In short
Yellowing of the eyes and skin means bilirubin is building up, and the cause sits in one of three places: the blood, the liver, or the bile ducts. In an adult it always needs assessment, and some causes need it the same day.
Emergency if: Jaundice with fever and shivering, severe abdominal pain, vomiting blood, black stools, or new confusion and drowsiness — go to an emergency department now.
On your report
Total Bilirubin, Direct Bilirubin, SGPT (ALT), SGOT (AST) +3 more
On this page
01
What jaundice is
Jaundice happens when a substance called bilirubin builds up in the body. Bilirubin is the yellow pigment produced when old red blood cells are broken down; the liver normally processes it and sends it out in bile, into the gut. When any step in that chain fails, bilirubin accumulates and stains the tissues.
The whites of the eyes yellow first and most visibly, because the tissue binds bilirubin readily. Checking in daylight rather than under artificial light makes a real difference, and on darker skin the eyes, the palms and the inside of the mouth are the most reliable places to look.
02
Three places the problem can sit
Before the liver, red cells may be breaking down faster than the liver can keep up — as in some inherited blood conditions and in sickle cell disease. This form usually produces mild yellowing with normal-coloured urine and stools, often alongside anaemia.
In the liver, the processing itself is impaired: viral hepatitis, alcohol-related liver disease, drug and herbal-supplement injury, or cirrhosis. After the liver, bile cannot drain — a gallstone lodged in the bile duct, inflammation of the pancreas, or a tumour pressing on the duct. This last group is the one that turns urine dark and stools pale, because bile pigment goes into the urine instead of the gut.
03
The symptoms that travel with it
Alongside yellow skin or eyes you may also have itchy skin, darker urine and paler stools than usual. That triad points strongly towards obstructed bile drainage and is worth reporting specifically, because it narrows the investigation immediately.
Other accompanying features guide the diagnosis. Pain in the upper right abdomen with fever suggests infection in an obstructed bile duct. Painless jaundice with weight loss in an older adult needs prompt investigation for a cause pressing on the duct. Fatigue, nausea and aversion to food fit viral hepatitis, and confusion or drowsiness signals that the liver is failing to clear toxins.
04
Gilbert's syndrome, and other harmless explanations
Not all raised bilirubin is disease. Gilbert's syndrome is a common, harmless inherited variation in how bilirubin is processed, affecting a noticeable share of the population. It produces mild yellowing that appears during fasting, illness, dehydration, lack of sleep or stress, then fades — with entirely normal liver enzymes and no other abnormality.
It needs no treatment and does not damage the liver. The usual reason it is worth identifying is to stop repeated investigation of a bilirubin that is never going to be normal. Yellow discolouration of the palms and soles with white eyes is not jaundice at all, and most often follows a very high intake of carotene-rich foods such as carrots and pumpkin.
05
What the assessment involves
The first tests are a liver panel including split total and direct bilirubin, a full blood count, and usually an ultrasound of the abdomen. That combination separates the three groups efficiently: the bilirubin split points to the level of the problem, and the ultrasound shows whether the bile ducts are dilated, which is the signature of obstruction.
Depending on what those show, next steps may include hepatitis testing, a review of every medicine and supplement taken in recent months, clotting tests, and more detailed imaging of the bile ducts. Bring an accurate list of everything you take, including herbal and over-the-counter products, since supplement-related liver injury is both common and easy to miss.
06
Urgency
New jaundice in an adult is never something to watch at home. Ask for an urgent medical appointment if your skin or the whites of your eyes look yellow, even if you feel otherwise well, because several of the causes are time-sensitive and the yellowing itself does not tell you which one you have.
Some presentations need emergency care rather than an appointment: jaundice with fever and shivering, with severe abdominal pain, with vomiting blood or black stools, or with confusion and drowsiness. In someone known to have liver disease, new confusion is a particular warning and should be acted on immediately.
When to act
Routine — see a doctor
Known Gilbert's syndrome with mild yellowing during illness or fasting, normal liver enzymes and no other symptoms: no action beyond your usual review.
Same-day — call promptly
Any new yellowing of the eyes or skin in an adult, especially with dark urine, pale stools, itching or weight loss — arrange an urgent appointment.
Emergency — act now
Jaundice with fever and shivering, severe abdominal pain, vomiting blood, black stools, or new confusion and drowsiness — go to an emergency department now.
Values mentioned in this story
Each one opens a visual guide with its normal range and what moves it — upload a report and we place your own numbers on the same scale.
Sources
- Jaundice — NHSnhs.uk
- Liver Disease — NIDDKniddk.nih.gov
- Liver Function Tests — MedlinePlusmedlineplus.gov
Share this story
Curious where your own values stand?
Two minutes from upload to a full visual picture. Free to analyze.