Jaundice

Definition

Yellow discoloration of the sclera, mucous membranes and skin due to hyperbilirubinemia. It is usually apparent by clinical examination when the serum bilirubin exceeds 3mg%.


1. Hemolytic

>80% unconjugated bilirubin

  • Hemolytic anemia (Differential diagnosis)
  • Reduced bilirubin uptake: Gilbert's syndrome, severe congestive heart failure and drugs.
  • Reduced bilirubin conjugation: Crigler-Najjar syndrome, breast milk jaundice.

2. Hepatocellular

Mainly conjugated bilirubin

1. Acute liver diseases

  • Infectious hepatitis
  • Drugs: alcohol, paracetamol, halothane, MAO inhibitors
  • Poisons: amanita phalloides, aflatoxin, carbon tetrachloride, tetracyclines
  • Wilson's disease.

2. Chronic liver diseases

  • Chronic viral hepatitis
  • Chronic autoimmune hepatitis
  • Drugs: methyl dopa, isoniazide, ketoconazole, nitrofurantoin.
  • Alpha - 1 antitrypsin deficiency
  • Wilson's disease

3. Obstructive

Mainly conjugated bilirubin

1. Intrahepatic

  • Biliary cirrhosis
  • Sclerosing cholangitis
  • Viral hepatitis
  • Congenital: Dubin-Johnson syndrome, Rotor syndrome

2. Extrahepatic

  • Cancer pancreas
  • Stone
  • Biliary stricture
  • Sclerosing cholangitis

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