Jaundice: Difference between revisions

Jump to navigation Jump to search
m (Bot: Removing from Primary care)
 
(158 intermediate revisions by 14 users not shown)
Line 1: Line 1:
{{CMG}}
__NOTOC__
 
{{Editor Help}}
 
{{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}} |
  ICD9          = {{ICD9|782.4}} |
  OMIM          = |
  MedlinePlus    = 003243 |
  eMedicineSubj  = |
  eMedicineTopic = |
  DiseasesDB    = 7038 |
  MeshID        = D007565 |
}}
}}


{{SI}}
'''For patient information, click [[Jaundice (patient information)|here]].'''
 
==Overview==
'''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.
 
'''[[Neonatal jaundice]]'''
 
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>
 
'''Jaundiced eye'''
 
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>
 
==Pathophysiology==
* 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
* Jaundice is visible in conjunctiva, skin and mucosa when the serum bilirubin level rises above 2 mg/dL
==Causes==
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]].
 
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.
===Common Causes===
===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Eclampsia]]
|-
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}
 
===Causes in Alphabetical Order===
===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> ===
* 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 ==
'''For the approach to a patient with jaundice, click [[Approach to a patient with jaundice|here]].'''
=== History ===
The caregiver should ask questions regarding
* Alcohol/hepatotoxic medication use


'''Various Symptoms'''
{{CMG}}; '''Associate Editor(s)-In-Chief:''' {{FKH}}, {{FA}}, {{EG}}, {{MJ}}
* '''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}}
* 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===
'''''Synonyms and keywords:''''' Icterus; hyperbilirubinemia, yellow discolouration.
* 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 overview|Overview]]==


The laboratory findings include
==[[Jaundice historical perspective|Historical Perspective]]==
* Urine: no bilirubin present, urobilirubin > 2 units (except in infants where [[gut flora]] has not developed).
* Serum: increased unconjugated bilirubin.


==[[Jaundice classification scheme|Classification]]==


''''''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..
==[[Jaundice pathophysiology|Pathophysiology]]==


Laboratory Findings: Urine: bilirubin present, Urobilirubin > 2 units but variable (Except in children)
==[[Jaundice causes|Causes]]==


==[[Jaundice differential diagnosis|Differentiating Jaundice from other Conditions]]==


''''''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]].
==[[Jaundice epidemiology and demographics|Epidemiology and Demographics]]==


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. 
==[[Jaundice risk factors|Risk Factors]]==


Patients also can present with elevated serum cholesterol.
==[[Jaundice screening|Screening]]==


Patients often complain of severe itching or "pruritus".
==[[Jaundice natural history|Natural History, Complications and Prognosis]]==


=== MRI and CT ===
==Diagnosis==
* Abdominal CT scan may be helpful
[[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]]
=== Echocardiography or Ultrasound ===
* Abdominal ultrasound
=== Other Diagnostic Studies ===
* Endoscopic retrograde cholangio-pancreatography (ERCP)


== 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
* Treat underlying etiologies
=== Acute Pharmacotherapies ===
* Steroids
===Surgery and Device Based Therapy===
* Cholecystectomy or ERCP
 


==External links==
==Case Studies==


[http://www.childliverdisease.org/education/yellowalert - Children's Liver Disease Foundation: information on jaundice in infants]
[[Jaundice case study one|Case #1]]


==See also==
==Related Chapters==
*[[Cholestasis]]
*[[Cholestasis]]
 
*[[Bilirubin]]
==External Links==
* [http://www.bidmc.org/YourHealth/ConditionsAZ.aspx?ChunkID=11737 Beth Israel Deaconess Medical Center: Jaundice]
 
==References==
==References==
{{Reflist|2}}
{{SIB}}
{{Symptoms and signs}}
[[ar:يرقان]]
[[bs:Žutica]]
[[ca:Icterícia]]
[[cs:Žloutenka]]
[[da:Gulsot]]
[[de:Ikterus]]
[[es:Ictericia]]
[[eo:Iktero]]
[[fr:Ictère]]
[[it:Ittero]]
[[he:צהבת]]
[[la:Icterus]]
[[lt:Gelta]]
[[ml:മഞ്ഞപ്പിത്തം]]
[[ms:Demam kuning jaundis]]
[[nl:Geelzucht]]
[[ja:黄疸]]
[[no:Gulsott]]
[[nn:Gulsot]]
[[pl:Żółtaczka (medycyna)]]
[[pt:Icterícia]]
[[sk:Žltačka]]
[[sl:Zlatenica]]
[[fi:Keltaisuus]]
[[sv:Gulsot]]
[[te:పచ్చకామెర్లు]]
[[tr:Sarılık]]
[[zh:黄疸]]
{{WikiDoc Help Menu}}
{{WikiDoc Help Menu}}
{{WikiDoc Sources}}
{{WikiDoc Sources}}
<references />


[[Category:Disease]]
[[Category:Disease]]
[[Category:Digestive system]]
[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Hepatology]]
[[Category:Hepatology]]
[[Category:Signs and symptoms]]

Latest revision as of 22:26, 29 July 2020

Template:DiseaseDisorder infobox

For patient information, click here.

For the approach to a patient with jaundice, click here.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Farnaz Khalighinejad, MD [2], Fatima Shaukat, MD [3], Eiman Ghaffarpasand, M.D. [4], Mehrian Jafarizade, M.D [5]

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; hyperbilirubinemia, yellow discolouration.

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Jaundice from other Conditions

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Chest X Ray | 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

Related Chapters

References

Template:WikiDoc Sources