Jaundice
Updates to Article Attributes
Jaundice refers to a clinical sign of hyperbilirubinemia (>2.5 mg/dl) which has many causes. It is often a clue to a diagnosis. It can be largely divided into two types:
- non-obstructive, i.e. pre-hepatic and hepatic causes
- obstructive, i.e. post-hepatic causes
Imaging has a major role in detecting the obstructive causes.
Clinical presentation
Jaundice is theClinically, jaundice presents with yellowing of the skin, conjunctiva (often incorrectly attributed to the sclerae) 5, and/or sclerae mobile oral tissues (e.g. Patients frenulum, palate) 6. These structures are affected due to their high elastin content, which bilirubin has a high affinity for 6.
It may present withbe painless, painful, or painful jaundicepruritic. Painless jaundice is always very suspicious for an underlying obstructive malignant cause 3.
Pathology
Categories of causes 3:
-
prehepatic
- haemolytic anaemia
- mechanical heart valve
- hypersplenism
-
hepatic
- acute hepatitis / acute liver failure
- cirrhosis
- Gilbert syndrome
-
post-hepatic (or obstructive jaundice)
- benign causes
- choledocholithiasis
- strictures, e.g. post-inflammatory/infectious, primary sclerosing cholangitis, traumatic
/or operative 4 - external biliary tree compression, e.g. pancreatic pseudocyst, Mirizzi syndrome
- malignant causes
- benign causes
Radiographic features
Patients presenting with jaundice is a common indication for imaging. Often a specific cause will not be found, and the main role is differentiating between non-obstructive and obstructive jaundice. In the latter, extrahepatic and/or intrahepatic bile duct dilatation can be expected, depending on the level of obstruction.
Hepatobiliary ultrasound and MRCP are the mainstay imaging modalities. Bilirubin levels are often too elevated for CT cholangiography to be performed.
Treatment and prognosis
Management depends on the underlying aetiology. In jaundiced neonates, phototherapy and exchange transfusion should be considered.
Complications
- bilirubin-induced neurologic dysfunction (e.g. kernicterus) in unconjugated jaundice
-</ul><p>Imaging has a major role in detecting the obstructive causes.</p><h4>Clinical presentation</h4><p>Jaundice is the yellowing of the skin and/or sclerae. Patients may present with painless or painful jaundice. Painless jaundice is always very suspicious for an underlying obstructive malignant cause <sup>3</sup>. </p><h4>Pathology</h4><p>Categories of causes <sup>3</sup>:</p><ul>- +</ul><p>Imaging has a major role in detecting the obstructive causes.</p><h4>Clinical presentation</h4><p>Clinically, jaundice presents with yellowing of the skin, <a title="Conjunctiva" href="/articles/conjunctiva">conjunctiva</a> (often incorrectly attributed to the sclerae) <sup>5</sup>, and mobile oral tissues (e.g. frenulum, <a title="Palate" href="/articles/palate">palate</a>) <sup>6</sup>. These structures are affected due to their high elastin content, which bilirubin has a high affinity for <sup>6</sup>.</p><p>It may be painless, painful, or pruritic. Painless jaundice is always very suspicious for an underlying obstructive malignant cause <sup>3</sup>. </p><h4>Pathology</h4><p>Categories of causes <sup>3</sup>:</p><ul>
-<li><a title="cirrhosis" href="/articles/cirrhosis">cirrhosis</a></li>-<li><a title="Gilbert syndrome" href="/articles/gilbert-syndrome">Gilbert syndrome</a></li>- +<li><a href="/articles/cirrhosis">cirrhosis</a></li>
- +<li><a href="/articles/gilbert-syndrome">Gilbert syndrome</a></li>
-<li>strictures, e.g. post-inflammatory/infectious, <a href="/articles/primary-sclerosing-cholangitis">primary sclerosing cholangitis</a>, <a href="/articles/traumatic-operative">traumatic / operative</a> <sup>4</sup>- +<li>strictures, e.g. post-inflammatory/infectious, <a href="/articles/primary-sclerosing-cholangitis">primary sclerosing cholangitis</a>, <a href="/articles/traumatic-operative">traumatic or operative</a> <sup>4</sup>
References changed:
- 5. Tripathi RC, Sidrys LA. 'Conjunctival icterus,' not 'scleral icterus'. (1979) JAMA. 242 (23): 2558. <a href="https://www.ncbi.nlm.nih.gov/pubmed/490877">Pubmed</a> <span class="ref_v4"></span>
- 6. Daley TD, Armstrong JE. Oral manifestations of gastrointestinal diseases. (2007) Canadian journal of gastroenterology = Journal canadien de gastroenterologie. 21 (4): 241-4. <a href="https://www.ncbi.nlm.nih.gov/pubmed/17431513">Pubmed</a> <span class="ref_v4"></span>