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Digestive Diseases (Basel, Switzerland) 2022Jaundice is a common clinical finding in clinical practice of hepatologists and general practitioners. It occurs when serum bilirubin levels exceed 3 mg/dL. (Review)
Review
BACKGROUND
Jaundice is a common clinical finding in clinical practice of hepatologists and general practitioners. It occurs when serum bilirubin levels exceed 3 mg/dL.
SUMMARY
In this review, we summarize the pathophysiological mechanism of jaundice, clinical approach to the patient with jaundice, and laboratory and imaging techniques. Clinical presentation of jaundice manifests through yellow skin and sclera coloration. Evaluation of every patient includes detailed medical history and examination. In the laboratory, evaluation of enzymes of hepatic inflammation as well as cholestatic enzymes with serum bilirubin must be included. Additional laboratory analysis and imaging modalities are needed in order to differentiate jaundice etiology. Moreover, imaging is available and needed in further evaluation, and treatment is dependent on the underlying cause.
KEY MESSAGES
In this review, we will outline the pathophysiological mechanism of jaundice, clinical approach to the patient with jaundice, and diagnostic and treatment approach to these patients.
Topics: Bilirubin; Cholestasis; General Practitioners; Humans; Jaundice; Liver Function Tests
PubMed: 34015787
DOI: 10.1159/000517301 -
American Family Physician Feb 2017Jaundice in adults can be an indicator of significant underlying disease. It is caused by elevated serum bilirubin levels in the unconjugated or conjugated form. The... (Review)
Review
Jaundice in adults can be an indicator of significant underlying disease. It is caused by elevated serum bilirubin levels in the unconjugated or conjugated form. The evaluation of jaundice relies on the history and physical examination. The initial laboratory evaluation should include fractionated bilirubin, a complete blood count, alanine transaminase, aspartate transaminase, alkaline phosphatase, ?-glutamyltransferase, prothrombin time and/or international normalized ratio, albumin, and protein. Imaging with ultrasonography or computed tomography can differentiate between extrahepatic obstructive and intrahepatic parenchymal disorders. Ultrasonography is the least invasive and least expensive imaging method. A more extensive evaluation may include additional cancer screening, biliary imaging, autoimmune antibody assays, and liver biopsy. Unconjugated hyperbilirubinemia occurs with increased bilirubin production caused by red blood cell destruction, such as hemolytic disorders, and disorders of impaired bilirubin conjugation, such as Gilbert syndrome. Conjugated hyperbilirubinemia occurs in disorders of hepatocellular damage, such as viral and alcoholic hepatitis, and cholestatic disorders, such as choledocholithiasis and neoplastic obstruction of the biliary tree.
Topics: Cholestasis; Diagnosis, Differential; Humans; Hyperbilirubinemia; Jaundice; Liver Diseases
PubMed: 28145671
DOI: No ID Found -
Journal of Biomedical Science Oct 2018Jaundice is a common symptom of inherited or acquired liver diseases or a manifestation of diseases involving red blood cell metabolism. Recent progress has elucidated... (Review)
Review
BACKGROUND
Jaundice is a common symptom of inherited or acquired liver diseases or a manifestation of diseases involving red blood cell metabolism. Recent progress has elucidated the molecular mechanisms of bile metabolism, hepatocellular transport, bile ductular development, intestinal bile salt reabsorption, and the regulation of bile acids homeostasis.
MAIN BODY
The major genetic diseases causing jaundice involve disturbances of bile flow. The insufficiency of bile salts in the intestines leads to fat malabsorption and fat-soluble vitamin deficiencies. Accumulation of excessive bile acids and aberrant metabolites results in hepatocellular injury and biliary cirrhosis. Progressive familial intrahepatic cholestasis (PFIC) is the prototype of genetic liver diseases manifesting jaundice in early childhood, progressive liver fibrosis/cirrhosis, and failure to thrive. The first three types of PFICs identified (PFIC1, PFIC2, and PFIC3) represent defects in FIC1 (ATP8B1), BSEP (ABCB11), or MDR3 (ABCB4). In the last 5 years, new genetic disorders, such as TJP2, FXR, and MYO5B defects, have been demonstrated to cause a similar PFIC phenotype. Inborn errors of bile acid metabolism also cause progressive cholestatic liver injuries. Prompt differential diagnosis is important because oral primary bile acid replacement may effectively reverse liver failure and restore liver functions. DCDC2 is a newly identified genetic disorder causing neonatal sclerosing cholangitis. Other cholestatic genetic disorders may have extra-hepatic manifestations, such as developmental disorders causing ductal plate malformation (Alagille syndrome, polycystic liver/kidney diseases), mitochondrial hepatopathy, and endocrine or chromosomal disorders. The diagnosis of genetic liver diseases has evolved from direct sequencing of a single gene to panel-based next generation sequencing. Whole exome sequencing and whole genome sequencing have been actively investigated in research and clinical studies. Current treatment modalities include medical treatment (ursodeoxycholic acid, cholic acid or chenodeoxycholic acid), surgery (partial biliary diversion and liver transplantation), symptomatic treatment for pruritus, and nutritional therapy. New drug development based on gene-specific treatments, such as apical sodium-dependent bile acid transporter (ASBT) inhibitor, for BSEP defects are underway.
SHORT CONCLUSION
Understanding the complex pathways of jaundice and cholestasis not only enhance insights into liver pathophysiology but also elucidate many causes of genetic liver diseases and promote the development of novel treatments.
Topics: Cholestasis, Intrahepatic; Humans; Jaundice, Obstructive
PubMed: 30367658
DOI: 10.1186/s12929-018-0475-8 -
Hong Kong Medical Journal = Xianggang... Jun 2018Jaundice is caused by an accumulation of bilirubin in the blood. The presentation in infants and children can be indicative of a wide range of conditions, with some... (Review)
Review
Jaundice is caused by an accumulation of bilirubin in the blood. The presentation in infants and children can be indicative of a wide range of conditions, with some self-limiting and others potentially life-threatening. This article aims to provide a concise review of the common medical and surgical causes in children and discuss their diagnosis and management.
Topics: Bilirubin; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Jaundice; Laparoscopy
PubMed: 29807950
DOI: 10.12809/hkmj187245 -
Hepatobiliary & Pancreatic Diseases... Feb 2018Obstructive jaundice is a common problem in daily clinical practice. Understanding completely the pathophysiological changes in obstructive jaundice remains a challenge... (Review)
Review
BACKGROUND
Obstructive jaundice is a common problem in daily clinical practice. Understanding completely the pathophysiological changes in obstructive jaundice remains a challenge for planning current and future management.
DATA SOURCES
A PubMed was searched for relevant articles published up to August 2016. The effect of obstructive jaundice on proinflammatory cytokines, coagulation status, hemodynamics and organ functions were evaluated.
RESULTS
The effects of obstructive jaundice included biliary tree, the hepatic cell and liver function as well as systemic complications. The lack of bile in the gut, the disruption of the intestinal mucosal barrier, the increased absorption of endotoxin and the subsequent endotoxemia cause proinflammatory cytokine production (TNF-α, IL-6). Bilirubin induces systemic inflammatory response syndrome which may lead to multiple organ dysfunction syndrome. The principal clinical manifestations include hemodynamic instability and acute renal failure, cardiovascular suppression, immune compromise, coagulation disorders, nutritional impairment, and wound healing defect. The proper management includes full replacement of water and electrolyte deficiency, prophylactic antibiotics, lactulose, vitamin K and fresh frozen plasma, albumin and dopamine. The preoperative biliary drainage has not been indicated in overall, but only in a few selected cases.
CONCLUSION
The perioperative management is an essential measure in improving the outcome after the appropriate surgical operation in jaundiced patients especially those with malignancy.
Topics: Animals; Bacterial Translocation; Biliary Tract; Biliary Tract Surgical Procedures; Biomarkers; Blood Coagulation; Cytokines; Endotoxins; Health Status; Hemodynamics; Humans; Inflammation Mediators; Intestinal Mucosa; Jaundice, Obstructive; Liver; Perioperative Care; Permeability; Postoperative Complications; Risk Factors; Treatment Outcome
PubMed: 29428098
DOI: 10.1016/j.hbpd.2018.01.008 -
Journal of Pediatric Gastroenterology... Jan 2017Cholestatic jaundice in infancy affects approximately 1 in every 2500 term infants and is infrequently recognized by primary providers in the setting of physiologic...
Guideline for the Evaluation of Cholestatic Jaundice in Infants: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition.
Cholestatic jaundice in infancy affects approximately 1 in every 2500 term infants and is infrequently recognized by primary providers in the setting of physiologic jaundice. Cholestatic jaundice is always pathologic and indicates hepatobiliary dysfunction. Early detection by the primary care physician and timely referrals to the pediatric gastroenterologist/hepatologist are important contributors to optimal treatment and prognosis. The most common causes of cholestatic jaundice in the first months of life are biliary atresia (25%-40%) followed by an expanding list of monogenic disorders (25%), along with many unknown or multifactorial (eg, parenteral nutrition-related) causes, each of which may have time-sensitive and distinct treatment plans. Thus, these guidelines can have an essential role for the evaluation of neonatal cholestasis to optimize care. The recommendations from this clinical practice guideline are based upon review and analysis of published literature and the combined experience of the authors. The committee recommends that any infant noted to be jaundiced after 2 weeks of age be evaluated for cholestasis with measurement of total and direct serum bilirubin, and that an elevated serum direct bilirubin level (direct bilirubin levels >1.0 mg/dL or >17 μmol/L) warrants timely consideration for evaluation and referral to a pediatric gastroenterologist or hepatologist. Of note, current differential diagnostic plans now incorporate consideration of modern broad-based next-generation DNA sequencing technologies in the proper clinical context. These recommendations are a general guideline and are not intended as a substitute for clinical judgment or as a protocol for the care of all infants with cholestasis. Broad implementation of these recommendations is expected to reduce the time to the diagnosis of pediatric liver diseases, including biliary atresia, leading to improved outcomes.
Topics: Biliary Atresia; Biliary Tract; Bilirubin; Cholestasis; Diagnosis, Differential; Europe; Gastroenterology; Humans; Hyperbilirubinemia; Infant; Infant, Newborn; Jaundice; Jaundice, Obstructive; Liver; Liver Diseases; North America; Pediatrics; Societies
PubMed: 27429428
DOI: 10.1097/MPG.0000000000001334 -
Techniques in Vascular and... Dec 2015Obstructive jaundice is a clinical symptom that results from cholestasis. Cholestasis can be extrahepatic or intrahepatic and is typically associated with biochemical... (Review)
Review
Obstructive jaundice is a clinical symptom that results from cholestasis. Cholestasis can be extrahepatic or intrahepatic and is typically associated with biochemical abnormalities in the liver function tests. Once these abnormalities are identified, more extensive imaging tests can be performed to determine the nature, etiology, and level of obstruction. This information is essential for clinicians as they decide on management and treatment strategies.
Topics: Cholangiopancreatography, Endoscopic Retrograde; Cholangiopancreatography, Magnetic Resonance; Diagnostic Imaging; Endosonography; Humans; Jaundice, Obstructive; Liver Function Tests; Predictive Value of Tests; Prognosis; Risk Factors; Severity of Illness Index
PubMed: 26615159
DOI: 10.1053/j.tvir.2015.07.002 -
The Medical Journal of Australia Nov 2019
Topics: Female; Humans; Jaundice; Liver Diseases; Pregnancy
PubMed: 31663144
DOI: 10.5694/mja2.50396 -
Gastroenterology Jun 2021
Topics: COVID-19; Cholangiopancreatography, Endoscopic Retrograde; Cholangitis, Sclerosing; Cholestasis; Critical Illness; Humans; Jaundice, Obstructive; Male; Middle Aged; Prognosis; Syndrome; Time Factors
PubMed: 33039462
DOI: 10.1053/j.gastro.2020.10.006 -
International Journal of Clinical... Jul 2017Mirtazapine is a commonly used drug indicated for the treatment of severe depression. It works as a presynaptic α-adrenoreceptor antagonist that increases central...
Mirtazapine is a commonly used drug indicated for the treatment of severe depression. It works as a presynaptic α-adrenoreceptor antagonist that increases central noradrenergic and serotonergic neurotransmission, and it is metabolized by the p450 cytochrome oxidase system. There is evidence within the literature to suggest a link between antidepressants and increased liver enzymes, although case reports demonstrating a link between mirtazapine specifically and steatosis are sparse. Here, we present a case of mirtazapine-induced steatosis in a 48-year-old office worker. She presented with painless jaundice of 2 days duration and generalized lethargy and peripheral edema present for 3 weeks beforehand. Extensive investigations were undertaken to identify the cause of her jaundice but no biochemical, blood-borne, or anatomical cause could be found. Mirtazapine was subsequently stopped, and her liver function, both clinically and biochemically, improved rapidly. She made a full recovery after discontinuation of her mirtazapine. .
Topics: Adrenergic alpha-2 Receptor Antagonists; Antidepressive Agents, Tricyclic; Biopsy; Chemical and Drug Induced Liver Injury; Fatty Liver; Female; Humans; Jaundice; Liver; Liver Function Tests; Mianserin; Middle Aged; Mirtazapine
PubMed: 28427497
DOI: 10.5414/CP202983