Jaundice

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Assosciate Editor(s)-In-Chief: Prashanth Saddala M.B.B.S

Jaundice Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Jaundice from other Conditions
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Chest X Ray
Electrocardiogram
CT
MRI
Echocardiography or Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Jaundice On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Jaundice All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Jaundice
CDC on Jaundice
Jaundice in the news
Blogs on Jaundice
Directions to Hospitals Treating Jaundice
Risk calculators and risk factors for Jaundice

Synonyms and keywords: Icterus

Classification

Neonatal jaundice | Prehepatic jaundice | Hepatic jaundice | Posthepatic jaundice

Causes

Common Causes | Causes by Organ System | Causes in Alphabetical Order

Diagnosis

History and symptoms

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. It was once believed persons suffering from the medical condition jaundice saw everything as yellow, but this is not true. 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."

The caregiver should ask questions regarding

• Alcohol/hepatotoxic medication use

Various Symptoms

• Alcohol Hepatitis

  • Aspartate aminotransferase:alanine aminotransferase ratio > 2 (AST:ALT)
  • Fever
  • Leukocytosis

• Viral Hepatitis

  • Anorexia
  • Dark urine
  • Fatigue
  • Hepatomegaly
  • Light-colored (acholic) loss stools
  • Nausea
  • Pruritis
  • Right upper quadrant (RUQ) pain
  • Nausea and Vomiting

Physical Examination

• Complete physical exam including evidence of:

  • Hepatomegaly
  • 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

Lab tests

• Total and unconjugated bilirubin
  • Bilirubin is the major breakdown product of hemoglobin that is released from dying or damaged erythrocytes
  • The normal bilirubin range is 0.3-1.0 mg/dL
• Aspartate aminotransferase
• Alanine aminotransferase
• Albumin
• Alkaline phosphatase
• HIV serologies
• Hepatitis serologies
• Antinuclear antibody (ANA)
• Antimitochondrial antibodies
• Haptoglobin
• Reticulocyte count
• Lactic dehydrogenase (LDH)

MRI and CT

• Abdominal CT scan may be helpful

Echocardiography or Ultrasound

• Abdominal ultrasound

Other Diagnostic Studies

• Endoscopic retrograde cholangio-pancreatography (ERCP)

Treatment

• Discontinue (and avoid) use of hepatotoxic medications
• Rehydrate
• Treat underlying etiologies

Acute Pharmacotherapies

• Steroids

Surgery and Device Based Therapy

• Cholecystectomy or ERCP

See also

• Cholestasis

References

Template:WikiDoc Sources