Short answers, pulled from the story.
The first visible sign of a dying liver is a sudden, unnatural yellowing of the eyes that can appear within hours. This condition is known as jaundice or icterus and serves as a surface indicator of complex internal failure involving abnormal heme metabolism or liver dysfunction.
The body produces bilirubin when red blood cells rupture after completing their 120-day lifespan and release hemoglobin. Macrophages break down the hemoglobin into heme and globin, and the heme molecule undergoes an oxidation reaction to produce biliverdin before being reduced into yellow bilirubin.
The three categories of jaundice are prehepatic or hemolytic jaundice caused by red blood cell breakdown, hepatic or hepatocellular jaundice caused by direct liver cell damage, and posthepatic or obstructive jaundice caused by blocked bile ducts. Prehepatic jaundice results from conditions like sickle-cell anemia, hepatic jaundice results from viral hepatitis or genetic disorders, and posthepatic jaundice results from gallstones or pancreatic cancer.
The sclera is the most sensitive indicator because the eye conjunctiva has a high affinity for bilirubin deposition due to its high elastin content. Slight increases in serum bilirubin can be detected early by observing the yellowing of the sclera, which typically indicates a serum bilirubin level of at least 3 milligrams per deciliter.
Doctors diagnose the cause of jaundice by analyzing liver function tests that measure enzymes such as alanine aminotransferase and alkaline phosphatase. Imaging techniques such as ultrasound and CT scans are used to detect bile-duct blockage, while the presence of conjugated bilirubin in the urine confirms that the bilirubin is water-soluble.
More than 80 percent of newborns experience jaundice during their first week of life, making it one of the most common conditions affecting infants under 28 days of age. This transient neonatal jaundice is often due to the immaturity of liver enzymes involved in bilirubin metabolism and the increased breakdown of fetal hemoglobin.