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    Approach To Jaundice

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    zhijiegoh357
    This document outlines different types and potential causes of jaundice based on whether it is pre-hepatic, hepatic, or post-hepatic in origin. Pre-hepatic causes include hematological disorders and drugs that can cause hemolysis. Hepatic jaundice presents with tea-colored urine and coagulopathy and is caused by toxic insults, viruses, alcohol use, cirrhosis, and genetic disorders. Post-hepatic jaundice causes dark urine and pale stools and includes gallstone disease, periampullary masses, and autoimmune conditions. Additional considerations in pregnancy include intrahepatic cholestasis, acute fatty liver, and HELLP syndrome.

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    Approach To Jaundice

    Uploaded by

    zhijiegoh357
    8 views2 pages
    This document outlines different types and potential causes of jaundice based on whether it is pre-hepatic, hepatic, or post-hepatic in origin. Pre-hepatic causes include hematological disorders and drugs that can cause hemolysis. Hepatic jaundice presents with tea-colored urine and coagulopathy and is caused by toxic insults, viruses, alcohol use, cirrhosis, and genetic disorders. Post-hepatic jaundice causes dark urine and pale stools and includes gallstone disease, periampullary masses, and autoimmune conditions. Additional considerations in pregnancy include intrahepatic cholestasis, acute fatty liver, and HELLP syndrome.

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    Differential diagnoses for various kinds of jaundice

    Original Title

    Approach to jaundice

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    This document outlines different types and potential causes of jaundice based on whether it is pre-hepatic, hepatic, or post-hepatic in origin. Pre-hepatic causes include hematological disorders and drugs that can cause hemolysis. Hepatic jaundice presents with tea-colored urine and coagulopathy and is caused by toxic insults, viruses, alcohol use, cirrhosis, and genetic disorders. Post-hepatic jaundice causes dark urine and pale stools and includes gallstone disease, periampullary masses, and autoimmune conditions. Additional considerations in pregnancy include intrahepatic cholestasis, acute fatty liver, and HELLP syndrome.

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    © All Rights Reserved
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    8 views2 pages

    Approach To Jaundice

    Uploaded by

    zhijiegoh357
    This document outlines different types and potential causes of jaundice based on whether it is pre-hepatic, hepatic, or post-hepatic in origin. Pre-hepatic causes include hematological disorders and drugs that can cause hemolysis. Hepatic jaundice presents with tea-colored urine and coagulopathy and is caused by toxic insults, viruses, alcohol use, cirrhosis, and genetic disorders. Post-hepatic jaundice causes dark urine and pale stools and includes gallstone disease, periampullary masses, and autoimmune conditions. Additional considerations in pregnancy include intrahepatic cholestasis, acute fatty liver, and HELLP syndrome.

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    Duration

    Acute - consider hepatic (drug injury) or post-hepatic (gallstone - choledocholithiasis or


    cholangitis)
    Chronic intermittent - perhaps triggered by stress, perhaps by illness, consider pre-hepatic
    Chronic persistent and progressive - consider malignancy

    Pre-Hepatic Jaundice
    Normal urine (may be dark due to haemoglobinuria), normal stools, signs of symptomatic
    anaemia
    -G6PD deficiency: drugs, fava beans
    -Thalassemia
    -Haematological malignancy (CLL)
    -Drugs (eg Bactrim)
    -Recent transfusion

    Hepatic Jaundice
    Tea-coloured urine, ascites, coagulopathy, encephalopathy

    Acute
    -Toxic: Drugs such as paracetamol, TB drugs, anti-epileptics, traditional medicine
    -Ischaemic: Hypotensive episode (sepsis), occurs 1-3 days after insult
    -Acute viral (Hep A, B, E, CMV, EBM, HSV, dengue)

    Chronic with acute flares


    -Alcoholic: Longstanding heavy alcohol use, tender hepatomegaly, fever
    -Hep B and C: Vertical transmission, sexually transmitted, blood-borne (IV drug use)

    Chronic
    -Cirrhosis: splenomegaly, ascites, thrombocytopenia, hyperoestrogenism
    -Congestive: Severe right heart failure, tricuspid regurgitation
    -NAFLD: Metabolic risk factors
    -Haemochromatosis: Hereditary; or secondary to chronic iron overload (thalassemia), other
    endocrine disease (diabetes, hypopituitarism, hypogonadism), cardiomyopathy,
    pseudogout/arthropathy and bronzing of skin
    -A1AT deficiency: history of young COPD
    -Congenital: eg biliary atresia

    Anything
    -Autoimmune: Other autoimmune disease symptoms
    -Wilson’s disease: Young patient, neurologic features (dysarthria, cerebellar, extrapyramidal
    and psychiatric), and haemolytic anaemia
    -Budd-Chiari syndrome: RHC pain, hepatomegaly and acute liver failure (acute), ascites and
    features of cirrhosis (chronic).

    Additional considerations in pregnancy:

    • Intrahepatic cholestasis of pregnancy: Presents in second to third trimester with pruritus and
    raised bilirubin, but women are otherwise well.

    • Acute fatty liver of pregnancy: Presents in third trimester with liver dysfunction (jaundice,
    elevated AST/ALT, coagulopathy), abdominal pain, nausea/vomiting and often renal
    impairment.

    • HELLP syndrome: Presents in the third trimester with haemolysis, elevated LFTs and low
    platelets. This is thought to be a severe form of pre-eclampsia, often with hypertension,
    proteinuria, abdominal pain and vomiting.

    Post-Hepatic Jaundice
    Dark urine and pale stools, pruitus

    Painful causes
    Painful obstructive jaundice is almost always due to gallstone disease.

    -Cholangitis: RHC pain, jaundice and fever (Charcot’s triad), obstruction usually due to
    gallstones, or possibly tumour, PBC etc.

    -Choledocholithiasis:

    -Hepatic abscess: RHC pain and jaundice, spiking fever with chills, anorexia and weight loss,
    jaundice and vomiting

    Painless causes

    -Periampullary mass: Painless progressive jaundice, constitutional symptoms

    -AIDS cholangiopathy (CD4 < 1000)

    -PBC and PSC: Autoimmune disease


    PSC - inflammatory bowel conditions

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