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Jaundice or icterus is a yellow colouration of skin and whites of the eye or mucous membranes due to excess bilirubin. Serum bilirubin more than 2mg% (34.2µmol/L).
Bilirubin is a yellow-coloured waste material that remains in the bloodstream after iron is removed from the blood.
Bilirubin is a waste product that is found in the blood after the iron has been removed from the blood. It is filtered by the liver out from blood and when it reaches the liver it is conjugated forming conjugated bilirubin. Once bilirubin has been conjugated it is released to bile and excreted to faeces.
Hyperbilirubinemia occurs when there is excessive leakage of bilirubin to the tissues.
Jaundice usually occurs as a result of an underlying disorder that either causes the production of too much bilirubin or prevents the liver from getting rid of bilirubin.
In general terms, hyperbilirubinaemia may be pre-hepatic, hepatic, or post-hepatic.
The table below gives you the most common causes of jaundice:
|Infectious hepatitis||Schistosomiasis, Infectious hepatitis|
|Brucellosis||Other infections like SBE, typhoid|
|fever, infectious mononucleosis|
|Blood conditions||Haemolytic anaemia||Haemolytic anaemia, e.g., sickle cell|
|Leukaemia||anaemia in child <3 years|
|Congestion||Cardiac failure||Portal vein thrombosis|
|Other||Liver tumour||Liver cirrhosis|
|Displaced rather than the enlarged liver.||Rheumatoid arthritis (Felty’s syndrome)|
The most common ones that you have or likely to encounter with are viral hepatitis, haemolytic anaemia (e.g., sickle cell, malaria), cirrhosis, biliary obstruction, hepatoma, drug-induced (e.g., alcohol, isoniazid).
There are three main types of jaundice:
Before ordering investigations, a meticulous clinical examination and history taking are key.
History should include exposure to hepatotoxic drugs pre-existing known as a haematological disorder. History of anorexia, nausea, and aversion to smoking is suggestive of viral hepatitis, while the history of dark urine, pale stool, and pruritus is suggestive of obstructive jaundice.
Physical examination should include observation for the presence of spider naevi, gynecomastia, loss of axillary hair, parotid gland enlargement, and ascites, which is suggestive of cirrhosis.
A yellow tinge to the skin and the whites of the eyes,
Splenomegaly is suggestive of parenchymal liver disease or haemolytic jaundice.
After you've carried out your physical examination you may need to order investigation tests to confirm your diagnosis or rule out some. The tests that you are likely to order are:
Treatment of jaundice is by treating the underlying cause since jaundice isn't a diagnosis by itself but just "a face" of an underlying disorder.
Anaemia-induced jaundice may be treated by boosting the amount of iron in the blood by either taking iron supplements or eating more iron-rich foods.
Patients with history and physical findings suggestive of viral hepatitis can be managed with bed rest, avoidance of alcohol and prescribe multivitamin tablets, steroids and antivirals.
Obstructive jaundice is treated by surgery.
If the jaundice is drug-induced, treatment for involves changing to an alternative medication
If the cause is not apparent you should admit the patient for investigations.
In any patient who has jaundice and mental complaint, you should consider hepatic encephalopathy.