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Jaundice

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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Associated Diseases
BETA

Gastrointestinal
Pancreatic
Haematology
Coagulation Disorders
Red Cell Disorders
Haematologic Malignancy
Infectious Diseases
Viral Hepatitis
Nutrition & Metabolic
Oncology
Paediatrics
Other
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