Overview of jaundice
Jaundice is the yellowish staining of the skin, sclera (the whites of the eyes) and mucus membranes that is caused by high levels of bilirubin in blood. The discoloration is detected clinically once the serum bilirubin level rises above 3 mg/ dL (51.3 µmol/L).1 Jaundice in an adult patient can be caused by a variety of benign or life-threatening disorders. A warning sign of hepatobiliary disease, it might also occur in the setting of cardiac, hematologic or pancreatic disorders.2
The laboratory work-up, which begin with a urine test for bilirubin, may proceed to abdominal imaging by ultrasonography or computed tomographic scanning. Occasionally, more invasive procedures such as cholangiography or liver biopsy may be needed to arrive at a diagnosis. The management of jaundice requires a diagnosis of the specific cause and therapy directed at the specific cause.
The causes of jaundice can be:3
- Prehepatic jaundice is caused by primary diseases of bilirubin metabolism such as in hemolytic anemia. Prehepatic causes of jaundice lead to elevated levels of unconjugated (indirect) bilirubin.
- Intrahepatic jaundice is defect in the liver that prevents bilirubin removal from the blood. Intrahepatic disorders can lead to unconjugated or conjugated hyperbilirubinemia. The conjugated (direct) bilirubin is often elevated by alcohol, infectious hepatitis, drug reactions and autoimmune disorders.
- Posthepatic jaundice—is blockage of the bile ducts that decreases the flow of bile and bilirubin from the liver into the intestines. The bile ducts can be blocked by cancers,gallstones or inflammation of the ducts. Posthepatic disorders cause conjugated hyperbilirubinemia.
Clinical Features (Symptoms of jaundice)
Patients with infectious jaundice present with fever, chills, abdominal pain and flu-like symptoms. Patients with noninfectious jaundice may complain of weight loss or pruritus. Abdominal pain is the most common symptom in patients with pancreatic cancer or biliary tract cancers.2 In viral hepatitis and obstructive jaundice, pale stool and darkening urine precede the jaundice.
Diagnosis and Management of jaundice
The initial work-up depends on whether the hyperbilirubinemia is conjugated or unconjugated. Presence of bilirubin in urinalysis indicates conjugated bilirubinemia. The findings of urinalysis should be confirmed with serum total and direct bilirubin levels. If the complete blood count and tests for liver function and infectious hepatitis are unrevealing, the work-up should include ultrasonography. Endoscopic retrograde cholangiopancreatography and computed tomographic scanning are performed as follow-up studies only when necessary.
Liver biopsy is done mostly for determining prognosis and when imaging studies fail to lead to a confirmed diagnosis. It can be particularly helpful in diagnosing autoimmune hepatitis or biliary tract disorders. The treatment is based on the etiology of jaundice and includes removal of causative medications or toxins, therapy for the underlying liver disease or surgery for extrahepatic obstruction.
Advice from your physician
- Discontinue and avoid potentially hepatotoxic medications
- Supportive care for viral hepatitis
- Rehydrate/refeed for Gilbert's syndrome
- Consider steroids in fulminant alcoholic hepatitis
- Cholecystectomy or ERCP with stone removal for obstructing gallstones
- Treat underlying causes of hemolysis or other disorders
- Antibiotics for cholangitis, sepsis
- Hydroxyurea and folate for sickle cell disease, prevent crises by adequate hydration, vaccinating against diseases, and try to prevent other infections
Do’s and Don’ts
- Decrease protein intake sharply.
- Increase intake of carbohydrates.
- In case of obstructive jaundice, consume a nutritious, balanced diet (avoiding high-fat foods) and frequent small meals.
- To decrease pruritus, frequently bathe, apply an antipruritic lotion, such as calamine; and take diphenhydramine or hydroxyzine, after asking your doctor.
1. Roche SP, Kobos R. Jaundice in the adult patient. Am Fam Physician. 2004; 69(2): 299–304.
2. Langeloh L, Hinrichsen H. Main symptom jaundice—differential diagnosis at the bedside. Med Klin (Munich). 2007; 102(1): 37–47.
3. Reichel C, Grünhage F. Differential diagnosis of jaundice. MMW Fortschr Med. 2006; 148(3): 37–40.
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Written by: healthplus24.com team
Date last updated: February 11, 2015