Jaundice natural history, complications, and prognosis: Difference between revisions
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*The symptoms of [[jaundice]] may develop as early as [[neonatal]] period to any decade of life depending on the underlying cause, and originates with symptoms such as Yellowish discoloration of skin and [[sclera]].<ref name="pmid204973612">{{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> Typically, [[jaundice]] is not evident clinically until serum [[bilirubin]] level reaches 2.5 mg/dL. It is first seen in the [[conjunctiva]] or oral [[Mucous membrane|mucous membranes]] such as the [[hard palate]] or under the [[tongue]]. As the serum concentration of [[bilirubin]] rises, [[jaundice]] proceeds caudally. | *The symptoms of [[jaundice]] may develop as early as [[neonatal]] period to any decade of life depending on the underlying cause, and originates with symptoms such as Yellowish discoloration of skin and [[sclera]].<ref name="pmid204973612">{{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> Typically, [[jaundice]] is not evident clinically until serum [[bilirubin]] level reaches 2.5 mg/dL. It is first seen in the [[conjunctiva]] or oral [[Mucous membrane|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 couple of week implies an [[Acute (medicine)|acute]] course ([[hepatitis]], whether [[drug]] or [[toxin]] induced, [[viral]] or [[bacterial]] i.e., [[leptospirosis]]). <ref name="pmid41915022">{{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> [[Jaundice]] appearing over the course of few weeks points towards a [[subacute]] [[hepatitis]] or [[extrahepatic obstruction]] ([[malignancy]], [[gallstone]], [[chronic pancreatitis]], or [[stricture]] in the [[common bile duct]]). Jaundice of fluctuating intensity implicates [[gallstones]], [[Ampulla of Vater|ampullary carcinoma]], or possible [[drug]] [[hepatitis]].<ref name="pmid159609302">{{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><ref name="pmid214608762">{{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> | *[[Jaundice]] appearing over a few days to couple of week implies an [[Acute (medicine)|acute]] course ([[hepatitis]], whether [[drug]] or [[toxin]] induced, [[viral]] or [[bacterial]] i.e., [[leptospirosis]]). <ref name="pmid41915022">{{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> [[Jaundice]] appearing over the course of few weeks points towards a [[subacute]] [[hepatitis]] or [[extrahepatic obstruction]] ([[malignancy]], [[gallstone]], [[chronic pancreatitis]], or [[stricture]] in the [[common bile duct]]). Jaundice of fluctuating intensity implicates [[gallstones]], [[Ampulla of Vater|ampullary carcinoma]], or possible [[drug]] [[hepatitis]].<ref name="pmid159609302">{{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><ref name="pmid214608762">{{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> | ||
*2/100,000 patients in USA with [[jaundice]] may progress to develop [[Acute (medicine)|acute]] [[Hepatic failure|liver failure]] which is manifested as sudden onset of | *2/100,000 patients in USA with [[jaundice]] may progress to develop [[Acute (medicine)|acute]] [[Hepatic failure|liver failure]] which is manifested as sudden onset of [[encephalopathy]] and [[liver]] cell dysfunction leading to [[coagulopathy]] in a healthy person with no known underlying [[liver]] [[disease]] previously. <ref name="Ostapowicz2002">{{cite journal|last1=Ostapowicz|first1=George|title=Results of a Prospective Study of Acute Liver Failure at 17 Tertiary Care Centers in the United States|journal=Annals of Internal Medicine|volume=137|issue=12|year=2002|pages=947|issn=0003-4819|doi=10.7326/0003-4819-137-12-200212170-00007}}</ref> | ||
==Complications== | ==Complications== | ||
| Line 26: | Line 26: | ||
==Prognosis== | ==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% .<ref name="pmid8305063">{{cite journal| author=Lee WM| title=Acute liver failure. | journal=N Engl J Med | year= 1993 | volume= 329 | issue= 25 | pages= 1862-72 | pmid=8305063 | doi=10.1056/NEJM199312163292508 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8305063 }}</ref> | * 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 (medicine)|acute]] [[suppurative]] [[cholangitis]] or [[Fulminant Hepatic Failure|fulminant hepatic failure]] can sometimes be fatal despite medical or surgical intervention. The mortality can be as high as 80% .<ref name="pmid8305063">{{cite journal| author=Lee WM| title=Acute liver failure. | journal=N Engl J Med | year= 1993 | volume= 329 | issue= 25 | pages= 1862-72 | pmid=8305063 | doi=10.1056/NEJM199312163292508 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8305063 }}</ref> | ||
* The development and severity of complications as well as patient's underlying health and comorbidities have a huge impact on the prognosis of patients. | * The development and severity of complications as well as patient's underlying health and comorbidities have a huge impact on the prognosis of patients. | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Natural history of jaundice varies greatly and symptoms can manifest at any age of life depending on the underlying cause. 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
Natural history of jaundice is as follows:
- The symptoms of jaundice may develop as early as neonatal period to any decade of life depending on the underlying cause, and originates with symptoms such as Yellowish discoloration of skin and sclera.[1] Typically, jaundice is not evident clinically until serum bilirubin level reaches 2.5 mg/dL. 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 couple of week implies an acute course (hepatitis, whether drug or toxin induced, viral or bacterial i.e., leptospirosis). [2] Jaundice appearing over the course of few weeks points towards a subacute hepatitis or extrahepatic obstruction (malignancy, gallstone, chronic pancreatitis, or stricture in the common bile duct). Jaundice of fluctuating intensity implicates gallstones, ampullary carcinoma, or possible drug hepatitis.[3][4]
- 2/100,000 patients in USA with jaundice may progress to develop acute liver failure which is manifested as sudden onset of encephalopathy and liver cell dysfunction leading to coagulopathy in a healthy person with no known underlying liver disease previously. [5]
Complications
Common complications of jaundice include:[6]
- 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% .[7]
- 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.
- ↑ 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.
- ↑ 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.
- ↑ Ostapowicz, George (2002). "Results of a Prospective Study of Acute Liver Failure at 17 Tertiary Care Centers in the United States". Annals of Internal Medicine. 137 (12): 947. doi:10.7326/0003-4819-137-12-200212170-00007. ISSN 0003-4819.
- ↑ 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.