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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