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Jaundice: Difference between revisions
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'''Jaundice''' or '''icterus''' refers to the yellowish discoloration of the skin, sclerae, and mucous membranes due to deposition of bilirubin. This occurs due to an increased concentration of bilirubin in the blood, called '''hyperbilirubinaemia'''. Discoloration of the sclerae occurs at lower concentrations of bilirubin than the skin. | '''Jaundice''' or '''icterus''' refers to the yellowish discoloration of the skin, sclerae, and mucous membranes due to deposition of [[bilirubin]]. This occurs due to an increased concentration of bilirubin in the blood, called '''hyperbilirubinaemia'''. Discoloration of the sclerae occurs at lower concentrations of bilirubin than the skin. | ||
The reference range of total bilirubin is 5 – 20 µmol/L. '''Scleral icterus''' (sometimes called '''subicterus''', but different definitions for subicterus exists) occurs when the bilirubin level reaches approx 40 µmol/L, while icterus occurs at approx 70 µmol/L. | The reference range of total bilirubin is 5 – 20 µmol/L. '''Scleral icterus''' (sometimes called '''subicterus''', but different definitions for subicterus exists) occurs when the bilirubin level reaches approx 40 µmol/L, while icterus occurs at approx 70 µmol/L. | ||
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* Prehepatic hyperbilirubinaemia | * Prehepatic hyperbilirubinaemia | ||
** Due to increased bilirubin production (increased haemoglobin breakdown) | ** Due to increased bilirubin production (increased haemoglobin breakdown) | ||
*** Haemolytic disorders (G6PD deficiency, sickle cell anaemia, etc.) | *** [[Haemolytic anaemia|Haemolytic]] disorders ([[Glucose 6-phosphate dehydrogenase (G6PD) deficiency|G6PD deficiency]], [[Sickle cell disease|sickle cell anaemia]], etc.) | ||
*** Dyserythropoiesis (thalassaemia, etc.) | *** Dyserythropoiesis ([[thalassaemia]], etc.) | ||
*** Resolving (healing) haematoma or haemorrhage | *** Resolving (healing) haematoma or haemorrhage | ||
** Due to impaired hepatic uptake of bilirubin | ** Due to impaired hepatic uptake of bilirubin | ||
*** Drugs | *** Drugs | ||
*** Heart failure | *** [[Heart failure]] | ||
** Impaired conjugation of bilirubin in the liver | ** Impaired conjugation of bilirubin in the liver | ||
*** Gilbert syndrome | *** [[Gilbert syndrome]] | ||
*** Crigler-Najjar syndrome | *** [[Crigler-Najjar syndrome]] | ||
*** Hepatitis | *** [[Hepatitis]] | ||
*** Cirrhosis | *** [[Cirrhosis]] | ||
*** Wilson disease | *** [[Wilson disease]] | ||
*** Hyperthyroidism | *** [[Hyperthyroidism and thyrotoxicosis|Hyperthyroidism]] | ||
* Intrahepatic hyperbilirubinaemia | * Intrahepatic hyperbilirubinaemia | ||
** Hepatitis | ** Hepatitis | ||
** Cirrhosis | ** Cirrhosis | ||
** Infiltrative diseases of the liver | ** [[Infiltrative disease|Infiltrative diseases]] of the liver | ||
* Posthepatic hyperbilirubinaemia ([[cholestasis]], obstructive jaundice) | * Posthepatic hyperbilirubinaemia ([[cholestasis]], obstructive jaundice) | ||
** Choledocholithiasis | ** [[Choledocholithiasis]] | ||
** Cholangitis | ** [[Cholangitis]] | ||
** Tumour compressing the biliary tree (pancreatic head, biliary, gallbladder, liver) | ** Tumour compressing the biliary tree ([[Pancreatic adenocarcinoma|pancreatic head]], [[Cholangiocellular carcinoma|biliary]], [[Cholangiocellular carcinoma|gallbladder]], [[Hepatocellular carcinoma|liver]]) | ||
== Clinical features == | == Clinical features == | ||
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== Evaluation == | == Evaluation == | ||
Further evaluation depends on the clinical and laboratory findings. AST and ALT are useful markers of liver injury, while ALP and GGT are markers of cholestasis. | Further evaluation depends on the clinical and laboratory findings. [[AST]] and [[ALT]] are useful markers of liver injury, while [[ALP]] and [[GGT]] are markers of cholestasis. | ||
If prehepatic jaundice is supected, the patient should be evaluated for haemolysis (LDH, haptoglobin, blood smear). | If prehepatic jaundice is supected, the patient should be evaluated for [[haemolysis]] ([[LDH]], [[haptoglobin]], [[blood smear]]). | ||
If intrahepatic jaundice is suspected, the patient should be evaluated for hepatitis, cirrhosis, and possible causes of them. | If intrahepatic jaundice is suspected, the patient should be evaluated for hepatitis, cirrhosis, and possible causes of them. | ||
If [[Biliary obstruction|posthepatic jaundice]] is suspected, the patient should be examined with ultrasound or CT. If this shows signs of biliary obstruction by stone, an ERCP should be performed, which may remove the stone. If imaging shows signs of malignancy, surgery may be indicated. | If [[Biliary obstruction|posthepatic jaundice]] is suspected, the patient should be examined with [[ultrasound]] or [[CT]]. If this shows signs of biliary obstruction by stone, an [[ERCP]] should be performed, which may remove the stone. If imaging shows signs of malignancy, surgery may be indicated. | ||
[[Category:Gastrointestinal surgery]] | [[Category:Gastrointestinal surgery]] | ||
[[Category:Gastroenterology]] | [[Category:Gastroenterology]] | ||