Revision 18 for 'Jaundice'

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Jaundice

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

Clinically, jaundice presents with yellowing of the skin, conjunctiva (often incorrectly attributed to the sclerae) 5, and mobile oral tissues (e.g. frenulum, palate) 6. These structures are affected due to their high elastin content, which bilirubin has a high affinity for 6.

It may be painless, painful, or pruritic. Painless jaundice is always very suspicious for an underlying obstructive malignant cause 3

Pathology

Categories of causes 3:

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 etiology. In jaundiced neonates, phototherapy and exchange transfusion should be considered.

Complications

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