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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 Jan 2004Jaundice in an adult patient can be caused by a wide variety of benign or life-threatening disorders. Organizing the differential diagnosis by prehepatic, intrahepatic,... (Review)
Review
Jaundice in an adult patient can be caused by a wide variety of benign or life-threatening disorders. Organizing the differential diagnosis by prehepatic, intrahepatic, and posthepatic causes may help make the work-up more manageable. Prehepatic causes of jaundice include hemolysis and hematoma resorption, which lead to elevated levels of unconjugated (indirect) bilirubin. Intrahepatic disorders can lead to unconjugated or conjugated hyperbilirubinemia. The conjugated (direct) bilirubin level is often elevated by alcohol, infectious hepatitis, drug reactions, and autoimmune disorders. Posthepatic disorders also can cause conjugated hyperbilirubinemia. Gallstone formation is the most common and benign posthepatic process that causes jaundice; however, the differential diagnosis also includes serious conditions such as biliary tract infection, pancreatitis, and malignancies. The laboratory work-up should begin with a urine test for bilirubin, which indicates that conjugated hyperbilirubinemia is present. If the complete blood count and initial tests for liver function and infectious hepatitis are unrevealing, the work-up typically proceeds to abdominal imaging by ultrasonography or computed tomographic scanning. In a few instances, more invasive procedures such as cholangiography or liver biopsy may be needed to arrive at a diagnosis.
Topics: Adult; Humans; Jaundice
PubMed: 14765767
DOI: No ID Found -
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 -
American Family Physician Mar 1992Jaundice is a disorder of bilirubin metabolism and has many causes. History and physical examination help establish the diagnosis in 70 to 80 percent of patients.... (Review)
Review
Jaundice is a disorder of bilirubin metabolism and has many causes. History and physical examination help establish the diagnosis in 70 to 80 percent of patients. Elevation of alkaline phosphatase and gamma-glutamyl transpeptidase suggests cholestasis, either intrahepatic (e.g., medication reactions) or extrahepatic (e.g., choledocholithiasis), whereas markedly elevated serum aminotransferases are indicative of hepatocellular damage from infection, toxins or ischemia. Ultrasound examination is a useful initial procedure when extrahepatic obstruction is suspected. Endoscopic retrograde cholangiopancreatography and computed tomography may be better used to diagnose obstruction at the level of the pancreas or distal common bile duct. The treatment is based on the etiology of jaundice and includes removal of offending medications or toxins, therapy for underlying liver disease or surgery for extrahepatic obstruction.
Topics: Female; Humans; Jaundice; Male
PubMed: 1543099
DOI: No ID Found -
NeoReviews Dec 2022
Topics: Infant; Humans; Jaundice
PubMed: 36450645
DOI: 10.1542/neo.23-12-e845 -
Bailliere's Clinical Gastroenterology Apr 1989
Review
Topics: Humans; Hyperbilirubinemia; Jaundice; Postoperative Complications
PubMed: 2655766
DOI: 10.1016/0950-3528(89)90012-2 -
The Journal of the Royal College of... Jun 2022
Topics: Humans; Jaundice
PubMed: 36147006
DOI: 10.1177/14782715221103716 -
Journal of Hepatology Jul 2023
Topics: Humans; Cholestasis; Jaundice, Obstructive; Jaundice
PubMed: 37193627
DOI: 10.1016/j.jhep.2023.03.031 -
Annales de L'anesthesiologie Francaise 1981
Review
Topics: Bilirubin; Humans; Jaundice; Liver; Postoperative Complications; Urination
PubMed: 6119949
DOI: No ID Found -
Postgraduate Medicine Sep 1991Jaundiced patients may not always be as sick as they look, and cholestatic patients may be quite ill but not yet jaundiced. There is variability in presentation of... (Review)
Review
Jaundiced patients may not always be as sick as they look, and cholestatic patients may be quite ill but not yet jaundiced. There is variability in presentation of cholestasis, and jaundice may be intrahepatic or extrahepatic and acute or chronic. Even though the diagnosis of jaundice can be elusive, an unnecessarily exhaustive search for a cause should be avoided, because some tests are not without dangers. Dr Gordon describes many possible causes, some of which are rare but are still worth consideration.
Topics: Cholangiography; Cholangiopancreatography, Endoscopic Retrograde; Cholestasis; Clinical Protocols; Decision Trees; Diagnosis, Differential; Education, Medical, Continuing; Endoscopy, Digestive System; Humans; Jaundice
PubMed: 1891435
DOI: 10.1080/00325481.1991.11701060