Jaundice natural history, complications, and prognosis: Difference between revisions
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==Natural History== | ==Natural History== | ||
* The symptoms of jaundice may develop as early as neonatal period<ref name="pmid20497361">{{cite journal| author=Gundur NM, Kumar P, Sundaram V, Thapa BR, Narang A| title=Natural history and predictive risk factors of prolonged unconjugated jaundice in the newborn. | journal=Pediatr Int | year= 2010 | volume= 52 | issue= 5 | pages= 769-72 | pmid=20497361 | doi=10.1111/j.1442-200X.2010.03170.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20497361 }}</ref> to any decade of life depending on the underlying cause, and start with symptoms such as yellowish discoloration of eyes and sclera. | * The symptoms of jaundice may develop as early as neonatal period<ref name="pmid20497361">{{cite journal| author=Gundur NM, Kumar P, Sundaram V, Thapa BR, Narang A| title=Natural history and predictive risk factors of prolonged unconjugated jaundice in the newborn. | journal=Pediatr Int | year= 2010 | volume= 52 | issue= 5 | pages= 769-72 | pmid=20497361 | doi=10.1111/j.1442-200X.2010.03170.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20497361 }}</ref> to any decade of life depending on the underlying cause, and start with symptoms such as yellowish discoloration of eyes and sclera. Typically, jaundice is not detectable clinically until serum bilirubin reaches 2.5 mg/dL.2 It is first seen in the conjunctiva or oral mucous membranes such as the hard palate or under the tongue. As the serum concentration of bilirubin rises, jaundice proceeds caudally. | ||
* | * Jaundice appearing over a few days to a week implies hepatitis, whether drug or toxin induced, viral<ref name="pmid4191502">{{cite journal| author=Krugman S, Giles JP| title=Viral hepatitis. New light on an old disease. | journal=JAMA | year= 1970 | volume= 212 | issue= 6 | pages= 1019-29 | pmid=4191502 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4191502 }}</ref> or bacterial (i.e., leptospirosis). Jaundice appearing over the course of weeks implies a subacute hepatitis or extrahepatic obstruction due to malignancy<ref name="pmid21460876">{{cite journal| author=Patel T| title=Cholangiocarcinoma--controversies and challenges. | journal=Nat Rev Gastroenterol Hepatol | year= 2011 | volume= 8 | issue= 4 | pages= 189-200 | pmid=21460876 | doi=10.1038/nrgastro.2011.20 | pmc=3888819 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21460876 }}</ref>, gallstone, chronic pancreatitis, or stricture in the common bile duct. Jaundice of fluctuating intensity implicates gallstones, ampullary<ref name="pmid15960930">{{cite journal| author=Porta M, Fabregat X, Malats N, Guarner L, Carrato A, de Miguel A et al.| title=Exocrine pancreatic cancer: symptoms at presentation and their relation to tumour site and stage. | journal=Clin Transl Oncol | year= 2005 | volume= 7 | issue= 5 | pages= 189-97 | pmid=15960930 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15960930 }}</ref> carcinoma, or possible drug hepatitis. | ||
* If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3]. | * If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3]. | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
The type and the severity of complications depends on the underlying cause leading to jaundice. Certain individuals may not suffer any long-term complications and recovers fully, while for others the appearance of jaundice may be the first indication of a life-threatening situation.
Natural History
- The symptoms of jaundice may develop as early as neonatal period[1] to any decade of life depending on the underlying cause, and start with symptoms such as yellowish discoloration of eyes and sclera. Typically, jaundice is not detectable clinically until serum bilirubin reaches 2.5 mg/dL.2 It is first seen in the conjunctiva or oral mucous membranes such as the hard palate or under the tongue. As the serum concentration of bilirubin rises, jaundice proceeds caudally.
- Jaundice appearing over a few days to a week implies hepatitis, whether drug or toxin induced, viral[2] or bacterial (i.e., leptospirosis). Jaundice appearing over the course of weeks implies a subacute hepatitis or extrahepatic obstruction due to malignancy[3], gallstone, chronic pancreatitis, or stricture in the common bile duct. Jaundice of fluctuating intensity implicates gallstones, ampullary[4] carcinoma, or possible drug hepatitis.
- If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
Complications
Common complications of jaundice include:[5]
- Electrolyte abnormalities
- Anemia
- Bleeding
- Infection/sepsis
- Chronic hepatitis
- Cancer
- Liver failure
- Kidney failure
- Hepatic encephalopathy (brain dysfunction)
- Death
Prognosis
- The prognosis for individuals with jaundice varies with the underlying cause of the condition. There are certain conditions that has the most favorable prognosis leading to full recovery. However, more serious causes of jaundice like acute suppurative cholangitis or fulminant hepatic failure can sometimes be fatal despite medical or surgical intervention. The mortality can be as high as 80% .[6]
- The development and severity of complications as well as patient's underlying health and comorbidities have a huge impact on the prognosis of patients.
References
- ↑ Gundur NM, Kumar P, Sundaram V, Thapa BR, Narang A (2010). "Natural history and predictive risk factors of prolonged unconjugated jaundice in the newborn". Pediatr Int. 52 (5): 769–72. doi:10.1111/j.1442-200X.2010.03170.x. PMID 20497361.
- ↑ Krugman S, Giles JP (1970). "Viral hepatitis. New light on an old disease". JAMA. 212 (6): 1019–29. PMID 4191502.
- ↑ Patel T (2011). "Cholangiocarcinoma--controversies and challenges". Nat Rev Gastroenterol Hepatol. 8 (4): 189–200. doi:10.1038/nrgastro.2011.20. PMC 3888819. PMID 21460876.
- ↑ Porta M, Fabregat X, Malats N, Guarner L, Carrato A, de Miguel A; et al. (2005). "Exocrine pancreatic cancer: symptoms at presentation and their relation to tumour site and stage". Clin Transl Oncol. 7 (5): 189–97. PMID 15960930.
- ↑ Sonthalia N, Rathi PM, Jain SS, Surude RG, Mohite AR, Pawar SV; et al. (2017). "Natural History and Treatment Outcomes of Severe Autoimmune Hepatitis". J Clin Gastroenterol. 51 (6): 548–556. doi:10.1097/MCG.0000000000000805. PMID 28272079.
- ↑ Lee WM (1993). "Acute liver failure". N Engl J Med. 329 (25): 1862–72. doi:10.1056/NEJM199312163292508. PMID 8305063.