancer detected early, while the tumour is small, carries a far better prognosis than cancer detected at an advanced stage when jaundice has finally prompted investigation.
Investigations for Jaundice in Adults
When a doctor evaluates adult jaundice, the investigation is structured to identify which category of jaundice is present and what is causing it. The workup typically includes:
- Blood tests: Liver function tests (LFTs), bilirubin level, full blood count, hepatitis B and C serology, and sometimes tumour markers.
- Abdominal ultrasound: The first-line imaging investigation. Excellent for detecting gallstones in the gallbladder and bile duct dilation (which signals obstruction), and for assessing the liver texture.
- CT scan or MRI/MRCP: Provides more detailed imaging of the bile ducts, pancreas, and surrounding structures — useful for identifying the cause and site of an obstruction.
- ERCP (Endoscopic Retrograde Cholangiopancreatography): When an obstruction is confirmed and treatment is needed — for example, to remove a bile duct stone or place a stent across a stricture — ERCP is both the diagnostic and therapeutic gold standard. At Redus Center for Digestive Health, our specialists perform ERCP to diagnose and treat bile duct obstructions causing jaundice.
Frequently Asked Questions
Is jaundice in adults always serious?
Not always — mild jaundice in adults from benign causes like Gilbert’s syndrome (a harmless genetic condition causing mild bilirubin elevation) is not serious. But jaundice in adults more often reflects a significant underlying condition and should always be properly investigated rather than assumed to be benign.
Can malaria cause jaundice?
Yes. Severe malaria — particularly Plasmodium falciparum malaria — can cause haemolysis (destruction of red blood cells) sufficient to cause jaundice. However, the pattern of malaria-related jaundice is different from obstructive jaundice: there is usually no pale stool or severe itching, and it is accompanied by fever, rigors, and other systemic features of malaria.
What is the difference between jaundice and yellow fever?
Yellow fever is a viral illness that can cause liver inflammation and jaundice as part of its severe form. It is accompanied by fever, headache, muscle pain, and in severe cases, bleeding. Yellow fever is vaccine-preventable. Adult jaundice without these accompanying features is more likely due to liver disease, gallstones, or bile duct obstruction than yellow fever.
Can ERCP treat jaundice?
ERCP can treat the cause of obstructive jaundice in adults — for example, by removing a bile duct stone or placing a stent to bypass a tumour-related stricture. Once the obstruction is relieved, bile flow resumes and the jaundice typically resolves over days to weeks. ERCP does not treat hepatic or pre-hepatic jaundice, which require different management approaches.
| Experiencing yellowing of the skin or eyes, dark urine, or pale stools? Don’t wait. Book an urgent consultation at Redus Center for Digestive Health, Lekki Phase 1, Lagos. Call +234 704 084 7895 or visit redushealth.com. |