Makindo Medical Notes.com Comprehensive Medical Encyclopedia | Education for Healthcare Professionals

Makindo Medical Notes.com
Download all this content in the Apps now Android App and Apple iPhone/Pad App

MEDICAL DISCLAIMER:The contents are under continuing development and improvements and despite all efforts may contain errors of omission or fact. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice by healthcare workers or laypeople. It is for educational purposes only. Please adhere to your local protocols. Use the BNF for drug information. If you are unwell please seek urgent healthcare advice. If you do not accept this then please do not use the website. Makindo Ltd

Causes of Jaundice: Clinical Presentation, Investigations, and Treatment

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
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.