Diagnosing jaundice

How is jaundice diagnosed in babies?

Babies will be examined within the initial 3 days of life when bilirubin levels typically peak. They may also be checked on several more occasions by the time they are 7 days old.

A doctor or paediatrician will assess:

• The level of bilirubin in the blood
• How well the new-born is feeding
• Whether any bruising has occurred during delivery

A paediatrician will also take into account whether the baby was born prematurely, how old the baby is and if the little one has an older sibling who also experienced severe jaundice in infancy.

Follow-up visits will be recommended and your paediatrician will likely ask the mother, a series of questions to assess potential for jaundice in the first few weeks of life, these may include:

• Is your baby feeding well?
• How often are you feeding your baby?
• Are you breastfeeding or using formula?
• How frequently does your baby have a soiled nappy (diaper) – wet or stools?
• Does your baby wake easily when it is time to feed?
• Have you noticed any changes in your baby’s temperature?
• Have you noticed any yellowing of your baby’s skin (including the arms, legs and abdomen) or eyes?

If moderate or severe jaundice is suspected, it is likely that your paediatrician may perform a blood test by taking a small sample via your baby’s toe (a small prick) to make a definite diagnosis. A skin test using a transcutaneous bilirubinometer can also be used to look at the condition of the skin. This device shines a special light on the surface of the skin making it easier for analysis.

During your follow-up, you may have questions too, and it is important that you ask them. Your paediatrician will guide you on the severity of your baby’s jaundice, if tests will be required, if treatment is necessary, if treatment will involve hospitalisation and whether or not your current schedule of feeding can still be maintained.

How is jaundice diagnosed in adults?

Your doctor will likely begin with a discussion about your medical history and what your symptoms are. Your doctor will also perform a physical exam to determine if there are any obvious signs which may point to a particular cause of jaundice.

If your doctor suspects liver dysfunction, he or she will begin checking for signs of liver disease. These signs may include:

• Spider angiomas (an abnormal collection of blood vessels close to the surface of the skin)
• Bruising on the skin
• Palmar erythema (a red colouration of the fingertips and palms of the hands)

A diagnosis for jaundice in adults will be determined through tests. Recommended tests will relate to your overall symptoms. Common tests may involve:

• Blood tests: The total amount of bilirubin in the body will be determined through a blood sample. Blood samples may also be used to diagnose various conditions causing jaundice, such as hepatitis. A doctor will also assess your CBC (complete blood count) and look for any signs of haemolytic anaemia (caused by abnormal degeneration of RBCs).
• Liver function tests: Blood samples can also be used to measure levels of proteins and enzymes produced by the liver. The tests will show healthy function as well as damage caused by an impairment.
• A liver biopsy: If any damage to the liver is suspected, small samples of liver tissue can be extracted for microscopic examination. This is done through the insertion of a needle between the lower ribs on the right-hand side to obtain a sample.
• Imaging tests: Abdominal ultrasounds, MRI and CT scans can give your doctor detailed images of your internal organs – particularly the liver, pancreas and gallbladder. This will help to determine if there’s been any damage caused to your organs and also help to diagnose any underlying causes. If the liver is of concern, your doctor can determine its size and level of tenderness (which can indicate any abnormal function). In some cases, a HIDA scan (cholescintigraphy) may be recommended to check for any obstructions in the bile ducts (such as tumours and gallstones).
• Urinalysis: The results of this test, which assesses the appearance, content and concentration of a sample of urine, is typically confirmed with a serum test (bilirubin levels and CBC).
• Endoscopic retrograde cholangiopancreatography (ERCP): This invasive test will be used as necessary combining an endoscopy (a tube passed down the throat, into the stomach and duodenum, the first part of the small intestine) with a fluoroscopy (continuous X-ray image on a monitor) to determine abnormalities in the pancreatic or biliary ductal systems.