Jaundice
Basics
Description
Description
- Yellow staining of tissues and body fluids due to hyperbilirubinemia, usually present at levels of >2.5 mg/dL
- Unconjugated (indirect) hyperbilirubinemia:
- Direct breakdown product of hemoglobin
- Water insoluble, circulates bound to albumin
- Hemolytic:
- Excessive production of unconjugated bilirubin
- Hepatic:
- Decreased hepatobiliary excretion of bilirubin
- Defective uptake (drugs, Crigler–Najjar syndrome)
- Defective conjugation (Gilbert syndrome, drugs)
- Defective excretion of bilirubin by the liver cell (drugs, Dubin–Johnson syndrome)
- Decreased hepatobiliary excretion of bilirubin
- Conjugated (direct) hyperbilirubinemia:
- Conjugated bilirubin is water soluble and measured as direct bilirubin
- In conjugated hyperbilirubinemia, bilirubin is returned to the bloodstream after conjugation in the liver instead of draining into the bile ducts
- Hepatocellular dysfunction:
- Hepatitis
- Cirrhosis
- Tumor invasion
- Toxic injury
- Intrahepatic (nonobstructive) cholestasis
- Extrahepatic (obstructive) cholestasis
Etiology
Etiology
- Prehepatic:
- Hemolysis (sickle cell, other hemoglobinopathies, G6PD deficiency)
- Ineffective erythropoiesis
- Drugs
- Gilbert syndrome: Usually benign inherited form of unconjugated hyperbilirubinemia
- Crigler–Najjar syndrome
- Prolonged fasting
- Cardiopulmonary bypass (ECMO)
- Hematoma reabsorption
- Hepatocellular:
- Hepatitis (infectious, alcoholic, autoimmune, toxin, drug induced)
- Cirrhosis
- Postischemic
- Hemochromatosis
- Intrahepatic cholestasis:
- Idiopathic cholestasis of pregnancy
- Drugs (TPN, statins, etc.)
- Dubin–Johnson syndrome
- Rotor syndrome
- Benign recurrent cholestasia
- Familial syndromes
- Sepsis
- Postoperative jaundice
- Lymphoma
- Extrahepatic obstruction:
- Common duct stone
- Biliary stricture
- Bacterial cholangitis
- Sclerosing cholangitis
- Carcinoma (ampulla, gallbladder, pancreas), cholangiosarcoma
- Pancreatitis, pancreatic pseudocyst
- Hemobilia
- Duodenal diverticula
- Ascariasis
- Postlaparoscopic cholecystectomy complications
- Congenital biliary atresia
- Congenital choledochal cyst
Pediatric Considerations
Intrahepatic cholestasis:
- Cardiovascular (congenital heart disease, congestive heart failure, shock, asphyxia)
- Metabolic or genetic (α1-antitrypsin deficiency, trisomy 18 and 21, cystic fibrosis, Gaucher disease, Niemann–Pick disease, glycogen storage disease type IV)
- Infectious (bacterial sepsis, cytomegalovirus, enterovirus, herpes simplex virus, rubella, syphilis, TB, varicella, viral hepatitis)
- Hematologic (severe isoimmune hemolytic disease)
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Citation
Schaider, Jeffrey J., et al., editors. "Jaundice." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307611/all/Jaundice.
Jaundice. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307611/all/Jaundice. Accessed December 5, 2024.
Jaundice. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307611/all/Jaundice
Jaundice [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 05]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307611/all/Jaundice.
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