Jaundice

Question 1

What is jaundice?

Answer 1

a.k.a. icterus.
Yellow discolouration of mucous membranes, sclera and skin.
This happens due to the accumulation of bilirubin.
Jaundice may be seen at a bilirubin concentration >2.5-3.0 mg/dL (42.8-51.3 mmol/L).

Question 2

What are the prehepatic causes of jaundice?

Answer 2

Crigler-Najjar syndrome.
Gilbert's syndrome.
Haemolysis, e.g. thalassaemia, sickle cell anaemia.
Drugs, e.g. rifampicin.
Malaria.
Haemolytic uraemic syndrome.

Question 3

What are the hepatic causes of jaundice?

Answer 3

Viral and drug induced hepatitis.
Alcoholic liver disease.
Hepatic cirrhosis.
Primary biliary cirrhosis.
Leptospirosis.
Physiological neonatal jaundice.

Question 4

What are the post-hepatic causes of jaundice?

Answer 4

Gallstones in common bile duct.
Pancreatic cancer.
Schistosomiasis.
Biliary atresia.
Cholangiocarcinoma.
Mirizzi's syndrome.

Question 5

What is the treatment of jaundice?

Answer 5

Treat the underlying cause.

Question 6

What are the complications of jaundice?

Answer 6

Liver failure
Renal failure
Sepsis
Pancreatitis
Biliary cirrhosis
Cholangitis
Kemicterus (serious complication in neonates)

Question 7

What investigations should be performed where jaundice is observed?

Answer 7

Must determine underlying cause.
Determine the type of jaundice: appearance of urine (normal = pre-hepatic, dark = hepatic or post-hepatic) and stool (normal = pre-hepatic, pale = hepatic or post-hepatic); LFTs (pre-hepatic = normal conjugated bilirubin and normal or high unconjugated bilirubin; hepatic = high conjugated and unconjugated bilirubin; post-hepatic = high conjugated and normal unconjugated bilirubin); bilirubin levels (total bilirubin is high in all types of jaundice, may be normal in pre-hepatic); alkaline phosphatase levels (normal = prehepatic, high = hepatic or post-hepatic).