Jaundice overview

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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

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Echocardiography or Ultrasound

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Jaundice is yellowish discoloration of the skin, conjunctiva (a clear covering over the sclera, or whites of the eyes) and mucous membranes caused by hyperbilirubinemia (increased levels of bilirubin in red blooded animals). Usually the concentration of bilirubin in the blood must exceed 2–3 mg/dL for the coloration to be easily visible.

Historical Perspective

Classification

Pathophysiology

Bilirubin is the catabolic product of the heme which is the main component of the red blood cells. Bilirubin is formed in the liver and spleen then it passes through several process in order to be metabolized. Metabolism processes include hepatic uptake, conjugation, clearance and excretion of the bilirubin in the bile. Jaundice develops due to increase the level of bilirubin and deposition under the skin and cause the yellow discoloration of the skin. Pathogenesis of neonatal jaundice includes physiologic process of bilirubin accumulation or pathological mechanism. The pathological jaundice may be acquired or inherited. Acquired neonatal jaundice include Rh hemolytic disease, ABO incompatibility disease, and hemolytic disease due to G6PD enzyme deficiency. Inherited neonatal jaundice is due to defect of one of the processes of bilirubin metabolism and it concludes some inherited syndromes. Inherited neonatal jaundice include Gilbert's syndrome, Crigler-Najjar syndrome type I and II, Lucey-Driscoll syndrome, Dubin-Johnson syndrome, and Rotor syndrome

Causes

Differential Diagnosis

Jaundice is yellowish discoloration of the skin, conjunctiva, and mucous membranes caused by hyperbilirubinemia. Usually, the concentration of bilirubin in the blood must exceed 2–3 mg/dL for the coloration to be easily visible. This page contains different causes of jaundice.

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications, and Prognosis

Natural History

Complications

Prognosis

Diagnosis

History and Symptoms

Common symptoms of jaundice that the patient will notice, is yellowing of the skin, nausea, and vomiting. Specific symptoms will depend on the underlying factor that caused jaundice to occur. Patients may present with fever, anorexia, dark urine, fatigue, pruritis, right upper quadrant pain. A detailed history of alcohol use, blood transfusions, history of viral hepatitis and family history of liver disease must be taken in all patients.

Physical Examination

Jaundice is a yellowish discoloration of the skin and sclerae that is an important symptom of elevated serum bilirubin. Physical examination of patients with jaundice is based on underlying disease, include Cervical lymphadenopathy, hepatomegaly, splenomegaly, and Peripheral edema

X-ray

CT

Abdominal CT scan may be helpful in the diagnosis of cirrhosis in patient with jaundice. Findings on CT scan suggestive of cirrhosis include cirrhotic liver, as shrinkage and atrophy in liver, dilated portal vein and/or splanchnic veins, esophageal varices, collaterals in any abdominal organ, splenomegaly, and ascites.

MRI

Abdominal MRI may be helpful in the diagnosis of jaundice caused by cirrhosis. Findings on MRI suggestive of cirrhosis include re-canalized umbilical vein, dilated portal vein and/or splanchnic veins, esophageal varices, collaterals in any abdominal organ, splenomegaly, and ascites.

Ultrasound

Other imaging studies

Other Diagnostic Studies

Endoscopic retrograde cholangio-pancreatography (ERCP)

Treatment

Medical Therapy

The mainstay of treatment for jaundice is to conjugate the unconjugated bilirubin or excretion and clearance of bilirubin from the circulation. Jaundice is treated mainly through treating underlying diseases, such as viral hepatitis, alcoholic hepatitis, or cirrhosis.

Surgery

Surgery is not the first-line treatment option for patients with jaundice. Surgery is usually reserved for patients with either cirrhosis, cholestasis, and liver failure. The surgical procedures which are used to treat jaundice include transjugular intrahepatic portosystemic shunting (TIPS), cholecystectomy, and liver transplantation.

References


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