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| {{CMG}}
| | __NOTOC__ |
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| {{Editor Help}}
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| {{DiseaseDisorder infobox | | | {{DiseaseDisorder infobox | |
| Name = Jaundice, NOS | | | Name = Jaundice, NOS | |
| Image = PHIL 2860 lores.jpg| | | Image = PHIL 2860 lores.jpg| |
| Caption = Yellowing of the [[skin]] and [[sclera]] caused by [[Hepatitis|Hepatitis A]].| | | Caption = Yellowing of the [[skin]] and [[sclera]], via Wikimedia Commons<ref>By Photo Credit: Content Providers(s): CDC/Dr. Thomas F. Sellers/Emory University [Public domain], <"https://commons.wikimedia.org/wiki/File%3AJaundice_eye.jpg"></ref>| |
| ICD10 = {{ICD10|R|17||r|10}} |
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| ICD9 = {{ICD9|782.4}} |
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| OMIM = |
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| MedlinePlus = 003243 |
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| eMedicineSubj = |
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| eMedicineTopic = |
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| DiseasesDB = 7038 |
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| MeshID = D007565 |
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| }} | | }} |
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| {{SI}}
| | '''For patient information, click [[Jaundice (patient information)|here]].''' |
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| ==Overview==
| | '''For the approach to a patient with jaundice, click [[Approach to a patient with jaundice|here]].''' |
| '''Jaundice''', also known as '''icterus''' (attributive adjective: "icteric"), is yellowish discoloration of the [[skin]], [[conjunctiva]] (a clear covering over the [[sclera]], or whites of the eyes) and [[mucous membrane]]s caused by hyperbilirubinemia (increased levels of [[bilirubin]] in red blooded animals). Usually the concentration of bilirubin in the [[blood]] must exceed 2–3 [[milligram|mg]]/[[decilitre|dL]] for the coloration to be easily visible. ''Jaundice'' comes from the French word ''jaune'', meaning yellow. Jaundice typically appears in a 'top to bottom' progression (starting with the face, progressing toward the feet), and resolves in a 'bottom to top' manner. | |
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| '''[[Neonatal jaundice]]''' | | {{CMG}}; '''Associate Editor(s)-In-Chief:''' {{FKH}}, {{FA}}, {{EG}}, {{MJ}} |
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| Neonatal jaundice can be '''physiological''' or '''pathological'''. Neonatal physiological jaundice is usually harmless: this condition is often seen in [[infants]] around the second day after birth, lasting until day 8 in normal births, or to around day 14 in [[premature birth]]s. Serum [[bilirubin]] normally drops to a low level without any intervention required: the jaundice is presumably a consequence of metabolic and physiological adjustments after birth. In extreme cases, a brain-damaging condition known as [[kernicterus]] can occur; there are concerns that this condition has been rising in recent years due to inadequate detection and treatment of neonatal hyperbilirubinemia. Neonatal jaundice is a risk factor for hearing loss.<ref>{{cite web|url=http://aapnews.aappublications.org/cgi/content/full/18/5/231 |title=Increased vigilance needed to prevent kernicterus in newborns --O�Keefe 18 (5): 231 -- AAP News |accessdate=2007-06-27 |format= |work=}}</ref>
| | {{Jaundice}} |
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| '''Jaundiced eye''' | | '''''Synonyms and keywords:''''' Icterus; hyperbilirubinemia, yellow discolouration. |
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| It was once believed persons suffering from the medical condition jaundice saw everything as yellow. By extension, the jaundiced eye came to mean a prejudiced view, usually rather negative or critical. [[Alexander Pope]], in 'An Essay on Criticism' (1711), wrote: "All seems infected that the infected spy, As all looks yellow to the jaundiced eye." <ref name=eye>From "The Dictionary of Cliches" by James Rogers (Ballantine Books, New York, 1985).</ref>
| | ==[[Jaundice overview|Overview]]== |
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| ==Pathophysiology== | | ==[[Jaundice historical perspective|Historical Perspective]]== |
| * Bilirubin is the major breakdown product of hemoglobin that is released from dying or damaged erythrocytes
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| * The normal bilirubin range is 0.3-1.0 mg/dL
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| * Jaundice is visible in conjunctiva, skin and mucosa when the serum bilirubin level rises above 2 mg/dL
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| ==Causes==
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| When [[red blood cell]]s die, the [[heme]] in their [[haemoglobin]] is converted to [[bilirubin]] in the [[spleen]] and in the hepatocytes in the liver. The [[bilirubin]] is processed by the [[liver]], enters [[bile]] and is eventually excreted through [[feces]].
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| Consequently, there are three different classes of causes for jaundice. ''Pre-hepatic'' or ''hemolytic'' causes, where too many red blood cells are broken down, ''hepatic'' causes where the processing of [[bilirubin]] in the liver does not function correctly, and ''post-hepatic'' or ''extrahepatic'' causes, where the removal of bile is disturbed.
| | ==[[Jaundice classification scheme|Classification]]== |
| ===Common Causes===
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| ===Causes by Organ System===
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| {|style="width:80%; height:100px" border="1"
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| |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
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| |style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Eclampsia]]
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| |-bgcolor="LightSteelBlue"
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| | '''Chemical / poisoning'''
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| |bgcolor="Beige"|[[1,2-Dibromoethane ]], [[2-acetylamino-fluorene ]], [[2-Nitropropane ]], [[3,3-Dichlorobenzidine ]], [[4-Dimethylaminoazobenzene ]], [[8-Hydroxyquinolone ]], [[Acer rubrum]], [[Acetates ]], [[Acetonitrile ]], [[Acetylene Tetrabromide ]], [[Acrylonitrile ]], [[Aflatoxin ]], [[Albitocin]], [[Alicyclic Hydrocarbons ]], [[Aliphatic Amines ]], [[Aliphatic Hydrocarbons ]], [[Aliphatic hydrogenated hydrocarbons ]], [[Allyl alcohol ]], [[Amanita phalloides]], [[Aromatic amines ]], [[Aromatic halogenated hydrocarbons ]], [[Aromatic Hydrocarbons ]], [[Arsenic ]], [[Arsine ]], [[Benzene ]], [[Benzyl chloride ]], [[Beryllium ]], [[Biliary colic]], [[Bipyridyl pesticides ]], [[Black nightshade poisoning ]], [[Boron ]], [[Cadmium ]], [[Carbarsone ]], [[Carbolic Acids and Anhydrides ]], [[Carbon Disulfide ]], [[Carbon Tetrachloride ]], [[Chloramphenicol ]], [[Chlorate salts ]], [[Chlordane]], [[Chlorinated benzenes ]], [[Chlorinated naphthalene ]], [[Chlorodiphenyls and derivatives ]], [[Chloroform]], [[Chloromethane ]], [[Chloroprene ]], [[Chromium ]], [[Comfrey ]], [[Copper ]], [[Cresol ]], [[Cycasin]], [[Cyclochlorotine ]], [[Dibromochloropropane ]], [[Diethylene Glycol ]], [[Dimethyl sulfate ]], [[Dimethylnitrosamine ]], [[Dinitrobenzene ]], [[Dinitrocresol ]], [[Dinitrophenol ]], [[Dinitrotoluene ]], [[Ethanolamines ]], [[Ethyl Acetate ]], [[Ethyl alcohol ]], [[Ethyl benzene ]], [[Ethyl Ether ]], [[Ethyl Salicylate ]], [[Ethylene chlorohydrin ]], [[Ethylene Dibromide ]], [[Ethylene dichloride ]], [[Ethylene oxide ]], [[Ethylenediamine ]], [[Germander ]], [[Germanium ]],, [[Gold ]], [[Hafnium ]], [[Horse nettle ]], [[Hydrogen bromides ]], [[Hydrogen Cyanide ]], [[Icterogenin]], [[Indospicine]], [[Isopropyl acetate ]], [[Kepone pesticides ]], [[Lanthanides ]], [[Lead ]], [[Mercaptans ]], [[Mercury ]], [[Methoxyflurane ]], [[Methyl acetate ]], [[Methyl Bromide ]], [[Methy, Chloride ]], [[Methylene chloride ]], [[Methylene Dianiline ]], [[Metolachlor]], [[Monomethylhydrazine]], [[N,N-Dimethylformamide ]], [[Naphthalene]], [[Naphthol ]], [[N-butyl acetate ]], [[Ngaione]], [[Nickel ]], [[Niobium ]], [[Nitriles ]], [[Nitrobenzene ]], [[Nitromethane ]], [[Nitroparaffins ]], [[N-N-Dimethylacetamide ]], [[N-Nitrosodimethylamine ]], [[N-propyl acetate ]], [[Ochratoxin ]], [[Para-Dichlorobenzene ]], [[Phosphine ]], [[Phosphorus]], [[Phthalic Anhydride ]], [[Picric Acid ]], [[Polybrominated biphenyls ]], [[Polychlorinated biphenyls ]], [[Polygonum multiflorum ]], [[Propylene dichloride ]], [[Psoralea Corylifolia ]], [[Pyrogallol ]], [[Pyrrolidizine]], [[Ragwort]], [[Rubratoxin ]], [[Safrole]], [[Solanine]], [[Solder ]], [[Sterigmatocystin ]], [[Stibine ]], [[Tellurium]], [[Tetrachloroethane]], [[Tetrachloroethylene ]], [[Tetramethylthiuram disulfide ]], [[Thallium]], [[Thioxanthene]], [[Thorium dioxide ]], [[Thorotrast , ]], [[Toluene ]], [[Trichloroethylene ]], [[Trinitrotoluene ]], [[Uranium ]], [[Vicia faba]], [[Vinyl Chloride ]], [[White Phosphorus ]], [[Xylene ]]
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| |-bgcolor="LightSteelBlue"
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| | '''Dermatologic'''
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| |bgcolor="Beige"|[[Griscelli disease ]], [[NISCH syndrome ]]
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| |-bgcolor="LightSteelBlue"
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| | '''Drug Side Effect'''
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| |bgcolor="Beige"|[[5-Fluorocytosine ]], [[Allopurinol ]], [[Alprazolam]], [[Amineptine]], [[Amiodarone]], [[Amlodipine]], [[Amodiaquine ]], [[Amphotericin ]], [[Anabolic C-17 ]], [[Bicalutamide]], [[Bromazepam]], [[Buprenorphine]], [[Butyrophenones]], [[Cefaclor]], [[Cephalosporins]], [[Cimetidine ]], [[Clarithromycin]], [[Clavulanic acid]], [[Clindamycin]], [[Co-amoxiclav]], [[Colchicine ]], [[Cyclopropane ]], [[Cycloserine ]], [[Cytarabine ]], [[Dantrolene ]], [[Dapsone]], [[Daptomycin]], [[Deracoxib]], [[Diazepam]], [[Diflunisal ]], [[Diphenoxylate and Atropine]], [[Disulfiram ]], [[Docetaxel]], [[Doxepine]], [[Duloxetine]], [[Dydrogesterone]], [[Erythromycin estolate ]], [[Erythromycin Ethyl succinate ]], [[Estrogen and Progestin]], [[Ethionamide ]], [[Fenoprofen ]], [[Flucloxacillin]], [[Framycetin]], [[Fusidic acid]], [[Griseofulvin ]], [[Halothane ]], [[Hycanthone ]], [[Ibuprofen ]], [[Idoxuridine ]], [[Imipramine]], [[Indomethacin ]], [[Isoniazid ]], [[Itraconazole]], [[Ketoconazole ]], [[Loprazolam]], [[Lorazepam]], [[Lormetazepam]], [[Mepacrine ]], [[Mephenytoin ]], [[Methimazole]], [[Methyldopa]], [[Metronidazole ]], [[Minocycline]], [[Mirtazapine]], [[Monoamine oxidase inhibitors]], [[Naproxen ]], [[Nitrofurantoin]], [[Nitrous Oxide ]], [[Novobiocin ]], [[Oxycodone]], [[p-aminosalicylic acid ]], [[Papaverine]], [[Paroxetine]], [[Penicillin ]], [[Phenol ]], [[Phenothiazine]], [[Phenylbutazone ]], [[Phenytoin ]], [[Pyridine ]], [[Quinidine-induced Immune Hemolytic Anemia]], [[Quinolone ]], [[Ranitidine ]], [[Rifampicin]], [[Salicylate ]], [[Sibutramine]], [[Spectinomycin ]], [[Sulindac ]], [[Sulphonamides]], [[Tamoxifen]], [[Tegaserod]], [[Telithromycin]], [[Tetracycline ]], [[Thiabendazole ]], [[Trazodone]], [[Valproic acid]], [[Vidarabine ]], [[Zoxazolamine ]],
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| |-bgcolor="LightSteelBlue"
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| | '''Ear Nose Throat'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Endocrine'''
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| |bgcolor="Beige"|[[Gestational diabetes]], [[Growth hormone deficiency]], [[Hypopitutarism]], [[Hypothyroidism]], [[Thyroid agenesis]]
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| |-bgcolor="LightSteelBlue"
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| | '''Environmental'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Gastroenterologic'''
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| |bgcolor="Beige"|[[Accessory pancreas]], [[Acinic cell carcinoma]], [[Acral dysostosis -- dyserythropoiesis ]], [[Acute Cholecystitis]], [[Acute fatty liver of pregnancy]], [[Acute hepatitis]], [[Acute liver failure]], [[Addison-Gull syndrome]], [[Alagille syndrome]], [[Alcoholic Hepatitis]], [[Alcoholic liver disease]], [[Angiosarcoma of the liver ]], [[Arthrogryposis -- renal dysfunction -- cholestasis syndrome ]], [[Ascending cholangitis]], [[Autoimmune Hepatitis ]], [[Baber's syndrome ]], [[Banti's syndrome]], [[Bile duct cancer]], [[Bile duct paucity, non syndromic form ]], [[Bile plug syndrome ]], [[Biliary atresia]], [[Biliary cirrhosis ]], [[Budd-Chiari syndrome]], [[Byler Disease ]], [[Caroli's Disease]], [[Chlorpropamide]], [[Cholangiocarcinoma]], [[Cholangitis]], [[Choledochal cyst, hand malformation ]], [[Choledochal cysts]], [[Choledocholithiasis]], [[Cholestasis ]], [[Cholestasis -- pigmentary retinopathy -- cleft palate ]], [[Chronic cholecystitis]], [[Chronic Hepatitis ]], [[Cirrhosis o, liver ]], [[Colorectal cancer]], [[Crigler-Najjar syndrome]], [[Eosinophilic gastroenteritis]], [[Esophageal cancer]], [[Gallbladder cancer]], [[Gallstones ]], [[Gilbert's syndrome]], [[Hemosuccus pancreaticus]], [[Hepatic amyloidosis with intrahepatic cholestasis ]], [[Hepatic encephalopathy syndrome ]], [[Hepatoma ]], [[Hyperemesis gravidarum]], [[Idiopathic liver cirrhosis ]], [[Intrahepatic cholangiocarcinoma ]], [[Intrahepatic cholestasis of pregnancy]], [[Islet Cell adenoma]], [[Liver cancer ]], [[Mirizzi's syndrome]], [[Mosse syndrome ]], [[Neonatal hepatitis ]], [[Neuroma biliary tract ]], [[Non-alcoholic fatty liver disease]], [[Obliterative portal venopathy ]], [[Pancreatic adenoma]], [[Pancreatic cancer]], [[Pancreatitis]], [[Pancreatoblastoma]], [[Papillary stenosis]], [[Peliosis hepatis]], [[Portal hypertension]], [[Primary biliary cirrhosis]], [[Primary sclerosing cholangitis]], [[Sarcoma botryoides of common bile duct]], [[Secondary Biliary Cirrhosis]], [[Spleen Cance, ]], [[Xanthogranulomatous cholecystitis]], [[Xanthomatous biliary cirrhosis]], [[Zieve's syndrome]]
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| |-bgcolor="LightSteelBlue"
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| | '''Genetic'''
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| |bgcolor="Beige"|[[Aagenaes syndrome ]], [[Aldolase A deficiency ]], [[Benign intrahepatic cholestasis ]], [[Chediak-Higashi syndrome ]], [[Cholesteryl ester storage disease]], [[Dubin-Johnson syndrome]], [[Exocrine Pancreatic Insufficiency, Dyserythropoietic Anemia, And Calvarial Hyperostosis ]], [[Familial progressive intrahepatic cholestasis ]], [[Familial Selective Vitamin B12 Malabsorption ]], [[Galactosemia ]], [[Glucose-6-phosphate dehydrogenase deficiency]], [[Glutaric aciduria ]], [[Hemochromatosis ]], [[Hereditary elliptocytosis ]], [[Hereditary fructose intolerance]], [[Hereditary xerocytosis]], [[Imerslund-Najman-Grasbeck Syndrome ]], [[Lucey-Driscoll syndrome]], [[Lymphoproliferative syndrome, EBV-Associated, Autosomal]], [[Niemann-Pick disease ]], [[Porphyria]], [[Progressive familial intrahepatic cholestasis (PFIC) ]], [[Pseudo-torch syndrome]], [[Rotor syndrome]], [[Sotos syndrome]], [[Summerskill-Walshe-Tygstrup syndrome]], [[Trichomegaly cataract hereditary spherocytosis]], [[Tyrosinemia]], , [Wilson's Disease]], [[Wolman disease]], [[X-linked alpha thalassemia mental retardation syndrome (ATR-X)]], [[X-linked lymphoproliferative syndrome]], [[X-linked sideroblastic anaemia]], [[Zellweger syndrome]]
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| |-bgcolor="LightSteelBlue"
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| | '''Hematologic'''
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| |bgcolor="Beige"|[[Achrestic anemia]], [[Autoimmune hemolytic anemia]], [[Evans syndrome]], [[Fanconi-ichthyosis-dysmorphism ]], [[Favism ]], [[Hashimoto-Pritzker syndrome ]], [[HELLP syndrome ]], [[Hemoglobin C homozygous (CC) ]], [[Hemolytic anemia]], [[Hemolytic disease of the newborn]], [[Hemophagocytic lymphohistiocytosis familial]] ,[[Hepatic veno-occlusive disease with immunodeficiency ]], [[Heptaosplenic T-cell Lymphoma ]], [[Hereditary spherocytosis]], [[HLH (Hemophagocytic lymphohistiocytosis)]], [[Hodgkin's Disease ]], [[Kawasaki disease ]], [[Langerhans Cell Histiocytosis ]], [[Lymphoma ]], [[Myelofibrosis-osteosclerosis ]] ,[[Pernicious anemia]], [[Rh deficiency syndrome]], [[Thalassemia]], [[Thrombotic thrombocytopenic purpura]],
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| |-bgcolor="LightSteelBlue"
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| | '''Iatrogenic'''
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| |bgcolor="Beige"|[[Post operative jaundice]] | |
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| |-bgcolor="LightSteelBlue"
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| | '''Infectious Disease'''
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| |bgcolor="Beige"|[[Alveolar Hydatid Disease .]], [[Aspergillosis]], [[Congenital TORCH infections]], [[Fascioliasis ]], [[Infective endocarditis ]], [[Malignant boutonneuse fever]], [[Nanukayami ]], [[Neonatal sepsis ]], [[Omphalitis]], [[Pneumonia]], [[Sepsis]], [[Tuberculosis]], [[Q fever]], [[Relapsing fever]], [[Syphilis]], [[Weil's disease]], [[Histoplasmosis]], [[Malaria ]], [[Cytomegalovirus]], [[Hepadnaviruses ]], [[Herpes]], [[Infectious mononucleosis]], [[Lábrea fever]], [[Marburg virus]], [[Viral Hepatitis A]], [[Viral Hepatitis B]], [[Viral Hepatitis C]], [[Viral Hepatitis D]], [[Viral Hepatitis E]], [[Viral hepatitis X (non-A,-B,-C,-D,-E)]]
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| |-bgcolor="LightSteelBlue"
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| | '''Musculoskeletal / Ortho'''
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| |bgcolor="Beige"|[[Deal-Barratt-Dillon syndrome ]]
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| |-bgcolor="LightSteelBlue"
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| | '''Neurologic'''
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| |bgcolor="Beige"|[[Absence of septum pellucidum and septo-optic dysplasia ]], [[Acute meningitis]],
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| |-bgcolor="LightSteelBlue"
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| | '''Nutritional / Metabolic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Obstetric/Gynecologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Oncologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Opthalmologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Overdose / Toxicity'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Psychiatric'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Pulmonary'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Renal / Electrolyte'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Rheum / Immune / Allergy'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Sexual'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Trauma'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Urologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Dental'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Miscellaneous'''
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| |bgcolor="Beige"| No underlying causes
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| |}
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| ===Causes in Alphabetical Order=== | | ==[[Jaundice pathophysiology|Pathophysiology]]== |
| {{MultiCol}}
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| *[[1,2-Dibromoethane ]]
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| *[[2-acetylamino-fluorene ]]
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| *[[2-Nitropropane ]]
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| *[[3,3-Dichlorobenzidine ]]
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| *[[4-Dimethylaminoazobenzene ]]
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| *[[5-Fluorocytosine ]]
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| *[[8-Hydroxyquinolone ]]
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| *[[Aagenaes syndrome ]]
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| *[[Absence of septum pellucidum and septo-optic dysplasia ]]
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| *[[Accessory pancreas]]
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| *[[Acer rubrum]]
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| *[[Acetaminophen]]
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| *[[Acetates ]]
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| *[[Acetonitrile ]]
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| *[[Acetylene Tetrabromide ]]
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| *[[Achrestic anemia]]
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| *[[Acinic cell carcinoma]]
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| *[[Acral dysostosis -- dyserythropoiesis ]]
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| *[[Acrylonitrile ]]
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| *[[Acute Cholecystitis]]
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| *[[Acute fatty liver of pregnancy]]
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| *[[Acute hepatitis]]
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| *[[Acute liver failure]]
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| *[[Acute meningitis]]
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| *[[Addison-Gull syndrome]]
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| *[[Aflatoxin ]]
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| *[[Alagille syndrome]]
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| *[[Albitocin]]
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| *[[Alcoholic Hepatitis]]
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| *[[Alcoholic liver disease]]
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| *[[Aldolase A deficiency ]]
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| *[[Alicyclic Hydrocarbons ]]
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| *[[Aliphatic Amines ]]
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| *[[Aliphatic Hydrocarbons ]]
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| *[[Aliphatic hydrogenated hydrocarbons ]]
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| *[[Allopurinol ]]
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| *[[Allyl alcohol ]]
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| *[[Alpha 1-Antitrypsin Deficiency ]]
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| *[[Alprazolam]]
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| *[[Alveolar Hydatid Disease .]]
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| *[[Amanita phalloides]]
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| *[[Amineptine]]
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| *[[Amiodarone]]
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| *[[Amlodipine]]
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| *[[Amodiaquine ]]
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| *[[Amphotericin ]]
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| *[[Anabolic C-17 ]]
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| *[[Angiosarcoma of the liver ]]
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| *[[Aromatic amines ]]
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| *[[Aromatic halogenated hydrocarbons ]]
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| *[[Aromatic Hydrocarbons ]]
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| *[[Arsenic ]]
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| *[[Arsine ]]
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| *[[Arthrogryposis -- renal dysfunction -- cholestasis syndrome ]]
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| *[[Ascending cholangitis]]
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| *[[Aspergillosis]]
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| *[[Autoimmune hemolytic anemia]]
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| *[[Autoimmune Hepatitis ]]
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| *[[Baber's syndrome ]]
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| *[[Babesiosis ]]
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| *[[Banti's syndrome]]
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| *[[Benign intrahepatic cholestasis ]]
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| *[[Benzene ]]
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| *[[Benzyl chloride ]]
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| *[[Beryllium ]]
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| *[[Bicalutamide]]
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| *[[Bile duct cancer]]
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| *[[Bile duct paucity, non syndromic form ]]
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| *[[Bile plug syndrome ]]
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| *[[Biliary atresia]]
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| *[[Biliary cirrhosis ]]
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| *[[Biliary colic]]
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| *[[Bipyridyl pesticides ]]
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| *[[Black nightshade poisoning ]]
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| *[[Boron ]]
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| *[[Breast cancer]]
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| *[[Breast feeding jaundice]]
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| *[[Breast milk jaundice ]]
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| *[[Bromazepam]]
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| *[[Brown Recluse spider bite ]]
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| *[[Budd-Chiari syndrome]]
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| *[[Buprenorphine]]
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| *[[Butyrophenones]]
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| *[[Byler Disease ]]
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| *[[Cadmium ]]
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| *[[Carbarsone ]]
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| *[[Carbolic Acids and Anhydrides ]]
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| *[[Carbon Disulfide ]]
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| *[[Carbon Tetrachloride ]]
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| *[[Caroli's Disease]]
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| *[[Cefaclor]]
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| *[[Cephalhematoma]]
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| *[[Cephalosporins]]
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| *[[Chediak-Higashi syndrome ]]
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| *[[Chloramphenicol ]]
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| *[[Chlorate salts ]]
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| *[[Chlordane]]
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| *[[Chlorinated benzenes ]]
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| *[[Chlorinated naphthalene ]]
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| *[[Chlorodiphenyls and derivatives ]]
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| *[[Chloroform]]
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| *[[Chloromethane ]]
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| *[[Chloroprene ]]
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| *[[Chlorpropamide]]
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| *[[Cholangiocarcinoma]]
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| *[[Cholangitis]]
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| *[[Choledochal cyst, hand malformation ]]
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| *[[Choledochal cysts]]
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| *[[Choledocholithiasis]]
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| *[[Cholestasis ]]
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| *[[Cholestasis -- pigmentary retinopathy -- cleft palate ]]
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| *[[Cholesteryl ester storage disease]]
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| *[[Chromium ]]
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| *[[Chronic cholecystitis]]
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| {{ColBreak}}
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| *[[Chronic Hepatitis ]]
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| *[[Cimetidine ]]
| |
| *[[Cirrhosis of liver ]]
| |
| *[[Clarithromycin]]
| |
| *[[Clavulanic acid]]
| |
| *[[Clindamycin]]
| |
| *[[Co-amoxiclav]]
| |
| *[[Colchicine ]]
| |
| *[[Colorectal cancer]]
| |
| *[[Comfrey ]]
| |
| *[[Congenital disorders of glycosylation]]
| |
| *[[Congenital TORCH infections]]
| |
| *[[Copper ]]
| |
| *[[Cresol ]]
| |
| *[[Crigler-Najjar syndrome]]
| |
| *[[Cycasin]]
| |
| *[[Cyclochlorotine ]]
| |
| *[[Cyclopropane ]]
| |
| *[[Cycloserine ]]
| |
| *[[Cytarabine ]]
| |
| *[[Cytomegalovirus]]
| |
| *[[Dantrolene ]]
| |
| *[[Dapsone]]
| |
| *[[Daptomycin]]
| |
| *[[Deal-Barratt-Dillon syndrome ]]
| |
| *[[Deracoxib]]
| |
| *[[Diazepam]]
| |
| *[[Dibromochloropropane ]]
| |
| *[[Diethylene Glycol ]]
| |
| *[[Diflunisal ]]
| |
| *[[Dimethyl sulfate ]]
| |
| *[[Dimethylnitrosamine ]]
| |
| *[[Dinitrobenzene ]]
| |
| *[[Dinitrocresol ]]
| |
| *[[Dinitrophenol ]]
| |
| *[[Dinitrotoluene ]]
| |
| *[[Diphenoxylate and Atropine]]
| |
| *[[Disulfiram ]]
| |
| *[[Docetaxel]]
| |
| *[[Doxepine]]
| |
| *[[Dubin-Johnson syndrome]]
| |
| *[[Duloxetine]]
| |
| *[[Dydrogesterone]]
| |
| *[[Eclampsia ]]
| |
| *[[Embryonal rhabdomyosarcoma]]
| |
| *[[Eosinophilic gastroenteritis]]
| |
| *[[Erythromycin estolate ]]
| |
| *[[Erythromycin Ethyl succinate ]]
| |
| *[[Esophageal cancer]]
| |
| *[[Estrogen and Progestin]]
| |
| *[[Ethanolamines ]]
| |
| *[[Ethionamide ]]
| |
| *[[Ethyl Acetate ]]
| |
| *[[Ethyl alcohol ]]
| |
| *[[Ethyl benzene ]]
| |
| *[[Ethyl Ether ]]
| |
| *[[Ethyl Salicylate ]]
| |
| *[[Ethylene chlorohydrin ]]
| |
| *[[Ethylene Dibromide ]]
| |
| *[[Ethylene dichloride ]]
| |
| *[[Ethylene oxide ]]
| |
| *[[Ethylenediamine ]]
| |
| *[[Evans syndrome]]
| |
| *[[Exocrine Pancreatic Insufficiency, Dyserythropoietic Anemia, And Calvarial Hyperostosis ]]
| |
| *[[Familial progressive intrahepatic cholestasis ]]
| |
| *[[Familial Selective Vitamin B12 Malabsorption ]]
| |
| *[[Fanconi-ichthyosis-dysmorphism ]]
| |
| *[[Fascioliasis ]]
| |
| *[[Favism ]]
| |
| *[[Fenoprofen ]]
| |
| *[[Flucloxacillin]]
| |
| *[[Framycetin]]
| |
| *[[Fructose intolerance]]
| |
| *[[Fusidic acid]]
| |
| *[[Galactosemia ]]
| |
| *[[Gallbladder cancer]]
| |
| *[[Gallstones ]]
| |
| *[[Germander ]]
| |
| *[[Germanium ]]
| |
| *[[Gestational diabetes]]
| |
| *[[Gilbert's syndrome]]
| |
| *[[Glucose-6-phosphate dehydrogenase deficiency]]
| |
| *[[Glutaric aciduria ]]
| |
| *[[Gold ]]
| |
| *[[Goldstein-Hutt syndrome ]]
| |
| *[[Graft-versus-host disease ]]
| |
| *[[Griscelli disease ]]
| |
| *[[Griseofulvin ]]
| |
| *[[Growth hormone deficiency]]
| |
| *[[Hafnium ]]
| |
| *[[Halothane ]]
| |
| *[[Hashimoto-Pritzker syndrome ]]
| |
| *[[HELLP syndrome ]]
| |
| *[[Hemochromatosis ]]
| |
| *[[Hemoglobin C homozygous (CC) ]]
| |
| *[[Hemolytic anemia]]
| |
| *[[Hemolytic disease of the newborn]]
| |
| *[[Hemophagocytic lymphohistiocytosis familial]]
| |
| *[[Hemosuccus pancreaticus]]
| |
| *[[Hepadnaviruses ]]
| |
| *[[Hepatic amyloidosis with intrahepatic cholestasis ]]
| |
| *[[Hepatic encephalopathy syndrome ]]
| |
| *[[Hepatic trauma]]
| |
| *[[Hepatic veno-occlusive disease with immunodeficiency ]]
| |
| *[[Hepatoma ]]
| |
| *[[Heptaosplenic T-cell Lymphoma ]]
| |
| *[[Hereditary elliptocytosis ]]
| |
| *[[Hereditary fructose intolerance]]
| |
| *[[Hereditary spherocytosis]]
| |
| *[[Hereditary xerocytosis]]
| |
| *[[Herpes]]
| |
| *[[Histoplasmosis]]
| |
| *[[HLH (Hemophagocytic lymphohistiocytosis)]]
| |
| *[[Hodgkin's Disease ]]
| |
| {{ColBreak}}
| |
| *[[Horse nettle ]]
| |
| *[[Hycanthone ]]
| |
| *[[Hydrogen bromides ]]
| |
| *[[Hydrogen Cyanide ]]
| |
| *[[Hyperemesis gravidarum]]
| |
| *[[Hypopitutarism]]
| |
| *[[Hypothyroidism]]
| |
| *[[Ibuprofen ]]
| |
| *[[Icterogenin]]
| |
| *[[Idiopathic liver cirrhosis ]]
| |
| *[[Idoxuridine ]]
| |
| *[[Imerslund-Najman-Grasbeck Syndrome ]]
| |
| *[[Imipramine]]
| |
| *[[Indomethacin ]]
| |
| *[[Indospicine]]
| |
| *[[Infectious mononucleosis]]
| |
| *[[Infective endocarditis ]]
| |
| *[[Intrahepatic cholangiocarcinoma ]]
| |
| *[[Intrahepatic cholestasis of pregnancy]]
| |
| *[[Iron ]]
| |
| *[[Islet Cell adenoma]]
| |
| *[[Isoniazid ]]
| |
| *[[Isopropyl acetate ]]
| |
| *[[Itraconazole]]
| |
| *[[Kaposiform hemangio-endothelioma ]]
| |
| *[[Kawasaki disease ]]
| |
| *[[Kepone pesticides ]]
| |
| *[[Ketoconazole ]]
| |
| *[[Lábrea fever]]
| |
| *[[Langerhans Cell Histiocytosis ]]
| |
| *[[Lanthanides ]]
| |
| *[[Lead ]]
| |
| *[[Leiomyosarcoma ]]
| |
| *[[Lissencephalic syndromes]]
| |
| *[[Liver cancer ]]
| |
| *[[Loprazolam]]
| |
| *[[Lorazepam]]
| |
| *[[Lormetazepam]]
| |
| *[[Lucey-Driscoll syndrome]]
| |
| *[[Lupus]]
| |
| *[[Lymphoma ]]
| |
| *[[Lymphoproliferative syndrome, EBV-Associated, Autosomal]]
| |
| *[[Malaria ]]
| |
| *[[Malignant boutonneuse fever]]
| |
| *[[Manganese deficiency]]
| |
| *[[Marburg virus]]
| |
| *[[Mepacrine ]]
| |
| *[[Mephenytoin ]]
| |
| *[[Mercaptans ]]
| |
| *[[Mercury ]]
| |
| *[[Mesothelioma]]
| |
| *[[Methimazole]]
| |
| *[[Methoxyflurane ]]
| |
| *[[Methyl acetate ]]
| |
| *[[Methyl Bromide ]]
| |
| *[[Methyl Chloride ]]
| |
| *[[Methyldopa]]
| |
| *[[Methylene chloride ]]
| |
| *[[Methylene Dianiline ]]
| |
| *[[Metolachlor]]
| |
| *[[Metronidazole ]]
| |
| *[[Minocycline]]
| |
| *[[Mirizzi's syndrome]]
| |
| *[[Mirtazapine]]
| |
| *[[Molybdenum deficiency]]
| |
| *[[Monoamine oxidase inhibitors]]
| |
| *[[Monomethylhydrazine]]
| |
| *[[Mosse syndrome ]]
| |
| *[[Myelofibrosis-osteosclerosis ]]
| |
| *[[N,N-Dimethylformamide ]]
| |
| *[[Nanukayami ]]
| |
| *[[Naphthalene]]
| |
| *[[Naphthol ]]
| |
| *[[Naproxen ]]
| |
| *[[N-butyl acetate ]]
| |
| *[[Neonatal adrenal hemorrhage]]
| |
| *[[Neonatal hepatitis ]]
| |
| *[[Neonatal physiological jaundice]]
| |
| *[[Neonatal sepsis ]]
| |
| *[[Neuroma biliary tract ]]
| |
| *[[Ngaione]]
| |
| *[[Nickel ]]
| |
| *[[Niemann-Pick disease ]]
| |
| *[[Niobium ]]
| |
| *[[NISCH syndrome ]]
| |
| *[[Nitriles ]]
| |
| *[[Nitrobenzene ]]
| |
| *[[Nitrofurantoin]]
| |
| *[[Nitromethane ]]
| |
| *[[Nitroparaffins ]]
| |
| *[[Nitrous Oxide ]]
| |
| *[[N-N-Dimethylacetamide ]]
| |
| *[[N-Nitrosodimethylamine ]]
| |
| *[[Non-alcoholic fatty liver disease]]
| |
| *[[Novobiocin ]]
| |
| *[[N-propyl acetate ]]
| |
| *[[Obliterative portal venopathy ]]
| |
| *[[Ochratoxin ]]
| |
| *[[Omphalitis]]
| |
| *[[Organic acidemia]]
| |
| *[[Oxycodone]]
| |
| *[[p-aminosalicylic acid ]]
| |
| *[[Pancreatic adenoma]]
| |
| *[[Pancreatic cancer]]
| |
| *[[Pancreatitis]]
| |
| *[[Pancreatoblastoma]]
| |
| *[[Papaverine]]
| |
| *[[Papillary stenosis]]
| |
| *[[Para-Dichlorobenzene ]]
| |
| *[[Paroxetine]]
| |
| *[[Peliosis hepatis]]
| |
| *[[Penicillin ]]
| |
| *[[Pernicious anemia]]
| |
| *[[Phenol ]]
| |
| {{ColBreak}}
| |
| *[[Phenothiazine]]
| |
| *[[Phenylbutazone ]]
| |
| *[[Phenytoin ]]
| |
| *[[Phosphine ]]
| |
| *[[Phosphorus]]
| |
| *[[Phthalic Anhydride ]]
| |
| *[[Picric Acid ]]
| |
| *[[Pneumonia]]
| |
| *[[Polybrominated biphenyls ]]
| |
| *[[Polychlorinated biphenyls ]]
| |
| *[[Polygonum multiflorum ]]
| |
| *[[Porphyria]]
| |
| *[[Portal hypertension]]
| |
| *[[Postoperative Jaundice]]
| |
| *[[Premature birth]]
| |
| *[[Primary biliary cirrhosis]]
| |
| *[[Primary sclerosing cholangitis]]
| |
| *[[Progressive familial intrahepatic cholestasis (PFIC) ]]
| |
| *[[Propylene dichloride ]]
| |
| *[[Pseudo-torch syndrome]]
| |
| *[[Psoralea Corylifolia ]]
| |
| *[[Pyridine ]]
| |
| *[[Pyrogallol ]]
| |
| *[[Pyrrolidizine]]
| |
| *[[Pyruvate kinase deficiency]]
| |
| *[[Q fever]]
| |
| *[[Quinidine-induced Immune Hemolytic Anemia]]
| |
| *[[Quinolone ]]
| |
| *[[Ragwort]]
| |
| *[[Ranitidine ]]
| |
| *[[Relapsing fever]]
| |
| *[[Reye's syndrome]]
| |
| *[[Reynolds syndrome]]
| |
| *[[Rh deficiency syndrome]]
| |
| *[[Rh disease]]
| |
| *[[Rifampicin]]
| |
| *[[Rotor syndrome]]
| |
| *[[Rubratoxin ]]
| |
| *[[Safrole]]
| |
| *[[Salicylate ]]
| |
| *[[Sarcoidosis]]
| |
| *[[Sarcoma botryoides of common bile duct]]
| |
| *[[Secondary Biliary Cirrhosis]]
| |
| *[[Selenium deficiency]]
| |
| *[[Sepsis]]
| |
| *[[Sibutramine]]
| |
| *[[Solanine]]
| |
| *[[Solder ]]
| |
| *[[Sotos syndrome]]
| |
| *[[Spectinomycin ]]
| |
| *[[Spleen Cancer]]
| |
| *[[Sterigmatocystin ]]
| |
| *[[Stibine ]]
| |
| *[[Sulindac ]]
| |
| *[[Sulphonamides]]
| |
| *[[Summerskill-Walshe-Tygstrup syndrome]]
| |
| *[[Syphilis]]
| |
| *[[Tamoxifen]]
| |
| *[[Tegaserod]]
| |
| *[[Telithromycin]]
| |
| *[[Tellurium]]
| |
| *[[Tetrachloroethane]]
| |
| *[[Tetrachloroethylene ]]
| |
| *[[Tetracycline ]]
| |
| *[[Tetramethylthiuram disulfide ]]
| |
| *[[Thalassemia]]
| |
| *[[Thallium]]
| |
| *[[Thiabendazole ]]
| |
| *[[Thioxanthene]]
| |
| *[[Thorium dioxide ]]
| |
| *[[Thorotrast ]]
| |
| *[[Thrombotic thrombocytopenic purpura]]
| |
| *[[Thyroid agenesis]]
| |
| *[[Toluene ]]
| |
| *[[Transfusion Reaction]]
| |
| *[[Trazodone]]
| |
| *[[Trichloroethylene ]]
| |
| *[[Trichomegaly cataract hereditary spherocytosis]]
| |
| *[[Trinitrotoluene ]]
| |
| *[[Tuberculosis]]
| |
| *[[Tyrosinemia]]
| |
| *[[Uranium ]]
| |
| *[[Valproic acid]]
| |
| *[[Vicia faba]]
| |
| *[[Vidarabine ]]
| |
| *[[Vinyl Chloride ]]
| |
| *[[Viral Hepatitis A]]
| |
| *[[Viral Hepatitis B]]
| |
| *[[Viral Hepatitis C]]
| |
| *[[Viral Hepatitis D]]
| |
| *[[Viral Hepatitis E]]
| |
| *[[Viral hepatitis X (non-A,-B,-C,-D,-E)]]
| |
| *[[Vitamin A overdose]]
| |
| *[[Vitamin B12 Deficiency]]
| |
| *[[Vitamin C ]]
| |
| *[[Weil's disease]]
| |
| *[[White Phosphorus ]]
| |
| *[[Wilson's Disease]]
| |
| *[[Wolman disease]]
| |
| *[[Xanthogranulomatous cholecystitis]]
| |
| *[[Xanthomatous biliary cirrhosis]]
| |
| *[[X-linked alpha thalassemia mental retardation syndrome (ATR-X)]]
| |
| *[[X-linked lymphoproliferative syndrome]]
| |
| *[[X-linked sideroblastic anaemia]]
| |
| *[[Xylene ]]
| |
| *[[Yellow fever]]
| |
| *[[Zellweger syndrome]]
| |
| *[[Zieve's syndrome]]
| |
| *[[Zoxazolamine ]]
| |
| {{EndMultiCol}}
| |
|
| |
|
| ===Differential Diagnosis<ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:98</ref><ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:51-54</ref> === | | ==[[Jaundice causes|Causes]]== |
| * Abdominal mass
| |
| * Acute [[alcoholic hepatitis]]
| |
| * [[Alcoholic Hepatitis]]
| |
| * [[Alpha-1 Antitrypsin Deficiency ]]
| |
| * [[Amyloidosis]]
| |
| * Annular pancreas
| |
| * Autoimmune [[hepatitis]]
| |
| * Autoimmunohemolysis
| |
| * Benign recurring cholestasis
| |
| * [[Bile duct tumor]]
| |
| * [[Biliary atresia]]
| |
| * Biliary tract obstruction
| |
| * [[Cholangitis]]
| |
| * [[Cholecystitis]]
| |
| * [[Choledocholithiasis]]
| |
| * [[Choledochal cyst]]
| |
| * Conditions following [[hemorrhage]]
| |
| * [[Congestive Heart Failure]]
| |
| * [[Crigler-Najjar Syndrome]]
| |
| * [[Cystic Fibrosis]]
| |
| * [[Cytomegalovirus]] (CMV)
| |
| * Decompensated [[cirrhosis]]
| |
| * [[Dubin-Johnson Syndrome]]
| |
| * [[Drugs]] and toxins
| |
| * [[Eclampsia]]
| |
| * [[Epstein-Barr Virus]] (EBV)
| |
| * Fetal [[erythroblastosis]]
| |
| * Following [[hemolytic disease of the newborn]] syndrome
| |
| * [[Galactosemia]]
| |
| * [[Gallbladder tumor]]
| |
| * [[Gilbert's Syndrome]]
| |
| * [[Glucose-6-phosphate dehydrogenase deficiency]]
| |
| * [[Graft-versus-host disease]]
| |
| * [[HELLP Syndrome]] ('''H'''emolysis, '''E'''levated '''L'''iver enzymes, '''L'''ow '''P'''latelet count)
| |
| * Hepatic trauma
| |
| * [[Hepatitis]]
| |
| * Hepatotoxic liver damage
| |
| * Hyperbilirubinemia after heart surgery
| |
| * Hyperbilirubinemia after portocaval shunt insertion
| |
| * [[Hyperemesis gravidarum]]
| |
| * Hypermethioninemia
| |
| * [[Hypopituitarism]]
| |
| * [[Hypothyroidism]]
| |
| * Intrauterine viral infections
| |
| * Intrahepatic cholestasis of [[pregnancy]]
| |
| * Intrahepatic and extrahepatic [[biliary atresia]]
| |
| * Intravascular [[hemolysis]]
| |
| * Jaundice of newborn
| |
| * [[Liver abscess]]
| |
| * Liver allograft rejection
| |
| * [[Liver cell carcinoma]]
| |
| * [[Lucey-Driscoll Syndrome]]
| |
| * [[Lymphoma]]
| |
| * [[Malignancy]]
| |
| * Neonatal [[hepatitis]]
| |
| * Nonalcoholic steatohepatitis or [[non-alcoholic fatty liver disease]]
| |
| * [[Pancreatic cancer]]
| |
| * [[Pancreatitis]]
| |
| * [[Parasite]]s
| |
| * [[Pernicious anemia]]
| |
| * [[Polycythemia vera]]
| |
| * Postoperative jaundice
| |
| * [[Primary biliary cirrhosis]]
| |
| * [[Hyperbilirubinemia|Primary hyperbilirubinemia]]
| |
| * [[Primary sclerosing cholangitis]]
| |
| * [[Rotor's Syndrome]]
| |
| * [[Sarcoidosis]]
| |
| * [[Sepsis]]
| |
| * [[Shock]]
| |
| * [[Sickle Cell Anemia]]
| |
| * [[Spherocytosis]]
| |
| * Storage diseases
| |
| * Strictures
| |
| * [[Thalassemia]]
| |
| * Total parenteral nutrition
| |
| * [[Transfusion]] reaction
| |
| * [[Trisomy 18]]
| |
| * [[Tuberculosis]]
| |
| * [[Tyrosinemia]]
| |
| * [[Viral hepatitis]] ([[Hepatitis A|A]], [[Hepatitis B|B]], [[Hepatitis C|C]], [[Hepatitis D|D]], [[Hepatitis E|E]])
| |
|
| |
|
| == Diagnosis == | | ==[[Jaundice differential diagnosis|Differentiating Jaundice from other Conditions]]== |
| === History ===
| |
| The caregiver should ask questions regarding
| |
| * Alcohol/hepatotoxic medication use
| |
|
| |
|
| '''Various Symptoms'''
| | ==[[Jaundice epidemiology and demographics|Epidemiology and Demographics]]== |
| * '''Alcohol Hepatitis'''
| |
| *:* Aspartate aminotransferase:alanine aminotransferase ratio > 2 (AST:ALT)
| |
| *:* [[Ddx:Fever|Fever]]
| |
| *:* [[Leukocytosis]]
| |
| * '''Viral Hepatitis'''
| |
| *:* [[Anorexia]]
| |
| *:* Dark urine
| |
| *:* [[Ddx:Fatigue|Fatigue]]
| |
| *:* [[Hepatomegaly]]
| |
| *:* Light-colored (acholic) loss stools
| |
| *:* [[Ddx:Nausea and Vomiting|Nausea]]
| |
| *:* [[Ddx:Pruritis|Pruritis]]
| |
| *:* [[Abdominal pain|Right upper quadrant (RUQ) pain]]
| |
| *:* [[Nausea and Vomiting]]
| |
|
| |
|
| ===Physical Examination=== | | ==[[Jaundice risk factors|Risk Factors]]== |
| * Complete physical exam including evidence of:
| |
| *:* [[Ddx:Hepatomegaly|Hepatomegaly]]
| |
| *:* [[Ddx:Splenomegaly|Splenomegaly]]
| |
| *:* Palpable gallbladder
| |
| *:* Signs of chronic liver disease
| |
| '''Appearance of the Patient'''
| |
| '''Skin'''
| |
| * Jaundice is visible in conjunctiva, skin and mucosa when the serum bilirubin level rises above 2 mg/dL
| |
| '''Eyes'''
| |
| * Jaundice is usually best seen in the periphery of the ocular conjunctivae
| |
| '''Abdomen'''
| |
| * Hepatomegaly may be present
| |
| '''Neurologic'''
| |
| * A flap may be present
| |
|
| |
|
| ===Laboratory Findings=== | | ==[[Jaundice screening|Screening]]== |
| * Total and unconjugated bilirubin
| |
| * Aspartate aminotransferase
| |
| * Alanine aminotransferase
| |
| * Albumin
| |
| * Alkaline phosphatase
| |
| * HIV serologies
| |
| * Hepatitis serologies
| |
| * Antinuclear antibody (ANA)
| |
| * Antimitochondrial antibodies
| |
| * Haptoglobin
| |
| * Reticulocyte count
| |
| * Lactic dehydrogenase (LDH)
| |
|
| |
|
| ''''''Pre-hepatic'''''' -(or hemolytic) jaundice is caused by anything which causes an increased rate of [[hemolysis]] (breakdown of [[red blood cell]]s). In tropical countries, [[malaria]] can cause jaundice in this manner. Certain [[Genetic disorder|genetic diseases]], such as[[sickle cell anemia]] and [[glucose 6-phosphate dehydrogenase deficiency]] can lead to increased red cell lysis and therefore hemolytic jaundice. Commonly, diseases of the kidney, such as [[hemolytic uremic syndrome]], can also lead to coloration. Defects in [[bilirubin metabolism]] also present as jaundice. Jaundice usually comes with high fevers.
| | ==[[Jaundice natural history|Natural History, Complications and Prognosis]]== |
|
| |
|
| The laboratory findings include
| | ==Diagnosis== |
| * Urine: no bilirubin present, urobilirubin > 2 units (except in infants where [[gut flora]] has not developed).
| | [[Jaundice history & symptoms|History and Symptoms]] | [[Jaundice physical examination|Physical Examination]] | [[Jaundice lab tests|Laboratory Findings]] | [[Jaundice chest x ray|Chest X Ray]] | [[Jaundice CT|CT]] | [[Jaundice MRI|MRI]] | [[Jaundice echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Jaundice other imaging findings|Other Imaging Findings]] | [[Jaundice other diagnostic studies|Other Diagnostic Studies]] |
| * Serum: increased unconjugated bilirubin.
| |
| | |
| | |
| ''''''Hepatic causes'''''' include acute [[hepatitis]], [[hepatotoxicity]] and [[alcoholic liver disease]], whereby cell necrosis reduces the liver's ability to metabolise and excrete [[bilirubin]] leading to a buildup in the blood. Less common causes include [[primary biliary cirrhosis]],[[Gilbert's syndrome]] (a genetic disorder of bilirubin metabolism which can result in mild jaundice, which is found in about 5% of the population) and [[metastasis|metastatic]] [[carcinoma]]. Jaundice seen in the newborn, known as neonatal jaundice, is common, occurring in almost every newborn as [[hepatic]] machinery for the conjugation and excretion of bilirubin does not fully mature until approximately two weeks of age..
| |
| | |
| Laboratory Findings: Urine: bilirubin present, Urobilirubin > 2 units but variable (Except in children) | |
| | |
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| ''''''Post-hepatic'''''' (or obstructive) jaundice, also called [[cholestasis]], is caused by an interruption to the drainage of [[bile]] in the biliary system. The most common causes are [[gallstone]]s in the [[common bile duct]], and [[pancreatic cancer]] in the head of the [[pancreas]]. Also, a group of parasites known as "[[liver fluke]]s" live in the common bile duct, causing obstructive jaundice. Other causes include strictures of the common bile duct, [[biliary atresia]], [[ductal carcinoma]], [[pancreatitis]] and [[pancreatic pseudocyst]]s. A rare cause of obstructive jaundice is [[Mirizzi's syndrome]].
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| The presence of pale stools and dark urine suggests an obstructive or post-hepatic cause as normal feces get their color from [[bile pigment]]s.
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| Patients also can present with elevated serum cholesterol.
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| Patients often complain of severe itching or "pruritus".
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| === MRI and CT ===
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| * Abdominal CT scan may be helpful
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| === Echocardiography or Ultrasound ===
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| * Abdominal ultrasound
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| === Other Diagnostic Studies ===
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| * Endoscopic retrograde cholangio-pancreatography (ERCP)
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| == Treatment == | | == Treatment == |
| * Discontinue (and avoid) use of hepatotoxic medications
| | [[Jaundice medical therapy|Medical Therapy]] | [[Jaundice surgery|Surgery]] | [[Jaundice primary prevention|Primary Prevention]] | [[Jaundice secondary prevention|Secondary Prevention]] | [[Jaundice cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Jaundice future or investigational therapies|Future or Investigational Therapies]] |
| * Rehydrate
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| * Treat underlying etiologies
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| === Acute Pharmacotherapies ===
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| * Steroids
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| ===Surgery and Device Based Therapy===
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| * Cholecystectomy or ERCP
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| ==External links== | | ==Case Studies== |
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| [http://www.childliverdisease.org/education/yellowalert - Children's Liver Disease Foundation: information on jaundice in infants] | | [[Jaundice case study one|Case #1]] |
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| ==See also== | | ==Related Chapters== |
| *[[Cholestasis]] | | *[[Cholestasis]] |
| | | *[[Bilirubin]] |
| ==External Links==
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| * [http://www.bidmc.org/YourHealth/ConditionsAZ.aspx?ChunkID=11737 Beth Israel Deaconess Medical Center: Jaundice] | |
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| ==References== | | ==References== |
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| {{Reflist|2}}
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| {{SIB}}
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| {{Symptoms and signs}}
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| [[ar:يرقان]]
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| [[bs:Žutica]]
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| [[ca:Icterícia]]
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| [[cs:Žloutenka]]
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| [[da:Gulsot]]
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| [[de:Ikterus]]
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| [[es:Ictericia]]
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| [[eo:Iktero]]
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| [[fr:Ictère]]
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| [[it:Ittero]]
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| [[he:צהבת]]
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| [[la:Icterus]]
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| [[lt:Gelta]]
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| [[ml:മഞ്ഞപ്പിത്തം]]
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| [[ms:Demam kuning jaundis]]
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| [[nl:Geelzucht]]
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| [[ja:黄疸]]
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| [[no:Gulsott]]
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| [[nn:Gulsot]]
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| [[pl:Żółtaczka (medycyna)]]
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| [[pt:Icterícia]]
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| [[sk:Žltačka]]
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| [[sl:Zlatenica]]
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| [[fi:Keltaisuus]]
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| [[sv:Gulsot]]
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| [[te:పచ్చకామెర్లు]]
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| [[tr:Sarılık]]
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| [[zh:黄疸]]
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| {{WikiDoc Help Menu}} | | {{WikiDoc Help Menu}} |
| {{WikiDoc Sources}} | | {{WikiDoc Sources}} |
| | <references /> |
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| [[Category:Disease]] | | [[Category:Disease]] |
| [[Category:Digestive system]]
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| [[Category:Gastroenterology]] | | [[Category:Gastroenterology]] |
| [[Category:Hepatology]] | | [[Category:Hepatology]] |
| [[Category:Signs and symptoms]]
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