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.
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.
Categories of causes 3:
- hemolytic anemia
- mechanical heart valve
post-hepatic (or obstructive jaundice)
- benign causes
- malignant causes
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.
Treatment and prognosis
Management depends on the underlying etiology. In jaundiced neonates, phototherapy and exchange transfusion should be considered.