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Symptoms
 
 

Jaundice

 
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Overview

Jaundice refers to a yellow discolouration of the skin, conjunctivae and mucous membranes due to deposition of bilirubin. This may be due to prehepatic (haemolytic), hepatocellular or posthepatic (cholestatic) causes.

Aetiology

  • Causes of Jaundice

  • Haemolytic

  • Erythrocyte defects - sickle cell anaemia, thalassaemia, sideroblastic anaemia, spherocytosis, lead poisoning
  • Excessive erythrocyte destruction - haemolytic anaemia, thermal injury, envenomation, DIC, haemodialysis, breast milk jaundice
  • Hepatocellular

  • Dysfunctional uptake - choramphenicol, probenecid, rifampin
  • Dysfunctional conjugation - Crigler-Najar, Gilbert’s disease
  • Dysfunctional bilirubin storage / excretion - Dubin-Johnson
  • Hepatocyte damage - viral hepatitis, tuberculosis, EBV, CMV, varicella, drug-induced hepatitis, autoimmune hepatitis, alpha-1 antitrypsin deficiency, haemochromatosis, Wilson’s disease, primary biliary cirrhosis, primary sclerosing cholangitis, paracetamol, statins, steatohepatitis
  • Cholestatic

  • Intrahepatic cholestasis - augmentin, chlorpromazine, pregnancy, cystic liver disease, alcoholic liver disease, sepsis, total parenteral nutrition, Hodgkin’s lymphoma, liver cancer (primary / metastatic), amyloidosis, sarcoidosis
  • Extrahepatic cholestasis - primary sclerosing cholangitis, choledocholithiasis, pancreatitis, tumours (eg. pancreatic), bile duct stenosis, bile duct strictures

History of Presenting Complaint

  • Onset

  • Whether the patient's jaundice began suddenly or gradually, and under what circumstances.
  • Timing

  • How long the jaundice has been going on for.
  • Associated Symptoms

  • Nausea / vomitingSuggestive of acute hepatitis or choledocholithiasis
  • Colicky right upper quadrant painSuggestive of choledocholithiasis
  • Abdominal distensionAscites is a sign of chronic liver disease
  • FeversSuggestive of acute hepatitis or cholangitis
  • PruritisSuggestive of obstructive cause
  • ArthritisSuggestive of autoimmune hepatitis or primary sclerosing cholangitis
  • Weight lossSuggestive of cholestasis secondary to malignancy
  • Pale grey stoolsSuggestive of obstructive causes
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