Jaundice

Published on 23/05/2015 by admin

Filed under Internal Medicine

Last modified 23/05/2015

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Jaundice

Jaundice is yellow discoloration of the tissues, noticed especially in the skin and sclera (Figs 28, 37), due to accumulation of bilirubin. For jaundice to be clinically apparent, the circulating bilirubin levels should be in excess of 35 μmol/L. Jaundice may be prehepatic (due to haemolysis), hepatic (due to intrinsic liver disease) or cholestatic (due to either intrahepatic cholestasis or post-hepatic biliary tract obstruction).

Figure 37 Jaundiced sclera in a patient with hepatitis.
Mild jaundice is evident in the sclera. There is no obvious jaundice in the skin. Jaundice in the sclera is usually clinically apparent when the circulating bilirubin levels are in excess of 35 μmol/L.

Causes

Prehepatic (Unconjugated Hyperbilirubinaemia)

Congenital Defects

• Gilbert’s disease

• Crigler–Najjar syndrome

Haemolysis

Congenital red cell defects

• Hereditary spherocytosis (congenital acholuric jaundice)

• Sickle cell disease

• G6PD deficiency

• Thalassaemia

Acquired

• Malaria • (common where malaria is endemic)

• Incompatible blood transfusion

• Haemolytic disease of the newborn

• Absorbing large haematoma

• Hypersplenism

Hepatic

Acute Hepatocellular Disease

• Viral hepatitis

• Hepatitis A, B, C

• EBV

• CMV

• Drugs, e.g. paracetamol, halothane

• Other infections

• Leptospirosis

• Toxins, e.g. carbon tetrachloride

Chronic hepatocellular disease

• Chronic viral hepatitis

• Chronic autoimmune hepatitis

• End-stage liver disease

• Haemochromatosis

• Wilson’s disease

Cholestatic

Intrahepatic

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