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Related Subjects: |Chronic liver disease |Cirrhosis |Alkaline phosphatase (ALP) |Liver Function Tests |Ascites Assessment and Management |Budd-Chiari syndrome |Autoimmune Hepatitis |Primary Biliary Cirrhosis |Primary Sclerosing Cholangitis |Wilson disease |Hereditary Haemochromatosis |Alpha-1 Antitrypsin (AAT) deficiency |Non alcoholic steatohepatitis (NASH) |Spontaneous Bacterial Peritonitis |Alcoholism and Alcoholic Liver Disease |Hepatitis C
Jaundice is detectable when serum bilirubin > 40 micromoles/L. It can be due to a number of causes including liver disease and haemolysis
Cause | Clinical Presentation | Investigations | Treatment |
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Pre-Hepatic (Haemolytic) Jaundice | Symptoms of anaemia, pallor, dark urine, splenomegaly, typically seen in conditions like haemolytic anaemia, sickle cell disease, and thalassemia. | Complete blood count (CBC), reticulocyte count, peripheral blood smear, haptoglobin, lactate dehydrogenase (LDH), direct and indirect bilirubin levels. | Treatment of the underlying cause (e.g., transfusions for haemolytic anaemia, hydroxyurea for sickle cell disease), folic acid supplementation, splenectomy in certain cases. |
Hepatic (Hepatocellular) Jaundice | Fatigue, anorexia, nausea, dark urine, pale stools, hepatomegaly, seen in viral hepatitis, alcoholic liver disease, and cirrhosis. | Liver function tests (LFTs), viral hepatitis serologies, autoimmune markers, imaging (ultrasound, CT, MRI), liver biopsy if needed. | Management of the underlying liver disease (e.g., antiviral therapy for hepatitis, abstinence and nutritional support in alcoholic liver disease), monitoring for liver failure, consideration of liver transplantation in advanced cases. |
Post-Hepatic (Obstructive) Jaundice | Cholestatic symptoms like pruritus, dark urine, pale stools, right upper quadrant pain, commonly due to gallstones, bile duct strictures, or pancreatic cancer. | Imaging (ultrasound, CT, MRCP), liver function tests (elevated ALP and GGT), ERCP or MRCP for further evaluation of bile duct obstruction. | Endoscopic retrograde cholangiopancreatography (ERCP) to remove bile duct stones or place stents, surgical removal of obstructions (e.g., cholecystectomy for gallstones), management of underlying malignancies. |
Inherited Conditions (e.g., Gilbert's Syndrome, Crigler-Najjar Syndrome) | Mild, fluctuating jaundice often triggered by stress, fasting, or illness, seen in conditions like Gilbert's syndrome, often asymptomatic aside from jaundice. | Direct and indirect bilirubin levels, genetic testing for confirmation of diagnosis, liver function tests typically normal. | No specific treatment required for Gilbert's syndrome, management of triggers; phototherapy or liver transplantation in severe cases of Crigler-Najjar syndrome. |
Drug-Induced Jaundice | Jaundice following the use of certain medications, may present with other signs of liver injury (e.g., fatigue, nausea), often due to drugs like acetaminophen, antibiotics, or statins. | Liver function tests, history of drug use, ruling out other causes of jaundice, liver biopsy if necessary. | Discontinuation of the offending drug, supportive care, monitoring for liver recovery, and avoiding future use of hepatotoxic medications. |
Neonatal Jaundice | Common in newborns, presents with yellowing of the skin and eyes, typically within the first week of life; may be physiological or due to conditions like Rh incompatibility, infection, or breast milk jaundice. | Serum bilirubin levels, blood type and Coombs test, glucose-6-phosphate dehydrogenase (G6PD) levels, clinical observation. | Phototherapy, exchange transfusion in severe cases, treating underlying causes (e.g., infection, G6PD deficiency), ensuring adequate feeding and hydration. |