jaundice (icterus)
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Etiology
- elevated unconjugated bilirubin
- increased bilirubin production
- extravascular hemolysis
- extravasation of blood into tissues
- intravascular hemolysis
- dyserythropoiesis
- impaired hepatic bilirubin uptake
- congestive heart failure
- porto-systemic shunt
- Gilbert's syndrome (some)
- pharmaceutical agents
- impaired bilirubin conjugation
- increased bilirubin production
- elevated conjugated bilirubin
- biliary obstruction (extrahepatic cholestasis)
- choledocholithiasis
- tumors, extrinsic & intrinsic
- cholangiocarcinoma
- pancreatic carcinoma
- periampullary carcinoma
- metastatic carcinoma
- primary sclerosing cholangitis
- AIDS cholangiopathy
- acute pancreatitis, chronic pancreatitis
- strictures after invasive procedures
- parasitic infections
- sphincter of Oddi dysfunction
- histiocytosis X
- Mirizzi's syndrome
- periampullary diverticulum
- intrahepatic cholestasis
- viral hepatitis
- alcoholic hepatitis
- non-alcoholic steatohepatitis (NASH)
- primary sclerosisng cholangitis
- primary biliary cirrhosis
- drugs & toxins
- amoxicillin clavulanate
- alkylated anabolic steroids
- chlorpromazine
- Jamaican bush tea
- arsenic
- sepsis & other states of hypoperfusion
- infiltrative diseases
- total parenteral nutrition
- post-operative
- post organ transplantation
- hepatic crisis in sickle cell disease
- pregnancy
- end-stage liver disease
- hepatocellular injury
- parasitic infection
- Clonorchis sinesis
- Fasciola hepatica
- Budd-Chiari syndrome
- familial intrahepatic cholestasis
- thyrotoxicosis
- Alagille syndrome
- Caroli's disease
- protoporphyria
- pregnancy
- disorders of carbohydrate, lipid or bile acid metabolism
- biliary obstruction (extrahepatic cholestasis)
- pharmaceutical causes:
Pathology
- plasma elevation of unconjugated bilirubin due to:
- overproduction of bilirubin
- impaired bilirubin uptake by the liver
- defect in bilitubin conjugation
- plasma elevation of both conjugated bilirubin & unconjugated bilirubin due to:
- heptocellular disease
- impaired canalicular excretion
- biliary obstruction
Clinical manifestations
Laboratory
- serum bilirubin:
- normal < 1 mg dL
- in the adult, jaundice may become apparent when serum bilirubin > 2.5-3.5 mg/dL
- in infants, serum bilirubin > 5-6 mg/dL for visible jaundice
- serum unconjugated bilirubin
- serum conjugated bilirubin (normal < 5% of total)
- serum delta bilirubin
- urine bilirubin
Diagnostic procedures
- abdominal ultrasound
- ERCP if biliary obstruction
- endoscopic ultrasound if biliary obstruction due to pancreatic mass suspected
Radiology
- abdominal CT
- magnetic resonance cholangiopancreatograpy if pancreas appears normal on abdominal CT & biliary obstruction due to pancreatic mass suspected[4]
Management
- see specific etiology
More general terms
More specific terms
Additional terms
References
- ↑ Harrison's Principles of Internal Medicine, 13th ed. Companion Handbook, Isselbacher et al (eds), McGraw-Hill Inc. NY, 1995, pg 829-39
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 361-62, 371-73
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 16 American College of Physicians, Philadelphia 2012
- ↑ 4.0 4.1 NEJM Knowledge+ Gastroenterology