Jaundice

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Definition

-  Yellowish discolouration of tissues due to billirubin deposition in the presence of hyperbilirubinaemia

 

Jaundice

 

Features

-  Sign of hepatobiliary pathology or haemolysis

-  Beware painless jaundice: Ca

-  Neonatal Jaundice

 

Associated S/S

-  Icteric sclera

-  Serum bilirubin > 50 umol/L

-  May be first evident under tongue

-  Abdo pain: RUQ pain: hepatitis, choledocolithiasis

-  Charcots Triad: RUQ pain, jaundice & fever: cholangitis

-  Reynolds Pentad: hypotension & altered mental state: ascending cholangitis

-  Painless: pancreatic Ca

-  Stool

-  Pale: cholestatic

-  Normal: prehepatic or heptocellular

-  Urine

-  Dark: cholestatic or hepatocellular

-  Normal: prehepatic

 

DDx

-  Quinicrine: effects sclera

-  Caratoderma: focus on palms, soles & forehead, no scleral icterus

 

Causes

-  Neonatal

-  Very common

-  Does not last > 2/52

-  Prehepatic

-  Haemolytic anaemias

-  Hereditary hyperbilirubinaemia

-  Gilberts

-  Dubin-Johnson

-  Criggler-Najjer

-  Hepatocellular

-  Chronic liver disease (EtOH..), hepatitis (esp A,B,C), sepsis, drugs

-  Obstructive

-  Cholangiolithiasis, duct ca, pancreatic ca

 

Ix

-  Serum Bilirubin

-  Conjugated: cholestatic

-  Unconjugated: prehepatic

-  Mixed: hepatocellular

-  Urinary urobilinogen

-  Inreased: prehepatic or hepatocellular

-  Normal: cholestatic

-  LFTs

-  Hepatocellular (hepatitic): raised AST, ALT

-  Cholestatic: raised ALP, GGT

-  Albumin

-  Hepatitis Serology: A,B,C

-  Abdominal Ultrasound

-  Dilated bile ducts: cholestatic

-  Gall stones

-  Cirrhosis: chronic liver disease

-  Pancreas: pancreatitis