Materiały źródłowe

• #1 Jaundice – Hepatic and Biliary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/hepatic-and-biliary-disorders/approach-to-the-patient-with-liver-disease/jaundice

  Jaundice is a yellowish discoloration of the skin and mucous membranes caused by hyperbilirubinemia. Jaundice becomes visible when the bilirubin level is about 2 to 3 mg/dL (34 to 51 micromol/L). […] Hyperbilirubinemia may involve predominantly unconjugated or conjugated bilirubin. […] Outcome is determined primarily by the cause of jaundice and the presence and severity of hepatic dysfunction. Hepatic dysfunction can result in coagulopathy, encephalopathy, and portal hypertension (which can lead to gastrointestinal bleeding). […] Although hyperbilirubinemia can be classified as predominantly unconjugated or conjugated, many hepatobiliary disorders cause both forms. […] Many conditions can cause jaundice, but the most common causes overall are inflammatory hepatitis (viral hepatitis, autoimmune hepatitis, toxic hepatic injury), alcohol-related liver disease, and biliary obstruction.

• #2 Assessment of jaundice – Differential diagnosis of symptoms | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/511

  Jaundice (icterus) is the result of accumulation of bilirubin in the bloodstream and subsequent deposition in the skin, sclera, and mucous membranes. The normal range for total bilirubin is 3.4 to 20.0 micromol/L (0.2 to 1.2 mg/dL). Jaundice may not be clinically evident until serum levels 51 micromol/L (3 mg/dL). […] Jaundice might result from increased bilirubin production (prehepatic), diseases that impair hepatocyte function (hepatocellular), or obstruction of the biliary system (cholestatic). […] After a focused history and examination, evaluation of the liver with full blood count, serum liver function tests, and ultrasound is appropriate for most patients. Further imaging and laboratory tests depend on the likely diagnosis.

• #3 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Jaundice-Diagnosis.aspx

  Jaundice is a symptom of an underlying condition rather than a disease in itself. Jaundice is caused by an accumulation of a yellowgreen substance called bilirubin in the tissues of the body, which causes a yellowing of the skin, eyes and mucous membranes. […] Jaundice is categorized into three different forms, depending on what the underlying cause of the bilirubin build-up is. The different types of jaundice are described below. […] For each type of jaundice, the clinical features of the disease are different, as outlined below. […] Pre-hepatic jaundice There is no bilirubin present in the urine and there is an increase in the level of unconjugated bilirubin in the blood. […] Hepatocellular jaundice Conjugated bilirubin is present in the urine. The plasma albumin level is reduced, but globulins are raised in response to an increase in antibodies. The urine is dark-colored and the stools are either normal or pale. Enzymes alkaline phosphatase, alanine transferase and aspartate transferase are all raised. […] Post hepatic or obstructive jaundice The blood level of conjugated bilirubin is raised; the urine is dark-colored and the stools are pale. Alkaline phosphatase, alanine transferase and aspartate transferase levels are all raised.

• #4 Adult Jaundice: What It Is, Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/symptoms/15367-adult-jaundice

  Jaundice (hyperbilirubinemia) is when your skin, sclera (whites of your eyes) and mucous membranes turn yellow. Jaundice occurs when your liver is unable to process bilirubin (a yellow substance made when red blood cells break down) in your blood. This can either be caused by too much red blood cell breakdown or liver injury. […] Jaundice can result from a problem in any of the three phases of bilirubin: […] Your provider can tell if you have jaundice by measuring the bilirubin levels in your blood and seeing whether its the type of bilirubin related to red blood cell breakdown (unconjugated) or liver injury (conjugated). […] Your healthcare provider will also examine you to decide your livers size and tenderness. They may use imaging (ultrasound and CT scanning) and liver biopsy (taking a tissue sample of your liver) to better understand whats causing your liver injury. […] Theres no specific treatment for jaundice. But your provider can treat the cause and the jaundice should improve. […] A healthcare provider should evaluate jaundice. Its a sign that somethings not right with your liver. If you notice signs of jaundice, call your healthcare provider.

• #5 Jaundice – Wikipedia

  https://en.wikipedia.org/wiki/Jaundice

  Jaundice, also known as icterus, is a yellowish or greenish pigmentation of the skin and sclera due to high bilirubin levels. Jaundice in adults is typically a sign indicating the presence of underlying diseases involving abnormal heme metabolism, liver dysfunction, or biliary-tract obstruction. […] The prevalence of jaundice in adults is rare, while jaundice in babies is common, with an estimated 80% affected during their first week of life. […] Normal levels of bilirubin in blood are below 1.0 mg/dl (17 mol/L), while levels over 23 mg/dl (3451 mol/L) typically result in jaundice. […] High blood bilirubin is divided into two types: unconjugated and conjugated bilirubin. […] Causes of jaundice vary from relatively benign to potentially fatal. […] High unconjugated bilirubin may be due to excess red blood cell breakdown, large bruises, genetic conditions such as Gilbert’s syndrome, not eating for a prolonged period of time, newborn jaundice, or thyroid problems.

• #6 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Jaundice-Diagnosis.aspx

  Jaundice is a symptom of an underlying condition rather than a disease in itself. Jaundice is caused by an accumulation of a yellowgreen substance called bilirubin in the tissues of the body, which causes a yellowing of the skin, eyes and mucous membranes. […] Jaundice is categorized into three different forms, depending on what the underlying cause of the bilirubin build-up is. The different types of jaundice are described below. […] For each type of jaundice, the clinical features of the disease are different, as outlined below. […] Pre-hepatic jaundice There is no bilirubin present in the urine and there is an increase in the level of unconjugated bilirubin in the blood. […] Hepatocellular jaundice Conjugated bilirubin is present in the urine. The plasma albumin level is reduced, but globulins are raised in response to an increase in antibodies. The urine is dark-colored and the stools are either normal or pale. Enzymes alkaline phosphatase, alanine transferase and aspartate transferase are all raised. […] Post hepatic or obstructive jaundice The blood level of conjugated bilirubin is raised; the urine is dark-colored and the stools are pale. Alkaline phosphatase, alanine transferase and aspartate transferase levels are all raised.

• #7 Jaundice in the Adult Patient | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/0115/p299.html

  Jaundice is not a common presenting complaint in adults. When present, it may indicate a serious problem. This article discusses the evaluation of the adult patient with jaundice. A systematic approach is warranted to clarify the cause quickly so that treatment can begin as soon as possible. […] The initial work-up of the patient with jaundice depends on whether the hyperbilirubinemia is conjugated (direct) or unconjugated (indirect). A urinalysis that is positive for bilirubin indicates the presence of conjugated bilirubinemia. Conjugated bilirubin is water soluble and therefore able to be excreted in urine. The findings of urinalysis should be confirmed by measurements of the serum total and direct bilirubin levels. […] First-line serum testing in a patient presenting with jaundice should include a complete blood count (CBC) and determination of bilirubin (total and direct fractions), aspartate transaminase (AST), alanine transaminase (ALT), -glutamyl transpeptidase, and alkaline phosphatase levels.

• #8 Jaundice Types: Causes, Treatments, Diagnosis, and More

  https://www.healthline.com/health/jaundice-types

  Jaundice is categorized into three types, depending on whether it is caused by issues with breaking down blood cells, filtering blood, or draining waste from the blood. […] Jaundice is a serious medical condition that makes your skin and the whites of your eyes look yellowish. This happens when too much bilirubin builds up in your blood. […] To diagnose pre-hepatic jaundice, a doctor will likely order tests to determine your liver function and measure bilirubin. […] A doctor may diagnose you with pre-hepatic jaundice if you have jaundice and there aren’t any issues with bilirubin being processed by your liver or within the gallbladder and biliary ducts. […] To diagnose hepatic jaundice, a doctor will likely order the following tests: a urinalysis to measure levels of substances in your urine related to your liver function; blood tests, such as a complete blood count (CBC) and antibody tests, or liver function tests to measure bilirubin in the blood and levels of substances that indicate that your liver may not be processing bilirubin properly.

• #9 Assessment of jaundice – Differential diagnosis of symptoms | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/511

  Jaundice (icterus) is the result of accumulation of bilirubin in the bloodstream and subsequent deposition in the skin, sclera, and mucous membranes. The normal range for total bilirubin is 3.4 to 20.0 micromol/L (0.2 to 1.2 mg/dL). Jaundice may not be clinically evident until serum levels 51 micromol/L (3 mg/dL). […] Jaundice might result from increased bilirubin production (prehepatic), diseases that impair hepatocyte function (hepatocellular), or obstruction of the biliary system (cholestatic). […] After a focused history and examination, evaluation of the liver with full blood count, serum liver function tests, and ultrasound is appropriate for most patients. Further imaging and laboratory tests depend on the likely diagnosis.

• #10 Jaundice Types: Causes, Treatments, Diagnosis, and More

  https://www.healthline.com/health/jaundice-types

  Jaundice is categorized into three types, depending on whether it is caused by issues with breaking down blood cells, filtering blood, or draining waste from the blood. […] Jaundice is a serious medical condition that makes your skin and the whites of your eyes look yellowish. This happens when too much bilirubin builds up in your blood. […] To diagnose pre-hepatic jaundice, a doctor will likely order tests to determine your liver function and measure bilirubin. […] A doctor may diagnose you with pre-hepatic jaundice if you have jaundice and there aren’t any issues with bilirubin being processed by your liver or within the gallbladder and biliary ducts. […] To diagnose hepatic jaundice, a doctor will likely order the following tests: a urinalysis to measure levels of substances in your urine related to your liver function; blood tests, such as a complete blood count (CBC) and antibody tests, or liver function tests to measure bilirubin in the blood and levels of substances that indicate that your liver may not be processing bilirubin properly.

• #11 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Jaundice-Diagnosis.aspx

  Jaundice is a symptom of an underlying condition rather than a disease in itself. Jaundice is caused by an accumulation of a yellowgreen substance called bilirubin in the tissues of the body, which causes a yellowing of the skin, eyes and mucous membranes. […] Jaundice is categorized into three different forms, depending on what the underlying cause of the bilirubin build-up is. The different types of jaundice are described below. […] For each type of jaundice, the clinical features of the disease are different, as outlined below. […] Pre-hepatic jaundice There is no bilirubin present in the urine and there is an increase in the level of unconjugated bilirubin in the blood. […] Hepatocellular jaundice Conjugated bilirubin is present in the urine. The plasma albumin level is reduced, but globulins are raised in response to an increase in antibodies. The urine is dark-colored and the stools are either normal or pale. Enzymes alkaline phosphatase, alanine transferase and aspartate transferase are all raised. […] Post hepatic or obstructive jaundice The blood level of conjugated bilirubin is raised; the urine is dark-colored and the stools are pale. Alkaline phosphatase, alanine transferase and aspartate transferase levels are all raised.

• #12 Laboratory Diagnosis of Jaundice | PPT

  https://www.slideshare.net/slideshow/laboratory-diagnosis-of-jaundice/64521162

  Jaundice is classified based on bilirubin type, etiology, and site of disease. […] Differential diagnosis of pre-hepatic, hepatocellular and obstructive jaundice is provided based on bilirubin levels, urine tests, and other features. […] Jaundice becomes clinically evident when serum bilirubin level exceeds 2.0 mg/dl. […] Evaluation of acute liver injury focuses on markers like ALT, AST, ALP and their patterns in hepatocellular vs cholestatic disease. […] Causes include Hemolysis Resorption of a large hematoma, Ineffective erythropoiesis (Thalassemia, Megaloblastic anemia) Physiologic jaundice of newborn. […] Classification of Jaundice II. According to etiology: Hemolytic Increased rate of RBC destruction Increased Hb breakdown to bilirubin in RES cells This exceeds the capacity of conjugation in liver.

• #13 Laboratory Diagnosis of Jaundice | PPT

  https://www.slideshare.net/slideshow/laboratory-diagnosis-of-jaundice/64521162

  Obstructive Failure of excretion of conjugated bilirubin into the intestine, causing its regurgitation in circulation. […] Presence of bilirubin in urine indicates conjugated hyperbilirubinemia (obstructive or hepatocellular jaundice) as only conjugated bilirubin is water-soluble. […] Increased RBC turnover RBCs are the major source of bilirubin. […] Jaundice is a condition characterized by yellowing of the skin and eyes due to high bilirubin levels in the blood. […] The document discusses the causes, types, signs, tests, and treatments for jaundice. […] The types of jaundice – hemolytic, obstructive, and hepatic – are distinguished based on conjugated and unconjugated bilirubin levels as well as other factors.

• #14 Jaundice Types: Causes, Treatments, Diagnosis, and More

  https://www.healthline.com/health/jaundice-types

  Jaundice is categorized into three types, depending on whether it is caused by issues with breaking down blood cells, filtering blood, or draining waste from the blood. […] Jaundice is a serious medical condition that makes your skin and the whites of your eyes look yellowish. This happens when too much bilirubin builds up in your blood. […] To diagnose pre-hepatic jaundice, a doctor will likely order tests to determine your liver function and measure bilirubin. […] A doctor may diagnose you with pre-hepatic jaundice if you have jaundice and there aren’t any issues with bilirubin being processed by your liver or within the gallbladder and biliary ducts. […] To diagnose hepatic jaundice, a doctor will likely order the following tests: a urinalysis to measure levels of substances in your urine related to your liver function; blood tests, such as a complete blood count (CBC) and antibody tests, or liver function tests to measure bilirubin in the blood and levels of substances that indicate that your liver may not be processing bilirubin properly.

• #15 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Jaundice-Diagnosis.aspx

  Jaundice is a symptom of an underlying condition rather than a disease in itself. Jaundice is caused by an accumulation of a yellowgreen substance called bilirubin in the tissues of the body, which causes a yellowing of the skin, eyes and mucous membranes. […] Jaundice is categorized into three different forms, depending on what the underlying cause of the bilirubin build-up is. The different types of jaundice are described below. […] For each type of jaundice, the clinical features of the disease are different, as outlined below. […] Pre-hepatic jaundice There is no bilirubin present in the urine and there is an increase in the level of unconjugated bilirubin in the blood. […] Hepatocellular jaundice Conjugated bilirubin is present in the urine. The plasma albumin level is reduced, but globulins are raised in response to an increase in antibodies. The urine is dark-colored and the stools are either normal or pale. Enzymes alkaline phosphatase, alanine transferase and aspartate transferase are all raised. […] Post hepatic or obstructive jaundice The blood level of conjugated bilirubin is raised; the urine is dark-colored and the stools are pale. Alkaline phosphatase, alanine transferase and aspartate transferase levels are all raised.

• #16 Evaluation of Jaundice in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0201/p164.html

  Jaundice in adults can be an indicator of significant underlying disease. It is caused by elevated serum bilirubin levels in the unconjugated or conjugated form. The evaluation of jaundice relies on the history and physical examination. The initial laboratory evaluation should include fractionated bilirubin, a complete blood count, alanine transaminase, aspartate transaminase, alkaline phosphatase, -glutamyltransferase, prothrombin time and/or international normalized ratio, albumin, and protein. Imaging with ultrasonography or computed tomography can differentiate between extrahepatic obstructive and intrahepatic parenchymal disorders. […] A retrospective study of more than 700 individuals found that most cases (55%) of acute jaundice in adults are caused by intrahepatic disorders, including viral hepatitis, alcoholic liver disease, and drug-induced liver injury. The remaining 45% of acute jaundice cases are extrahepatic and include gallstone disease, hemolysis, and malignancy.

• #17 Obstructive Jaundice | Center for Advanced Digestive Care – NewYork-Presbyterian/Weill Cornell Medical Center

  https://www.nyp.org/cadc/liver-diseases-and-transplantation/obstructive-jaundice

  Jaundice is a yellow color of the skin, mucus membranes, or eyes. The yellow coloring comes from bilirubin, a byproduct of old red blood cells. Obstructive jaundice is a specific type of jaundice, where symptoms develop due to a narrowed or blocked bile duct or pancreatic duct, preventing the normal drainage of bile from the bloodstream into the intestines. […] Specialists at the Center for Advanced Digestive Care (CADC) at NewYork-Presbyterian/Weill Cornell Medical Center are experienced in diagnosing and treating the causes of obstructive jaundice. Our Center for Liver Disease and Transplantation uses a multidisciplinary approach and tailor treatment to the needs of each patient. […] Obstructive jaundice, also known as cholestatic jaundice, is a condition characterized by the obstruction of bile flow from the liver to the small intestine. This obstruction can occur due to various reasons, such as gallstones, tumors, or inflammation of the bile ducts. Recognizing the symptoms of obstructive jaundice is crucial for timely diagnosis and treatment.

• #18 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Jaundice-Diagnosis.aspx

  Jaundice is a symptom of an underlying condition rather than a disease in itself. Jaundice is caused by an accumulation of a yellowgreen substance called bilirubin in the tissues of the body, which causes a yellowing of the skin, eyes and mucous membranes. […] Jaundice is categorized into three different forms, depending on what the underlying cause of the bilirubin build-up is. The different types of jaundice are described below. […] For each type of jaundice, the clinical features of the disease are different, as outlined below. […] Pre-hepatic jaundice There is no bilirubin present in the urine and there is an increase in the level of unconjugated bilirubin in the blood. […] Hepatocellular jaundice Conjugated bilirubin is present in the urine. The plasma albumin level is reduced, but globulins are raised in response to an increase in antibodies. The urine is dark-colored and the stools are either normal or pale. Enzymes alkaline phosphatase, alanine transferase and aspartate transferase are all raised. […] Post hepatic or obstructive jaundice The blood level of conjugated bilirubin is raised; the urine is dark-colored and the stools are pale. Alkaline phosphatase, alanine transferase and aspartate transferase levels are all raised.

• #19 Jaundice – Wikipedia

  https://en.wikipedia.org/wiki/Jaundice

  High conjugated bilirubin may be due to liver diseases such as cirrhosis or hepatitis, infections, medications, or blockage of the bile duct, due to factors including gallstones, cancer, or pancreatitis. […] Treatment of jaundice is typically determined by the underlying cause. […] If a bile duct blockage is present, surgery is typically required; otherwise, management is medical. […] Medical management may involve treating infectious causes and stopping medication that could be contributing to the jaundice. […] Most people presenting with jaundice have various predictable patterns of liver panel abnormalities, though significant variation does exist. […] The typical liver panel includes blood levels of enzymes found primarily from the liver, such as the aminotransferases (ALT, AST), and alkaline phosphatase (ALP); bilirubin (which causes the jaundice); and protein levels, specifically, total protein and albumin.

• #20 Evaluation of Jaundice in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0201/p164.html

  This article provides a systematic approach to the diagnosis of jaundice in adults and reviews common etiologies of hyperbilirubinemia. An algorithm for the evaluation of jaundice in adults is provided in Figure 1. […] The initial workup of jaundice should focus on the history and physical examination to help clarify the diagnosis. […] The laboratory evaluation to determine the etiology of jaundice should include fractionated bilirubin, a complete blood count, alanine transaminase, aspartate transaminase, -glutamyltransferase, alkaline phosphatase, prothrombin time and/or international normalized ratio, albumin, and protein. […] If the jaundice etiology is unknown after the initial laboratory evaluation, it is necessary to perform additional tests including hepatitis panels and autoimmune panels, such as antinuclear, smooth muscle, and liver-kidney microsomal antibodies. […] Liver biopsy should be reserved for cases of jaundice in which the diagnosis is unclear after the initial history and physical examination, laboratory studies, and imaging. It should be performed only if biopsy results are required to determine treatment and prognosis.

• #21

  https://journals.lww.com/co-gastroenterology/fulltext/2017/05000/diagnosis_and_evaluation_of_hyperbilirubinemia.10.aspx

  Jaundice, the physical finding associated with hyperbilirubinemia, results when the liver is unable to properly metabolize or excrete bilirubin. The purpose of this review is to examine some of the most common causes of jaundice in adults, provide insight into the diagnostic evaluation of jaundice, and review information on the outcomes of patients with jaundice. […] The best approach to evaluating a patient with jaundice is to start with a careful history and physical examination, followed by imaging assessment of the biliary tree and liver. […] Evaluation of patients with jaundice starts with a careful history and physical examination, followed by directed imaging of the biliary tree and liver.

• #22 Jaundice – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK544252/

  The prevalence of jaundice differs among patient populations; newborns and elderly more commonly present with the disease. […] Hepatitis A was found to be the most afflicting cause of jaundice among children. […] The pathophysiology of jaundice is best explained by dividing the metabolism of bilirubin into three phases: prehepatic, hepatic, and post-hepatic. […] Dysfunction in prehepatic phase results in elevated serum levels of unconjugated bilirubin while insult in post hepatic phase marks elevated conjugated bilirubin. […] Patients usually present with varying symptoms apart from yellowish discoloration of skin along with pruritus, thus providing clues to narrow down the etiology or can also be asymptomatic. […] A thorough questioning regarding the use of drugs, alcohol or other toxic substances, risk factors for hepatitis (travel, unsafe sexual practices), HIV status, personal or family history of any inherited disorders or hemolytic disorders is vital.

• #23 Jaundice – Clinical Methods – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK413/

  Jaundice is the yellow color of skin and mucous membranes due to accumulation of bile pigments in blood and their deposition in body tissues. Jaundice must be distinguished from yellow or green skin color resulting from carotenemia or quinacrine ingestion. The majority of jaundiced patients may be diagnosed by careful and meticulous history and physical examination. Assessment of constitutional symptoms often provides the first clue to the mechanism of jaundice. Symptoms associated with jaundice often provide a diagnosis. The jaundiced patient requires thorough documentation of all recent drug and toxin exposures. Potential contact with hepatitis viruses and other infectious agents should also be determined. Surgical history, whether recent or remote may be implicated in the cause of jaundice. Other systemic conditions may have complications related to the liver. A family history of jaundice, liver disease, or anemia should be sought. In most instances, physical examination of the jaundiced patient confirms a diagnosis suspected by history or provides diagnostic proof in its own right. Examination of the skin may reveal bruising resulting from disturbed blood coagulation mechanisms. Auscultation over the liver should be performed prior to manual manipulation of the area. Palpation of the liver is the single most crucial step in evaluation of the jaundiced patient. Splenomegaly is frequently found in the jaundiced patient, although its specific etiology is variable. Ascites in the jaundiced patient is an ominous sign, usually signifying severely decompensated cirrhosis with portal hypertension or malignancy. Dark urine resembling tea, which develops a green foam on shaking, is caused by bile pigment. Laboratory tests usually serve to confirm the pathophysiology of jaundice. The complete blood count may provide evidence for hemolysis by demonstrating anemia in a patient without blood loss. Liver function tests are nonspecific indicators of liver disease. Normal serum bilirubin concentration is usually no greater than 1.5 mg/dl and is composed primarily of the unconjugated form. Serum alkaline phosphatase is often elevated to at least three times the upper limit of normal in patients with jaundice due to intra- or extrahepatic obstruction. Transaminase elevations are common in both hepatocellular and obstructive jaundice. Prothrombin precursor is a protein manufactured by the liver whose full expression of activity in coagulation relies on a vitamin K-dependent carboxylase. Albumin is synthesized in the liver. Serologic assays for hepatitis A and B viruses should be performed in cases of acutely developing jaundice. Imaging investigation should start with a chest x-ray and plain film of the abdomen. Abdominal sonography is a valuable screening test in the jaundiced patient. Computerized tomography has the advantage of surveying the entire abdomen as well as the hepatobiliary-pancreatic axis. Until recently, hepatobiliary scintigraphy had little to contribute to the differential diagnosis of jaundice. Percutaneous transhepatic cholangiography involves passage of a thin needle into the liver under fluoroscopic guidance and injection of contrast into the biliary tree. Endoscopic retrograde cholangiopancreatography is performed by passing a flexible fiberoptic endoscope into the patient’s duodenum. The most important question to answer in the evaluation of any jaundiced patient is, „Will this patient require surgery to relieve biliary obstruction?”

• #24

  https://journals.lww.com/jaapa/fulltext/2011/06000/the_assessment_of_jaundice_in_adults__tests,.9.aspx

  The diagnostic possibilities can be narrowed considerably, and many clues to the etiology of hyperbilirubinemia and the presence of liver pathology can be ascertained from a carefully performed history and physical examination, basic laboratory test results, and biochemical and serological markers. […] The first-line imaging study for jaundice is ultrasonography (US), which is inexpensive, noninvasive, and does not require use of contrast or ionizing radiation. […] Although the cause of jaundice can often be anticipated through a focused history and examination, confirmatory testing is needed.

• #25 Jaundice in Adults – Liver and Gallbladder Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/liver-and-gallbladder-disorders/manifestations-of-liver-disease/jaundice-in-adults

  Jaundice is obvious, but identifying its cause requires a doctor’s examination, blood tests, and sometimes other tests. […] If people have any warning signs, they should see a doctor as soon as possible. People with no warning signs should see a doctor within a few days. […] Doctors typically measure bilirubin levels in the blood and do blood tests to determine how well the liver is functioning and whether it is damaged (tests of liver function) and to assess the blood’s ability to clot. […] Tests include the following: Blood tests to evaluate how well the liver is functioning and whether it is damaged (liver tests). […] Doctors first ask questions about the person’s symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause and the tests that may need to be done.

• #26 Jaundice in Adults – Liver and Gallbladder Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/liver-and-gallbladder-disorders/manifestations-of-liver-disease/jaundice-in-adults

  During the physical examination, doctors look for signs of serious disorders (such as fever, very low blood pressure, and a rapid heart rate) and for signs that liver function is greatly impaired (such as easy bruising, a rash of tiny dots or splotches, or changes in mental function). […] If the cause is a blocked bile duct, a procedure may be done to open the bile duct. This procedure can usually be done during ERCP, using instruments threaded through the endoscope.

• #27 Jaundice – Clinical Methods – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK413/

  Jaundice is the yellow color of skin and mucous membranes due to accumulation of bile pigments in blood and their deposition in body tissues. Jaundice must be distinguished from yellow or green skin color resulting from carotenemia or quinacrine ingestion. The majority of jaundiced patients may be diagnosed by careful and meticulous history and physical examination. Assessment of constitutional symptoms often provides the first clue to the mechanism of jaundice. Symptoms associated with jaundice often provide a diagnosis. The jaundiced patient requires thorough documentation of all recent drug and toxin exposures. Potential contact with hepatitis viruses and other infectious agents should also be determined. Surgical history, whether recent or remote may be implicated in the cause of jaundice. Other systemic conditions may have complications related to the liver. A family history of jaundice, liver disease, or anemia should be sought. In most instances, physical examination of the jaundiced patient confirms a diagnosis suspected by history or provides diagnostic proof in its own right. Examination of the skin may reveal bruising resulting from disturbed blood coagulation mechanisms. Auscultation over the liver should be performed prior to manual manipulation of the area. Palpation of the liver is the single most crucial step in evaluation of the jaundiced patient. Splenomegaly is frequently found in the jaundiced patient, although its specific etiology is variable. Ascites in the jaundiced patient is an ominous sign, usually signifying severely decompensated cirrhosis with portal hypertension or malignancy. Dark urine resembling tea, which develops a green foam on shaking, is caused by bile pigment. Laboratory tests usually serve to confirm the pathophysiology of jaundice. The complete blood count may provide evidence for hemolysis by demonstrating anemia in a patient without blood loss. Liver function tests are nonspecific indicators of liver disease. Normal serum bilirubin concentration is usually no greater than 1.5 mg/dl and is composed primarily of the unconjugated form. Serum alkaline phosphatase is often elevated to at least three times the upper limit of normal in patients with jaundice due to intra- or extrahepatic obstruction. Transaminase elevations are common in both hepatocellular and obstructive jaundice. Prothrombin precursor is a protein manufactured by the liver whose full expression of activity in coagulation relies on a vitamin K-dependent carboxylase. Albumin is synthesized in the liver. Serologic assays for hepatitis A and B viruses should be performed in cases of acutely developing jaundice. Imaging investigation should start with a chest x-ray and plain film of the abdomen. Abdominal sonography is a valuable screening test in the jaundiced patient. Computerized tomography has the advantage of surveying the entire abdomen as well as the hepatobiliary-pancreatic axis. Until recently, hepatobiliary scintigraphy had little to contribute to the differential diagnosis of jaundice. Percutaneous transhepatic cholangiography involves passage of a thin needle into the liver under fluoroscopic guidance and injection of contrast into the biliary tree. Endoscopic retrograde cholangiopancreatography is performed by passing a flexible fiberoptic endoscope into the patient’s duodenum. The most important question to answer in the evaluation of any jaundiced patient is, „Will this patient require surgery to relieve biliary obstruction?”

• #28 Jaundice: What’s the Diagnosis?

  https://www.medscape.co.uk/viewarticle/jaundice-what-s-diagnosis-2023a10009l4

  In adults, common causes of cholestatic jaundice comprise biliary obstruction by stones, strictures, and malignancy. […] For the jaundiced patient, careful and detailed history taking and examination should always be performed to elicit any red-flag symptoms and identify risk factors for liver disease, including alcohol misuse. […] Some cases of jaundice can be managed safely in primary care. However, emergency admission should be considered if the patient is systemically unwell in conjunction with jaundice, and any patient with marked derangement of liver blood tests, evidence of liver synthetic failure such as reduced albumin or prolonged prothrombin time, or clinical symptoms suspicious of malignancy or other serious underlying condition should be urgently referred. […] In neonates, a referral for urgent medical review should be made for babies with suspected or obvious jaundice in the first 24 hours of life to exclude pathological causes of jaundice. […] Babies with prolonged jaundice should be investigated in accordance with NICE guidance, and all babies with a conjugated bilirubin level greater than 25 micromol/l should be referred urgently to secondary care to assess for severe underlying liver disease.

• #29 Jaundice – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK544252/

  The most important laboratory test to be done is liver function tests. […] The results of the bilirubin, enzymes, and liver function tests will direct the diagnosis towards a hepatocellular or cholestatic cause and offer some idea of the duration and severity of the disease. […] Treatment of choice for jaundice is the correction of the underlying hepatobiliary or hematological disease, when possible. […] Jaundice is an indication for hepatic decompensation and may be an indication for liver transplant evaluation depending on the severity of the hepatic injury. […] Prognosis of jaundice depends on the etiology. […] As a general rule, malignant biliary obstructions and cirrhosis with jaundice predict a poorer prognosis.

• #30 Jaundice in the Adult Patient | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/0115/p299.html

  Jaundice is not a common presenting complaint in adults. When present, it may indicate a serious problem. This article discusses the evaluation of the adult patient with jaundice. A systematic approach is warranted to clarify the cause quickly so that treatment can begin as soon as possible. […] The initial work-up of the patient with jaundice depends on whether the hyperbilirubinemia is conjugated (direct) or unconjugated (indirect). A urinalysis that is positive for bilirubin indicates the presence of conjugated bilirubinemia. Conjugated bilirubin is water soluble and therefore able to be excreted in urine. The findings of urinalysis should be confirmed by measurements of the serum total and direct bilirubin levels. […] First-line serum testing in a patient presenting with jaundice should include a complete blood count (CBC) and determination of bilirubin (total and direct fractions), aspartate transaminase (AST), alanine transaminase (ALT), -glutamyl transpeptidase, and alkaline phosphatase levels.

• #31 Diagnostic approach to the adult with jaundice or asymptomatic hyperbilirubinemia – UpToDate

  https://www.uptodate.com/contents/diagnostic-approach-to-the-adult-with-jaundice-or-asymptomatic-hyperbilirubinemia

  Diagnostic approach to the adult with jaundice or asymptomatic hyperbilirubinemia […] Jaundice and asymptomatic hyperbilirubinemia are common clinical problems that can be caused by a variety of disorders, including bilirubin overproduction, impaired bilirubin conjugation, biliary obstruction, and hepatic inflammation. […] This topic will provide an overview of the diagnostic approach to adults with jaundice or asymptomatic hyperbilirubinemia. The causes of jaundice and asymptomatic hyperbilirubinemia, detailed discussions of the specific testing used, and the evaluation of patients with other liver test abnormalities are discussed elsewhere. […] For clinical purposes, serum bilirubin is fractionated to classify hyperbilirubinemia into one of two major categories: Unconjugated hyperbilirubinemia is characterized by plasma elevation of predominantly unconjugated (indirect) bilirubin. This may be due to the overproduction of bilirubin, impaired bilirubin uptake by the liver, or abnormalities of bilirubin conjugation. […] In patients with conjugated hyperbilirubinemia, both unconjugated and conjugated (direct) bilirubin are elevated. This may be due to hepatocellular disease, impaired canalicular excretion of bilirubin, or biliary obstruction.

• #32

  https://journals.lww.com/co-gastroenterology/fulltext/2017/05000/diagnosis_and_evaluation_of_hyperbilirubinemia.10.aspx

  Jaundice, the physical finding associated with hyperbilirubinemia, results when the liver is unable to properly metabolize or excrete bilirubin. The purpose of this review is to examine some of the most common causes of jaundice in adults, provide insight into the diagnostic evaluation of jaundice, and review information on the outcomes of patients with jaundice. […] The best approach to evaluating a patient with jaundice is to start with a careful history and physical examination, followed by imaging assessment of the biliary tree and liver. […] Evaluation of patients with jaundice starts with a careful history and physical examination, followed by directed imaging of the biliary tree and liver.

• #33 Evaluation of Jaundice in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0201/p164.html

  This article provides a systematic approach to the diagnosis of jaundice in adults and reviews common etiologies of hyperbilirubinemia. An algorithm for the evaluation of jaundice in adults is provided in Figure 1. […] The initial workup of jaundice should focus on the history and physical examination to help clarify the diagnosis. […] The laboratory evaluation to determine the etiology of jaundice should include fractionated bilirubin, a complete blood count, alanine transaminase, aspartate transaminase, -glutamyltransferase, alkaline phosphatase, prothrombin time and/or international normalized ratio, albumin, and protein. […] If the jaundice etiology is unknown after the initial laboratory evaluation, it is necessary to perform additional tests including hepatitis panels and autoimmune panels, such as antinuclear, smooth muscle, and liver-kidney microsomal antibodies. […] Liver biopsy should be reserved for cases of jaundice in which the diagnosis is unclear after the initial history and physical examination, laboratory studies, and imaging. It should be performed only if biopsy results are required to determine treatment and prognosis.

• #34 Testing for Jaundice | VCA Animal Hospitals

  https://vcahospitals.com/know-your-pet/testing-for-jaundice

  The major feature noted on the serum biochemistry profile when increased red blood cell destruction is the cause of jaundice is an increase in the serum bilirubin concentrations (hyperbilirubinemia). […] A urinalysis confirms the presence of hyperbilirubinemia by documenting increased amounts of bilirubin in the urine. […] Occasionally, immune-mediated destruction of red blood cells is suspected but cannot be definitively confirmed with the above screening tests. […] The CBC may indicate the presence of inflammation or infection within the liver and/or gall bladder by an increased white blood cell count. […] Although changes in the biochemistry profile may support the diagnosis of liver disease, they rarely indicate the exact cause. […] Destruction of individual liver cells (hepatocytes) is indicated by increases in the liver enzymes ALT (alanine aminotransferase) and AST (aspartate transaminase).

• #35 Jaundice – Symptoms, Types, Causes & Diagnosis

  https://www.ganeshdiagnostic.com/blog/jaundice-symptoms-types-causes-and-diagnosis

  Jaundice, also referred to as hyperbilirubinemia, is characterised as a yellow discolouration of bodily tissue brought on by the buildup of too much bilirubin. Bilirubin deposition only occurs when there is an excess of bilirubin, which suggests increased production or impaired excretion. […] The most crucial laboratory test to perform is a liver function test after taking a comprehensive medical history and performing physical exams. […] Aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP), gamma-glutamyltransferase, serum albumin, protein, and bilirubin levels are measured during liver function exams. […] If the AST, ALT, and ALP values are normal, liver or bile duct damage is not the cause of the jaundice. Pre-hepatic conditions such as blood disorders, inherited liver conjugation disorders, or defects in hepatic excretion must be the reason. (Rotor, Dubin-Johnson).

• #36 Jaundice – Hepatic and Biliary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/hepatic-and-biliary-disorders/approach-to-the-patient-with-liver-disease/jaundice

  Suspect hepatocellular dysfunction if aminotransferase levels are 500 U/L and alkaline phosphatase elevation is 3 times normal. […] Suspect cholestasis if aminotransferase levels are 200 U/L and alkaline phosphatase elevation is 3 times normal. […] Hepatic dysfunction is significant if mental status is altered and coagulopathy is present.

• #37 Jaundice: What’s the Diagnosis?

  https://www.medscape.co.uk/viewarticle/jaundice-what-s-diagnosis-2023a10009l4

  The challenge for the clinician is to establish the cause of jaundice and, as part of this, decide whether jaundice represents a benign and self-limiting condition or a serious underlying illness. […] The patients clinical presentation is suggestive of acute hepatitis. […] Although jaundice in neonates is common and normal, especially in breast-fed babies, both early jaundice (within the first week of life) and prolonged jaundice (jaundice persisting beyond the first 14 days) may be indicators of an underlying medical condition. […] In a child with prolonged jaundice, the clinician must always consider biliary atresia as a possible cause, and early diagnosis of this condition is crucial. […] Jaundice with predominantly raised ALP and only moderately raised ALT suggests a cholestatic or post-hepatic picture, in which the biliary tree external to the liver is blocked.

• #38 Evaluation of Jaundice in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0201/p164.html

  This article provides a systematic approach to the diagnosis of jaundice in adults and reviews common etiologies of hyperbilirubinemia. An algorithm for the evaluation of jaundice in adults is provided in Figure 1. […] The initial workup of jaundice should focus on the history and physical examination to help clarify the diagnosis. […] The laboratory evaluation to determine the etiology of jaundice should include fractionated bilirubin, a complete blood count, alanine transaminase, aspartate transaminase, -glutamyltransferase, alkaline phosphatase, prothrombin time and/or international normalized ratio, albumin, and protein. […] If the jaundice etiology is unknown after the initial laboratory evaluation, it is necessary to perform additional tests including hepatitis panels and autoimmune panels, such as antinuclear, smooth muscle, and liver-kidney microsomal antibodies. […] Liver biopsy should be reserved for cases of jaundice in which the diagnosis is unclear after the initial history and physical examination, laboratory studies, and imaging. It should be performed only if biopsy results are required to determine treatment and prognosis.

• #39 Jaundice: Causes, Symptoms, and Treatment Options

  https://www.webmd.com/hepatitis/jaundice-why-happens-adults

  Diagnosing Jaundice […] Your doctor will ask you about your symptoms and medical history. They’ll then give you a physical exam to see if there’s swelling in your liver. […] To get more information, your doctor will likely order blood tests to measure bilirubin and cholesterol levels and get a complete blood count (CBC). If you have jaundice, your level of bilirubin will be high. Your doctor may order other tests to find the cause of your jaundice and how severe it is, including: […] A hepatitis panel, which is a blood test that shows if you have, or have had, hepatitis. It tests for hepatitis A, hepatitis B, and hepatitis C. If there are no hepatitis antibodies in your blood, it means you don’t have the condition, or you had it in the past, but your body has cleared it. […] Tests to check enzyme levels in the liver to see how well it is functioning. If enzyme levels are higher or lower than normal, it can mean you have disease or damage to the liver or bile ducts. […] Imaging, like a CT scan, ultrasound, or magnetic resonance cholangiopancreatography, a type of MRI that checks for blocked ducts near the gallbladder […] A liver biopsy, to show if you have damage to, or disease in, your liver. During the test, a small piece of your liver is removed either with a needle inserted into the belly to the liver, through a vein in your neck, or through a cut in your belly. […] Prothrombin time, which measures how long it takes for blood plasma to clot. Your blood will be taken, and a laboratory will test it to see if it clots faster or slower than the normal range (which is between 10 and 13 seconds). If it clots too slowly, that may mean there are problems with your liver.

• #40 Blood Tests For Jaundice For Diagnosis And Management – MyHealth

  https://redcliffelabs.com/myhealth/health/blood-tests-for-jaundice-for-diagnosis-and-management/

  Elevated Bilirubin levels are usually a sign of Jaundice, and the bilirubin test helps diagnose it. It is the most common test doctors may recommend to confirm or rule out the disease and is mostly used to measure bilirubin levels in newborns. […] A bilirubin blood test for jaundice in adults can also help in early detection and promote preventive care. […] Depending on your symptoms, severity, medical history, age, and gender, doctors often suggest different blood tests for Jaundice. […] A blood test for jaundice helps identify underlying health issues and encourages timely management and treatment. […] Therefore, prompt diagnosis is crucial to uncover the root cause of the problem and initiate timely treatment before it is too late. Early detection and intervention help prevent complications and ensure effective condition management.

• #41 Diagnostic imaging to identify the cause of jaundice – University of Iowa

  https://iro.uiowa.edu/esploro/outputs/9984051542902771?institution=01IOWA_INST&skipUsageReporting=true&recordUsage=false

  Imaging studies can be helpful in identifying the etiology of conjugated (direct) hyper-bilirubinemia. An elevated direct bilirubin level suggests obstructive jaundice, and ultrasound or computed tomographic (CT) imaging may identify the responsible structural lesion. […] A cost-effective strategy for determining the cause of direct hyperbilirubinemia rests on ultrasound as the primary modality. Endoscopic retrograde cholangiopancreatography and CT are performed as follow-up studies only when necessary. Magnetic resonance imaging is rarely useful.

• #42

  https://journals.lww.com/jaapa/fulltext/2011/06000/the_assessment_of_jaundice_in_adults__tests,.9.aspx

  The diagnostic possibilities can be narrowed considerably, and many clues to the etiology of hyperbilirubinemia and the presence of liver pathology can be ascertained from a carefully performed history and physical examination, basic laboratory test results, and biochemical and serological markers. […] The first-line imaging study for jaundice is ultrasonography (US), which is inexpensive, noninvasive, and does not require use of contrast or ionizing radiation. […] Although the cause of jaundice can often be anticipated through a focused history and examination, confirmatory testing is needed.

• #43 Jaundice: Causes, Symptoms, and Treatment Options

  https://www.webmd.com/hepatitis/jaundice-why-happens-adults

  Diagnosing Jaundice […] Your doctor will ask you about your symptoms and medical history. They’ll then give you a physical exam to see if there’s swelling in your liver. […] To get more information, your doctor will likely order blood tests to measure bilirubin and cholesterol levels and get a complete blood count (CBC). If you have jaundice, your level of bilirubin will be high. Your doctor may order other tests to find the cause of your jaundice and how severe it is, including: […] A hepatitis panel, which is a blood test that shows if you have, or have had, hepatitis. It tests for hepatitis A, hepatitis B, and hepatitis C. If there are no hepatitis antibodies in your blood, it means you don’t have the condition, or you had it in the past, but your body has cleared it. […] Tests to check enzyme levels in the liver to see how well it is functioning. If enzyme levels are higher or lower than normal, it can mean you have disease or damage to the liver or bile ducts. […] Imaging, like a CT scan, ultrasound, or magnetic resonance cholangiopancreatography, a type of MRI that checks for blocked ducts near the gallbladder […] A liver biopsy, to show if you have damage to, or disease in, your liver. During the test, a small piece of your liver is removed either with a needle inserted into the belly to the liver, through a vein in your neck, or through a cut in your belly. […] Prothrombin time, which measures how long it takes for blood plasma to clot. Your blood will be taken, and a laboratory will test it to see if it clots faster or slower than the normal range (which is between 10 and 13 seconds). If it clots too slowly, that may mean there are problems with your liver.

• #44 What Are the Laboratory Tests Available for Jaundice?

  https://gemhospitals.com/blog/laboratory-tests-jaundice

  Because the liver produces proteins that aid in clotting, this test checks for your blood’s ability to clot properly. Abnormal results might indicate severe liver dysfunction. […] While not a blood test, ultrasound imaging of the liver and gallbladder can help identify physical anomalies like tumors or stones that could be causing jaundice. […] Understanding the interaction between these tests can provide a clearer diagnosis of jaundice. For instance, if the bilirubin test and hepatic function panel both show abnormal results, further investigation with an ultrasound might be recommended. […] If you or a loved one are showing signs of jaundice, it’s essential to undergo these laboratory tests promptly. Early diagnosis leads to more effective management of the underlying condition. Should the tests indicate a serious health issue, medical professionals might recommend more specific tests to pinpoint the exact cause and decide on the best treatment plan.

• #45 Jaundice – Clinical Methods – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK413/

  Jaundice is the yellow color of skin and mucous membranes due to accumulation of bile pigments in blood and their deposition in body tissues. Jaundice must be distinguished from yellow or green skin color resulting from carotenemia or quinacrine ingestion. The majority of jaundiced patients may be diagnosed by careful and meticulous history and physical examination. Assessment of constitutional symptoms often provides the first clue to the mechanism of jaundice. Symptoms associated with jaundice often provide a diagnosis. The jaundiced patient requires thorough documentation of all recent drug and toxin exposures. Potential contact with hepatitis viruses and other infectious agents should also be determined. Surgical history, whether recent or remote may be implicated in the cause of jaundice. Other systemic conditions may have complications related to the liver. A family history of jaundice, liver disease, or anemia should be sought. In most instances, physical examination of the jaundiced patient confirms a diagnosis suspected by history or provides diagnostic proof in its own right. Examination of the skin may reveal bruising resulting from disturbed blood coagulation mechanisms. Auscultation over the liver should be performed prior to manual manipulation of the area. Palpation of the liver is the single most crucial step in evaluation of the jaundiced patient. Splenomegaly is frequently found in the jaundiced patient, although its specific etiology is variable. Ascites in the jaundiced patient is an ominous sign, usually signifying severely decompensated cirrhosis with portal hypertension or malignancy. Dark urine resembling tea, which develops a green foam on shaking, is caused by bile pigment. Laboratory tests usually serve to confirm the pathophysiology of jaundice. The complete blood count may provide evidence for hemolysis by demonstrating anemia in a patient without blood loss. Liver function tests are nonspecific indicators of liver disease. Normal serum bilirubin concentration is usually no greater than 1.5 mg/dl and is composed primarily of the unconjugated form. Serum alkaline phosphatase is often elevated to at least three times the upper limit of normal in patients with jaundice due to intra- or extrahepatic obstruction. Transaminase elevations are common in both hepatocellular and obstructive jaundice. Prothrombin precursor is a protein manufactured by the liver whose full expression of activity in coagulation relies on a vitamin K-dependent carboxylase. Albumin is synthesized in the liver. Serologic assays for hepatitis A and B viruses should be performed in cases of acutely developing jaundice. Imaging investigation should start with a chest x-ray and plain film of the abdomen. Abdominal sonography is a valuable screening test in the jaundiced patient. Computerized tomography has the advantage of surveying the entire abdomen as well as the hepatobiliary-pancreatic axis. Until recently, hepatobiliary scintigraphy had little to contribute to the differential diagnosis of jaundice. Percutaneous transhepatic cholangiography involves passage of a thin needle into the liver under fluoroscopic guidance and injection of contrast into the biliary tree. Endoscopic retrograde cholangiopancreatography is performed by passing a flexible fiberoptic endoscope into the patient’s duodenum. The most important question to answer in the evaluation of any jaundiced patient is, „Will this patient require surgery to relieve biliary obstruction?”

• #46 Diagnostic imaging to identify the cause of jaundice – University of Iowa

  https://iro.uiowa.edu/esploro/outputs/9984051542902771?institution=01IOWA_INST&skipUsageReporting=true&recordUsage=false

  Imaging studies can be helpful in identifying the etiology of conjugated (direct) hyper-bilirubinemia. An elevated direct bilirubin level suggests obstructive jaundice, and ultrasound or computed tomographic (CT) imaging may identify the responsible structural lesion. […] A cost-effective strategy for determining the cause of direct hyperbilirubinemia rests on ultrasound as the primary modality. Endoscopic retrograde cholangiopancreatography and CT are performed as follow-up studies only when necessary. Magnetic resonance imaging is rarely useful.

• #47 Jaundice: Causes, Symptoms, and Treatment Options

  https://www.webmd.com/hepatitis/jaundice-why-happens-adults

  Diagnosing Jaundice […] Your doctor will ask you about your symptoms and medical history. They’ll then give you a physical exam to see if there’s swelling in your liver. […] To get more information, your doctor will likely order blood tests to measure bilirubin and cholesterol levels and get a complete blood count (CBC). If you have jaundice, your level of bilirubin will be high. Your doctor may order other tests to find the cause of your jaundice and how severe it is, including: […] A hepatitis panel, which is a blood test that shows if you have, or have had, hepatitis. It tests for hepatitis A, hepatitis B, and hepatitis C. If there are no hepatitis antibodies in your blood, it means you don’t have the condition, or you had it in the past, but your body has cleared it. […] Tests to check enzyme levels in the liver to see how well it is functioning. If enzyme levels are higher or lower than normal, it can mean you have disease or damage to the liver or bile ducts. […] Imaging, like a CT scan, ultrasound, or magnetic resonance cholangiopancreatography, a type of MRI that checks for blocked ducts near the gallbladder […] A liver biopsy, to show if you have damage to, or disease in, your liver. During the test, a small piece of your liver is removed either with a needle inserted into the belly to the liver, through a vein in your neck, or through a cut in your belly. […] Prothrombin time, which measures how long it takes for blood plasma to clot. Your blood will be taken, and a laboratory will test it to see if it clots faster or slower than the normal range (which is between 10 and 13 seconds). If it clots too slowly, that may mean there are problems with your liver.

• #48 Jaundice: Symptoms, Causes, Diagnosis, and Treatment

  https://www.health.com/jaundice-8621676

  Imaging scans: An abdominal ultrasound, computed tomography (CT) scan, magnetic resonance imaging (MRI), or endoscopic retrograde cholangiopancreatography (ERCP) can help look for a bile duct blockage by taking detailed images of the bile and pancreatic ducts. […] Liver biopsy: Takes a small sample of tissue from your liver to check for signs of damage, disease, infection, or inflammation. […] Laparoscopy: Makes a small incision (cut) near your belly button and inserts a tube with a camera to get a direct view of your liver and gallbladder to check for damage or infection.

• #49 Jaundice in Adults – Liver and Gallbladder Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/liver-and-gallbladder-disorders/manifestations-of-liver-disease/jaundice-in-adults

  During the physical examination, doctors look for signs of serious disorders (such as fever, very low blood pressure, and a rapid heart rate) and for signs that liver function is greatly impaired (such as easy bruising, a rash of tiny dots or splotches, or changes in mental function). […] If the cause is a blocked bile duct, a procedure may be done to open the bile duct. This procedure can usually be done during ERCP, using instruments threaded through the endoscope.

• #50 Jaundice – Causes, Symptoms, Treatment, Diagnosis – MedBroadcast.com

  https://medbroadcast.com/condition/getcondition/jaundice

  Jaundice is a symptom of many medical problems but it is most often associated with conditions of the liver or the gallbladder. Jaundice causes yellow skin and eyes because of an excess amount of the bile pigment bilirubin (a yellow pigment) in the blood. Either the body is producing too much, or it’s not getting rid of it fast enough. […] Your doctor will take a medical history and perform a physical exam. Your doctor will ask how suddenly the jaundice came on, what other symptoms accompanied it, and how the stool and urine look. A blood sample will also be taken and checked for hepatitis virus antibodies, abnormal red blood cells, bilirubin levels, and various other substances that give clues about liver function. Your doctor may also order other tests such as an ultrasound, CT scan, or biopsy to determine the cause of jaundice. An endoscopic retrograde cholangiopancreatography (ERCP) may be done to look at the gallbladder, liver, or bile ducts.

• #51 Obstructive Jaundice | Center for Advanced Digestive Care – NewYork-Presbyterian/Weill Cornell Medical Center

  https://www.nyp.org/cadc/liver-diseases-and-transplantation/obstructive-jaundice

  If you or someone you know is experiencing any of these symptoms, especially jaundice, seeking medical attention promptly for proper diagnosis and management is essential. Early detection and treatment can help prevent complications and improve outcomes for individuals with obstructive jaundice. […] Because obstructive jaundice has high mortality rates, early detection, diagnosis and treatment is essential. The following tests may be performed by our specialists to diagnose the cause of obstructive jaundice: Imaging tests such as CT scanning and magnetic resonance imaging, Blood tests to examine bilirubin levels, Endoscopic retrograde cholangiopancreatography (ERCP), Endoscopic ultrasound (EUS), Choledochoscopy, Probe-based confocal endomicroscopy, Narrow band imaging of the bile duct. […] The treatment of obstructive jaundice depends on its cause. Clogged or narrowed bile or pancreatic ducts may be relieved by inserting a stent using ERCP. The CADC’s interventional endoscopy specialists are experts in performing ERCP, EUS, EUS-guided ERCP, and other EUS-guided procedures.

• #52 Evaluation of Jaundice in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0201/p164.html

  This article provides a systematic approach to the diagnosis of jaundice in adults and reviews common etiologies of hyperbilirubinemia. An algorithm for the evaluation of jaundice in adults is provided in Figure 1. […] The initial workup of jaundice should focus on the history and physical examination to help clarify the diagnosis. […] The laboratory evaluation to determine the etiology of jaundice should include fractionated bilirubin, a complete blood count, alanine transaminase, aspartate transaminase, -glutamyltransferase, alkaline phosphatase, prothrombin time and/or international normalized ratio, albumin, and protein. […] If the jaundice etiology is unknown after the initial laboratory evaluation, it is necessary to perform additional tests including hepatitis panels and autoimmune panels, such as antinuclear, smooth muscle, and liver-kidney microsomal antibodies. […] Liver biopsy should be reserved for cases of jaundice in which the diagnosis is unclear after the initial history and physical examination, laboratory studies, and imaging. It should be performed only if biopsy results are required to determine treatment and prognosis.

• #53 Jaundice: Causes, Symptoms, and Treatment Options

  https://www.webmd.com/hepatitis/jaundice-why-happens-adults

  Diagnosing Jaundice […] Your doctor will ask you about your symptoms and medical history. They’ll then give you a physical exam to see if there’s swelling in your liver. […] To get more information, your doctor will likely order blood tests to measure bilirubin and cholesterol levels and get a complete blood count (CBC). If you have jaundice, your level of bilirubin will be high. Your doctor may order other tests to find the cause of your jaundice and how severe it is, including: […] A hepatitis panel, which is a blood test that shows if you have, or have had, hepatitis. It tests for hepatitis A, hepatitis B, and hepatitis C. If there are no hepatitis antibodies in your blood, it means you don’t have the condition, or you had it in the past, but your body has cleared it. […] Tests to check enzyme levels in the liver to see how well it is functioning. If enzyme levels are higher or lower than normal, it can mean you have disease or damage to the liver or bile ducts. […] Imaging, like a CT scan, ultrasound, or magnetic resonance cholangiopancreatography, a type of MRI that checks for blocked ducts near the gallbladder […] A liver biopsy, to show if you have damage to, or disease in, your liver. During the test, a small piece of your liver is removed either with a needle inserted into the belly to the liver, through a vein in your neck, or through a cut in your belly. […] Prothrombin time, which measures how long it takes for blood plasma to clot. Your blood will be taken, and a laboratory will test it to see if it clots faster or slower than the normal range (which is between 10 and 13 seconds). If it clots too slowly, that may mean there are problems with your liver.

• #54 Jaundice: Causes, symptoms, and treatments

  https://www.medicalnewstoday.com/articles/165749

  Jaundice is the yellowing of the skin, mucous membranes, and whites of the eyes that occurs when the body does not process bilirubin as it should. […] Doctors will most likely start with the persons history and a physical exam to diagnose jaundice. They may later also order lab tests. […] The doctor may often include lab tests to help determine the underlying cause of jaundice. These include: […] A high level of unconjugated bilirubin compared to levels of conjugated bilirubin suggest hemolytic jaundice. […] The AAFP states that a healthcare professional may perform a liver biopsy. A liver biopsy can check for inflammation, cirrhosis, cancer, and fatty liver. This test involves inserting a needle into the liver to obtain a tissue sample. A healthcare professional will then examine the sample under the microscope.

• #55 Jaundice: Symptoms, Causes, Diagnosis, and Treatment

  https://www.health.com/jaundice-8621676

  Imaging scans: An abdominal ultrasound, computed tomography (CT) scan, magnetic resonance imaging (MRI), or endoscopic retrograde cholangiopancreatography (ERCP) can help look for a bile duct blockage by taking detailed images of the bile and pancreatic ducts. […] Liver biopsy: Takes a small sample of tissue from your liver to check for signs of damage, disease, infection, or inflammation. […] Laparoscopy: Makes a small incision (cut) near your belly button and inserts a tube with a camera to get a direct view of your liver and gallbladder to check for damage or infection.

• #56 Jaundice in Newborns: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/22263-jaundice-in-newborns

  Jaundice in newborns is the yellow coloring in an infants skin. Jaundice occurs when bilirubin (pronounced bil-ih-ROO-bin) builds up in your babys blood. Hyperbilirubinemia is the medical term for this condition. […] Jaundice happens when your babys blood has too much bilirubin. Bilirubin is a chemical your body makes when it breaks down old red blood cells. Your liver normally filters bilirubin from your blood. Your body gets rid of it when you poop. […] Your babys healthcare provider will check for signs of jaundice while youre still in the hospital. Your babys bilirubin level will be highest when theyre three to five days old. Its important that your babys healthcare provider checks them again within this time frame. […] Treatment for jaundice in newborns isnt usually necessary. Mild levels of jaundice typically go away on their own as your babys liver continues to develop. This can take one to two weeks.

• #57

  https://www.nhs.uk/conditions/jaundice-newborn/diagnosis/

  Your baby will be checked for jaundice within 72 hours of being born during the newborn physical examination. […] Tests will need to be carried out to see whether treatment is needed. […] Your baby will have a visual examination to look for signs of jaundice. […] If it’s thought your baby has jaundice, the level of bilirubin in their blood will need to be tested. […] In most cases, a bilirubinometer is used to check for jaundice in babies. […] The level of bilirubin detected in your baby’s blood is used to decide whether any treatment is needed. […] Further blood tests may be needed if your baby’s jaundice lasts longer than 2 weeks or treatment is needed. […] These tests help determine whether there’s an underlying cause for the raised levels of bilirubin.

• #58 Jaundice in early infancy

  https://www.rch.org.au/clinicalguide/guideline_index/jaundice_in_early_infancy/

  Jaundice in early infancy […] If significant jaundice is clinically suspected, a serum bilirubin level should be performed as visual estimation of jaundice is unreliable. […] The majority of jaundice in well infants is physiological, and does not require investigation and management. […] Features suggestive of pathological jaundice include: onset 24 hours old, unwell baby, elevated conjugated bilirubin component, prolonged jaundice, pale stool. These require prompt investigation and management. […] Jaundice (or hyperbilirubinaemia) occurs in approximately 60% of full term and 80% of pre-term babies within the first week of life. […] Hyperbilirubinaemia occurs when there is an imbalance between bilirubin production, conjugation and elimination. […] Kernicterus is a rare complication of neonatal unconjugated hyperbilirubinaemia that can lead to major long-term neurological sequelae. […] Total serum bilirubin (SBR): unconjugated (indirect) and conjugated (direct), then FBE and Coombs depending on clinical presentation. […] TCB/SBR should be plotted on an appropriate gestation-based chart/nomogram in order to determine need for treatment. […] If conjugated fraction 10% of total bilirubin, refer to a specialty unit. […] Extrahepatic obstruction: Biliary atresia, choledochal cyst, bile plug. […] May present with dark urine, pale stools conjugated hyperbilirubinaemia NOT excluded by negative abdominal US. […] Diagnosis of exclusion after considering above causes. […] Parents should be advised to seek medical review if: jaundice is present for 2-3 weeks and cause has not previously been established.

• #59 Neonatal jaundice – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/672

  Neonatal jaundice is usually noted clinically when serum bilirubin is 5 mg/dL. Occurs in 60% to 70% of term neonates. Most cases are physiologic. […] Jaundice in the first 24 hours of life is considered pathologic. […] Treatment for hyperbilirubinemia may include phototherapy and if more severe, exchange transfusion. […] Key diagnostic factors include presence of risk factors, cephalocaudal progression, decreasing gestational age, male, family history of jaundice, family history of anemia, family history of splenectomy, maternal exposure to sulfonamides or antimalarials, hepatosplenomegaly, microcephaly, chorioretinitis, small for gestational age, cephalhematoma, hypertonia, high-pitched cry, retrocollis, opisthotonus. […] 1st tests to order include transcutaneous bilirubin (TcB), total serum bilirubin, direct Coombs test, direct serum bilirubin.

• #60 Neonatal jaundice – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/672

  Tests to consider include hematocrit, CBC, reticulocyte count, peripheral blood smear, blood groups, glucose-6-phosphate dehydrogenase (G6PD) screening, osmotic fragility test, blood culture, liver function tests, urine for reducing substances, plasma amino acids, urine organic acids, urine culture, abdominal ultrasound, percutaneous liver biopsy.

• #61 Jaundice in infants and children: causes, diagnosis, and management | HKMJ

  https://www.hkmj.org/abstracts/v24n3/285.htm

  If total serum bilirubin exceeds 200 mol/L, further investigation is required. […] The diagnosis is made by excluding other causes of unconjugated hyperbilirubinaemia although genetic testing is available. No treatment is necessary. […] The diagnosis of BA should be confirmed by direct visualisation of the fibrotic biliary tract. […] The diagnosis is usually made in the first few years of life when the patient presents with jaundice or abdominal pain. […] The differentiation between medical and surgical causes should be made early on by measuring the blood level of conjugated and unconjugated bilirubin. […] Laparoscopy should be considered in any patient with persistent cholestatic jaundice to exclude BA that requires early intervention.

• #62 Jaundice in the Adult Patient | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/0115/p299.html

  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.

• #63 Jaundice in the Adult Patient | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/0115/p299.html

  Jaundice is not a common presenting complaint in adults. When present, it may indicate a serious problem. This article discusses the evaluation of the adult patient with jaundice. A systematic approach is warranted to clarify the cause quickly so that treatment can begin as soon as possible. […] The initial work-up of the patient with jaundice depends on whether the hyperbilirubinemia is conjugated (direct) or unconjugated (indirect). A urinalysis that is positive for bilirubin indicates the presence of conjugated bilirubinemia. Conjugated bilirubin is water soluble and therefore able to be excreted in urine. The findings of urinalysis should be confirmed by measurements of the serum total and direct bilirubin levels. […] First-line serum testing in a patient presenting with jaundice should include a complete blood count (CBC) and determination of bilirubin (total and direct fractions), aspartate transaminase (AST), alanine transaminase (ALT), -glutamyl transpeptidase, and alkaline phosphatase levels.

• #64 Evaluation of Jaundice in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0201/p164.html

  This article provides a systematic approach to the diagnosis of jaundice in adults and reviews common etiologies of hyperbilirubinemia. An algorithm for the evaluation of jaundice in adults is provided in Figure 1. […] The initial workup of jaundice should focus on the history and physical examination to help clarify the diagnosis. […] The laboratory evaluation to determine the etiology of jaundice should include fractionated bilirubin, a complete blood count, alanine transaminase, aspartate transaminase, -glutamyltransferase, alkaline phosphatase, prothrombin time and/or international normalized ratio, albumin, and protein. […] If the jaundice etiology is unknown after the initial laboratory evaluation, it is necessary to perform additional tests including hepatitis panels and autoimmune panels, such as antinuclear, smooth muscle, and liver-kidney microsomal antibodies. […] Liver biopsy should be reserved for cases of jaundice in which the diagnosis is unclear after the initial history and physical examination, laboratory studies, and imaging. It should be performed only if biopsy results are required to determine treatment and prognosis.

• #65 Evaluation of Jaundice in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0201/p164.html

  This article provides a systematic approach to the diagnosis of jaundice in adults and reviews common etiologies of hyperbilirubinemia. An algorithm for the evaluation of jaundice in adults is provided in Figure 1. […] The initial workup of jaundice should focus on the history and physical examination to help clarify the diagnosis. […] The laboratory evaluation to determine the etiology of jaundice should include fractionated bilirubin, a complete blood count, alanine transaminase, aspartate transaminase, -glutamyltransferase, alkaline phosphatase, prothrombin time and/or international normalized ratio, albumin, and protein. […] If the jaundice etiology is unknown after the initial laboratory evaluation, it is necessary to perform additional tests including hepatitis panels and autoimmune panels, such as antinuclear, smooth muscle, and liver-kidney microsomal antibodies. […] Liver biopsy should be reserved for cases of jaundice in which the diagnosis is unclear after the initial history and physical examination, laboratory studies, and imaging. It should be performed only if biopsy results are required to determine treatment and prognosis.

• #66

  https://www.nuhs.edu.sg/patient-care/find-a-condition/jaundice-newborn

  Jaundice is the yellowish colour of the skin due to the presence of bilirubin (a breakdown product of red blood cells) which is removed from the bloodstream by the liver and excreted in the stools and urine. […] How is Jaundice diagnosed? […] If your newborn appears Jaundiced in the hospital, the nurse or doctor may do a Jaundice screen with a device applied to the skin (transcutaneous bilirubinometer), and confirm the bilirubin level by a blood test from a heel prick. […] Based on your newborn’s age and level of bilirubin, the doctor will advise you on what to do. […] Please bring your newborn to the doctor if: […] Your baby develops Jaundice during the first 48 hours of life, if the level of Jaundice increases rapidly to involve the lower tummy and legs, or jaundice is still present after day 14 of life.

• #67 Jaundice – Hepatic and Biliary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/hepatic-and-biliary-disorders/approach-to-the-patient-with-liver-disease/jaundice

  The following findings are of particular concern: marked abdominal pain and tenderness, altered mental status, gastrointestinal (GI) bleeding (occult or gross), ecchymoses, petechiae, or purpura. […] Severity of illness is indicated mainly by the degree (if any) of hepatic dysfunction. […] Treatment of causes and complications is necessary. Jaundice itself requires no treatment in adults. […] Symptoms may be attenuated or missed in the older patient; eg, abdominal pain may be mild or absent in acute viral hepatitis. […] Suspect acute viral hepatitis in patients, particularly young and healthy patients, who have acute jaundice, particularly with a viral prodrome. […] Suspect biliary obstruction due to cancer in older patients with painless jaundice, weight loss, an abdominal mass, and minimal pruritus.

• #68 Jaundice in adults | healthdirect

  https://www.healthdirect.gov.au/jaundice

  If you have jaundice and sudden symptoms such as fever, confusion and intense abdominal pain, call triple zero (000) for an ambulance. […] Jaundice is when your skin and the whites of your eyes turn yellow. […] Its important to see your doctor as soon as possible if you think you might have jaundice. […] Jaundice is caused by the build-up of a substance called bilirubin in your blood. […] Jaundice can happen if there is: an increase in the breakdown of red blood cells (prehepatic causes), a problem with how your liver processes bilirubin (hepatocellular, or liver causes), a blockage that stops processed bilirubin from leaving your body (post-hepatic causes). […] Your doctor will talk with you about your symptoms. […] Your doctor may order some tests. These may include: blood tests, urine tests, scans of your abdomen, such as an ultrasound, MRI scan or CT scan. […] If you have jaundice, you should see your doctor as soon as possible. […] See your doctor or midwife straight away if you develop jaundice during pregnancy. […] Treatment depends on the underlying cause of jaundice. […] Talk with your doctor about the treatment options for your situation.

• #69 Jaundice: What’s the Diagnosis?

  https://www.medscape.co.uk/viewarticle/jaundice-what-s-diagnosis-2023a10009l4

  In adults, common causes of cholestatic jaundice comprise biliary obstruction by stones, strictures, and malignancy. […] For the jaundiced patient, careful and detailed history taking and examination should always be performed to elicit any red-flag symptoms and identify risk factors for liver disease, including alcohol misuse. […] Some cases of jaundice can be managed safely in primary care. However, emergency admission should be considered if the patient is systemically unwell in conjunction with jaundice, and any patient with marked derangement of liver blood tests, evidence of liver synthetic failure such as reduced albumin or prolonged prothrombin time, or clinical symptoms suspicious of malignancy or other serious underlying condition should be urgently referred. […] In neonates, a referral for urgent medical review should be made for babies with suspected or obvious jaundice in the first 24 hours of life to exclude pathological causes of jaundice. […] Babies with prolonged jaundice should be investigated in accordance with NICE guidance, and all babies with a conjugated bilirubin level greater than 25 micromol/l should be referred urgently to secondary care to assess for severe underlying liver disease.

• #70 Jaundice in Adults: The Challenges of Diagnosis and Treatment

  https://www.ebmedicine.net/topics/hepatic-renal-genitourinary/jaundice-bilirubin

  This issue of Emergency Medicine Practice focuses on the pathophysiology, evaluation, and treatment of the jaundiced patient in the ED using the best available evidence from the literature. […] All patients with jaundice and hepatic encephalopathy should be admitted. […] Ascending cholangitis is a potentially fatal cause of jaundice. Many patients will resolve with antibiotics and supportive measures; however, some patients will require biliary drainage.

• #71 Classification and causes of jaundice or asymptomatic hyperbilirubinemia – UpToDate

  https://www.uptodate.com/contents/classification-and-causes-of-jaundice-or-asymptomatic-hyperbilirubinemia

  CLASSIFICATION […] For clinical purposes, the predominant type of bile pigments in the plasma can be used to classify hyperbilirubinemia into two major categories (table 1). […] ● Unconjugated hyperbilirubinemia – Unconjugated hyperbilirubinemia is characterized by plasma elevation of predominantly unconjugated bilirubin due to the overproduction of bilirubin, impaired bilirubin uptake by the liver, or abnormalities of bilirubin conjugation.

• #72 Jaundice – Wikipedia

  https://en.wikipedia.org/wiki/Jaundice

  Jaundice, also known as icterus, is a yellowish or greenish pigmentation of the skin and sclera due to high bilirubin levels. Jaundice in adults is typically a sign indicating the presence of underlying diseases involving abnormal heme metabolism, liver dysfunction, or biliary-tract obstruction. […] The prevalence of jaundice in adults is rare, while jaundice in babies is common, with an estimated 80% affected during their first week of life. […] Normal levels of bilirubin in blood are below 1.0 mg/dl (17 mol/L), while levels over 23 mg/dl (3451 mol/L) typically result in jaundice. […] High blood bilirubin is divided into two types: unconjugated and conjugated bilirubin. […] Causes of jaundice vary from relatively benign to potentially fatal. […] High unconjugated bilirubin may be due to excess red blood cell breakdown, large bruises, genetic conditions such as Gilbert’s syndrome, not eating for a prolonged period of time, newborn jaundice, or thyroid problems.

• #73 Neonatal Jaundice Differential Diagnoses

  https://emedicine.medscape.com/article/974786-differential

  Such conditions include the following: Bowel atresia, Hypertrophic pyloric stenosis, Choledochal cyst, Conjugated hyperbilirubinemia, Crigler-Najjar syndrome, Arias syndrome, Gilbert syndrome, Immune hemolytic anemia, Nonimmune hemolytic anemia, Congenital infections with cytomegalovirus or toxoplasmosis. […] Diagnostic considerations are crucial in the management of neonatal jaundice.

• #74 Gilbert syndrome – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/gilberts-syndrome/diagnosis-treatment/drc-20372816

  Your health care provider may suspect Gilbert syndrome if you have unexplained jaundice or if the level of bilirubin is elevated in your blood. […] The combination of standard blood counts and liver enzymes with an elevated bilirubin level is an indicator of Gilbert syndrome. No other testing usually is needed, although genetic testing can confirm the diagnosis. […] Gilbert syndrome doesn’t require treatment. The bilirubin levels in your blood may fluctuate over time. You may occasionally have jaundice, which usually resolves on its on with no ill effects. […] Certain life events, such as stress, can trigger episodes of higher bilirubin levels in Gilbert syndrome, leading to jaundice. […] Is jaundice harmful?

• #75 Jaundice – Wikipedia

  https://en.wikipedia.org/wiki/Jaundice

  High conjugated bilirubin may be due to liver diseases such as cirrhosis or hepatitis, infections, medications, or blockage of the bile duct, due to factors including gallstones, cancer, or pancreatitis. […] Treatment of jaundice is typically determined by the underlying cause. […] If a bile duct blockage is present, surgery is typically required; otherwise, management is medical. […] Medical management may involve treating infectious causes and stopping medication that could be contributing to the jaundice. […] Most people presenting with jaundice have various predictable patterns of liver panel abnormalities, though significant variation does exist. […] The typical liver panel includes blood levels of enzymes found primarily from the liver, such as the aminotransferases (ALT, AST), and alkaline phosphatase (ALP); bilirubin (which causes the jaundice); and protein levels, specifically, total protein and albumin.

• #76 Evaluation of Jaundice in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0201/p164.html

  Jaundice in adults can be an indicator of significant underlying disease. It is caused by elevated serum bilirubin levels in the unconjugated or conjugated form. The evaluation of jaundice relies on the history and physical examination. The initial laboratory evaluation should include fractionated bilirubin, a complete blood count, alanine transaminase, aspartate transaminase, alkaline phosphatase, -glutamyltransferase, prothrombin time and/or international normalized ratio, albumin, and protein. Imaging with ultrasonography or computed tomography can differentiate between extrahepatic obstructive and intrahepatic parenchymal disorders. […] A retrospective study of more than 700 individuals found that most cases (55%) of acute jaundice in adults are caused by intrahepatic disorders, including viral hepatitis, alcoholic liver disease, and drug-induced liver injury. The remaining 45% of acute jaundice cases are extrahepatic and include gallstone disease, hemolysis, and malignancy.

• #77 Jaundice: What’s the Diagnosis?

  https://www.medscape.co.uk/viewarticle/jaundice-what-s-diagnosis-2023a10009l4

  In adults, common causes of cholestatic jaundice comprise biliary obstruction by stones, strictures, and malignancy. […] For the jaundiced patient, careful and detailed history taking and examination should always be performed to elicit any red-flag symptoms and identify risk factors for liver disease, including alcohol misuse. […] Some cases of jaundice can be managed safely in primary care. However, emergency admission should be considered if the patient is systemically unwell in conjunction with jaundice, and any patient with marked derangement of liver blood tests, evidence of liver synthetic failure such as reduced albumin or prolonged prothrombin time, or clinical symptoms suspicious of malignancy or other serious underlying condition should be urgently referred. […] In neonates, a referral for urgent medical review should be made for babies with suspected or obvious jaundice in the first 24 hours of life to exclude pathological causes of jaundice. […] Babies with prolonged jaundice should be investigated in accordance with NICE guidance, and all babies with a conjugated bilirubin level greater than 25 micromol/l should be referred urgently to secondary care to assess for severe underlying liver disease.

• #78

• #79 Jaundice – Hepatic and Biliary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/hepatic-and-biliary-disorders/approach-to-the-patient-with-liver-disease/jaundice

  Jaundice is a yellowish discoloration of the skin and mucous membranes caused by hyperbilirubinemia. Jaundice becomes visible when the bilirubin level is about 2 to 3 mg/dL (34 to 51 micromol/L). […] Hyperbilirubinemia may involve predominantly unconjugated or conjugated bilirubin. […] Outcome is determined primarily by the cause of jaundice and the presence and severity of hepatic dysfunction. Hepatic dysfunction can result in coagulopathy, encephalopathy, and portal hypertension (which can lead to gastrointestinal bleeding). […] Although hyperbilirubinemia can be classified as predominantly unconjugated or conjugated, many hepatobiliary disorders cause both forms. […] Many conditions can cause jaundice, but the most common causes overall are inflammatory hepatitis (viral hepatitis, autoimmune hepatitis, toxic hepatic injury), alcohol-related liver disease, and biliary obstruction.

• #80 Jaundice revisited: recent advances in the diagnosis and treatment of inherited cholestatic liver diseases | Journal of Biomedical Science | Full Text

  https://jbiomedsci.biomedcentral.com/articles/10.1186/s12929-018-0475-8

  Jaundice is a common symptom of inherited or acquired liver diseases or a manifestation of diseases involving red blood cell metabolism. […] The diagnosis of genetic liver diseases has evolved from direct sequencing of a single gene to panel-based next generation sequencing. […] Prompt differential diagnosis is important because oral primary bile acid replacement may effectively reverse liver failure and restore liver functions. […] Understanding the complex pathways of jaundice and cholestasis not only enhance insights into liver pathophysiology but also elucidate many causes of genetic liver diseases and promote the development of novel treatments. […] A careful clinical history is important to investigate common secondary causes of jaundice and cholestasis, including hemolytic anemia, G6PD deficiency, hereditary spherocytosis and other red cell membrane disorders, prematurity, sepsis, drug-induced liver injury, parenteral nutrition-associated liver diseases, ischemia, and pregnancy.

• #81 Jaundice revisited: recent advances in the diagnosis and treatment of inherited cholestatic liver diseases | Journal of Biomedical Science | Full Text

  https://jbiomedsci.biomedcentral.com/articles/10.1186/s12929-018-0475-8

  The traditional phenotypic diagnosis includes low GGT as a signature of PFIC1 (FIC1 defect) and PFIC2 (BSEP defect). […] For patients suspecting jaundice or cholestasis, routine liver biochemistry tests include total and direct bilirubin levels, aspartate transferase levels, ALT levels, GGT and alkaline phosphatase (ALP) levels. […] Genetic diagnosis is a definitive diagnosis for inherited genetic liver diseases, as many of these diseases lack adequate biomarkers. […] Liver transplantation is considered a curative treatment for various liver diseases. […] The disruption of bile acid transport not only causes PFIC but has also been associated with hepatocellular carcinoma and cholangiocarcinoma.

• #82 Gilbert syndrome – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/gilberts-syndrome/diagnosis-treatment/drc-20372816

  Your health care provider may suspect Gilbert syndrome if you have unexplained jaundice or if the level of bilirubin is elevated in your blood. […] The combination of standard blood counts and liver enzymes with an elevated bilirubin level is an indicator of Gilbert syndrome. No other testing usually is needed, although genetic testing can confirm the diagnosis. […] Gilbert syndrome doesn’t require treatment. The bilirubin levels in your blood may fluctuate over time. You may occasionally have jaundice, which usually resolves on its on with no ill effects. […] Certain life events, such as stress, can trigger episodes of higher bilirubin levels in Gilbert syndrome, leading to jaundice. […] Is jaundice harmful?

• #83 Jaundice revisited: recent advances in the diagnosis and treatment of inherited cholestatic liver diseases | Journal of Biomedical Science | Full Text

  https://jbiomedsci.biomedcentral.com/articles/10.1186/s12929-018-0475-8

  The traditional phenotypic diagnosis includes low GGT as a signature of PFIC1 (FIC1 defect) and PFIC2 (BSEP defect). […] For patients suspecting jaundice or cholestasis, routine liver biochemistry tests include total and direct bilirubin levels, aspartate transferase levels, ALT levels, GGT and alkaline phosphatase (ALP) levels. […] Genetic diagnosis is a definitive diagnosis for inherited genetic liver diseases, as many of these diseases lack adequate biomarkers. […] Liver transplantation is considered a curative treatment for various liver diseases. […] The disruption of bile acid transport not only causes PFIC but has also been associated with hepatocellular carcinoma and cholangiocarcinoma.

• #84 Neonatal jaundice – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/672

  Tests to consider include hematocrit, CBC, reticulocyte count, peripheral blood smear, blood groups, glucose-6-phosphate dehydrogenase (G6PD) screening, osmotic fragility test, blood culture, liver function tests, urine for reducing substances, plasma amino acids, urine organic acids, urine culture, abdominal ultrasound, percutaneous liver biopsy.

• #85 What Are the Laboratory Tests Available for Jaundice?

  https://gemhospitals.com/blog/laboratory-tests-jaundice

  Because the liver produces proteins that aid in clotting, this test checks for your blood’s ability to clot properly. Abnormal results might indicate severe liver dysfunction. […] While not a blood test, ultrasound imaging of the liver and gallbladder can help identify physical anomalies like tumors or stones that could be causing jaundice. […] Understanding the interaction between these tests can provide a clearer diagnosis of jaundice. For instance, if the bilirubin test and hepatic function panel both show abnormal results, further investigation with an ultrasound might be recommended. […] If you or a loved one are showing signs of jaundice, it’s essential to undergo these laboratory tests promptly. Early diagnosis leads to more effective management of the underlying condition. Should the tests indicate a serious health issue, medical professionals might recommend more specific tests to pinpoint the exact cause and decide on the best treatment plan.

• #86 Obstructive Jaundice | Center for Advanced Digestive Care – NewYork-Presbyterian/Weill Cornell Medical Center

  https://www.nyp.org/cadc/liver-diseases-and-transplantation/obstructive-jaundice

  If you or someone you know is experiencing any of these symptoms, especially jaundice, seeking medical attention promptly for proper diagnosis and management is essential. Early detection and treatment can help prevent complications and improve outcomes for individuals with obstructive jaundice. […] Because obstructive jaundice has high mortality rates, early detection, diagnosis and treatment is essential. The following tests may be performed by our specialists to diagnose the cause of obstructive jaundice: Imaging tests such as CT scanning and magnetic resonance imaging, Blood tests to examine bilirubin levels, Endoscopic retrograde cholangiopancreatography (ERCP), Endoscopic ultrasound (EUS), Choledochoscopy, Probe-based confocal endomicroscopy, Narrow band imaging of the bile duct. […] The treatment of obstructive jaundice depends on its cause. Clogged or narrowed bile or pancreatic ducts may be relieved by inserting a stent using ERCP. The CADC’s interventional endoscopy specialists are experts in performing ERCP, EUS, EUS-guided ERCP, and other EUS-guided procedures.

• #87 Jaundice – Clinical Methods – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK413/

  Jaundice is the yellow color of skin and mucous membranes due to accumulation of bile pigments in blood and their deposition in body tissues. Jaundice must be distinguished from yellow or green skin color resulting from carotenemia or quinacrine ingestion. The majority of jaundiced patients may be diagnosed by careful and meticulous history and physical examination. Assessment of constitutional symptoms often provides the first clue to the mechanism of jaundice. Symptoms associated with jaundice often provide a diagnosis. The jaundiced patient requires thorough documentation of all recent drug and toxin exposures. Potential contact with hepatitis viruses and other infectious agents should also be determined. Surgical history, whether recent or remote may be implicated in the cause of jaundice. Other systemic conditions may have complications related to the liver. A family history of jaundice, liver disease, or anemia should be sought. In most instances, physical examination of the jaundiced patient confirms a diagnosis suspected by history or provides diagnostic proof in its own right. Examination of the skin may reveal bruising resulting from disturbed blood coagulation mechanisms. Auscultation over the liver should be performed prior to manual manipulation of the area. Palpation of the liver is the single most crucial step in evaluation of the jaundiced patient. Splenomegaly is frequently found in the jaundiced patient, although its specific etiology is variable. Ascites in the jaundiced patient is an ominous sign, usually signifying severely decompensated cirrhosis with portal hypertension or malignancy. Dark urine resembling tea, which develops a green foam on shaking, is caused by bile pigment. Laboratory tests usually serve to confirm the pathophysiology of jaundice. The complete blood count may provide evidence for hemolysis by demonstrating anemia in a patient without blood loss. Liver function tests are nonspecific indicators of liver disease. Normal serum bilirubin concentration is usually no greater than 1.5 mg/dl and is composed primarily of the unconjugated form. Serum alkaline phosphatase is often elevated to at least three times the upper limit of normal in patients with jaundice due to intra- or extrahepatic obstruction. Transaminase elevations are common in both hepatocellular and obstructive jaundice. Prothrombin precursor is a protein manufactured by the liver whose full expression of activity in coagulation relies on a vitamin K-dependent carboxylase. Albumin is synthesized in the liver. Serologic assays for hepatitis A and B viruses should be performed in cases of acutely developing jaundice. Imaging investigation should start with a chest x-ray and plain film of the abdomen. Abdominal sonography is a valuable screening test in the jaundiced patient. Computerized tomography has the advantage of surveying the entire abdomen as well as the hepatobiliary-pancreatic axis. Until recently, hepatobiliary scintigraphy had little to contribute to the differential diagnosis of jaundice. Percutaneous transhepatic cholangiography involves passage of a thin needle into the liver under fluoroscopic guidance and injection of contrast into the biliary tree. Endoscopic retrograde cholangiopancreatography is performed by passing a flexible fiberoptic endoscope into the patient’s duodenum. The most important question to answer in the evaluation of any jaundiced patient is, „Will this patient require surgery to relieve biliary obstruction?”

• #88 Evaluation of Jaundice in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0201/p164.html

  This article provides a systematic approach to the diagnosis of jaundice in adults and reviews common etiologies of hyperbilirubinemia. An algorithm for the evaluation of jaundice in adults is provided in Figure 1. […] The initial workup of jaundice should focus on the history and physical examination to help clarify the diagnosis. […] The laboratory evaluation to determine the etiology of jaundice should include fractionated bilirubin, a complete blood count, alanine transaminase, aspartate transaminase, -glutamyltransferase, alkaline phosphatase, prothrombin time and/or international normalized ratio, albumin, and protein. […] If the jaundice etiology is unknown after the initial laboratory evaluation, it is necessary to perform additional tests including hepatitis panels and autoimmune panels, such as antinuclear, smooth muscle, and liver-kidney microsomal antibodies. […] Liver biopsy should be reserved for cases of jaundice in which the diagnosis is unclear after the initial history and physical examination, laboratory studies, and imaging. It should be performed only if biopsy results are required to determine treatment and prognosis.

• #89 Jaundice in the Adult Patient | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/0115/p299.html

  Jaundice is not a common presenting complaint in adults. When present, it may indicate a serious problem. This article discusses the evaluation of the adult patient with jaundice. A systematic approach is warranted to clarify the cause quickly so that treatment can begin as soon as possible. […] The initial work-up of the patient with jaundice depends on whether the hyperbilirubinemia is conjugated (direct) or unconjugated (indirect). A urinalysis that is positive for bilirubin indicates the presence of conjugated bilirubinemia. Conjugated bilirubin is water soluble and therefore able to be excreted in urine. The findings of urinalysis should be confirmed by measurements of the serum total and direct bilirubin levels. […] First-line serum testing in a patient presenting with jaundice should include a complete blood count (CBC) and determination of bilirubin (total and direct fractions), aspartate transaminase (AST), alanine transaminase (ALT), -glutamyl transpeptidase, and alkaline phosphatase levels.

• #90

  https://journals.lww.com/jaapa/fulltext/2011/06000/the_assessment_of_jaundice_in_adults__tests,.9.aspx

  Jaundice, or icterus, is yellowish discoloration of the skin, mucous membranes, sclerae, and body fluids resulting from excess accumulation and deposition of bilirubin in the body in the presence of serum hyperbilirubinemia. […] To appreciate the differential diagnosis of jaundice requires an understanding of the fundamental metabolism of bilirubin; the risk factors, epidemiology, and pathophysiology of common causes of jaundice; and the available serologic and imaging studies used in the workup of jaundiced patients. […] The differential diagnosis for jaundice is based on whether the disease responsible for jaundice is prehepatic (primarily unconjugated hyperbilirubinemia), hepatic (mixed hyperbilirubinemia), or posthepatic (conjugated hyperbilirubinemia). […] The initial steps in evaluating the jaundiced patient are to determine whether the hyperbilirubinemia is predominantly conjugated or unconjugated; whether the disease process responsible for jaundice is likely to be hemolytic, hepatocellular, or cholestatic; and whether other biochemical liver test results are abnormal.

• #91 Testing for Jaundice | VCA Animal Hospitals

  https://vcahospitals.com/know-your-pet/testing-for-jaundice

  The major feature noted on the serum biochemistry profile when increased red blood cell destruction is the cause of jaundice is an increase in the serum bilirubin concentrations (hyperbilirubinemia). […] A urinalysis confirms the presence of hyperbilirubinemia by documenting increased amounts of bilirubin in the urine. […] Occasionally, immune-mediated destruction of red blood cells is suspected but cannot be definitively confirmed with the above screening tests. […] The CBC may indicate the presence of inflammation or infection within the liver and/or gall bladder by an increased white blood cell count. […] Although changes in the biochemistry profile may support the diagnosis of liver disease, they rarely indicate the exact cause. […] Destruction of individual liver cells (hepatocytes) is indicated by increases in the liver enzymes ALT (alanine aminotransferase) and AST (aspartate transaminase).

• #92 Diagnostic imaging to identify the cause of jaundice – University of Iowa

  https://iro.uiowa.edu/esploro/outputs/9984051542902771?institution=01IOWA_INST&skipUsageReporting=true&recordUsage=false

  Imaging studies can be helpful in identifying the etiology of conjugated (direct) hyper-bilirubinemia. An elevated direct bilirubin level suggests obstructive jaundice, and ultrasound or computed tomographic (CT) imaging may identify the responsible structural lesion. […] A cost-effective strategy for determining the cause of direct hyperbilirubinemia rests on ultrasound as the primary modality. Endoscopic retrograde cholangiopancreatography and CT are performed as follow-up studies only when necessary. Magnetic resonance imaging is rarely useful.

• #93 Jaundice in Adults (Hyperbilirubinemia): Causes, Symptoms, & Treatment

  https://www.medicinenet.com/jaundice_in_adults/article.htm

  Jaundice is a yellowish discoloration of the skin, mucous membranes, and the whites of the eyes caused by elevated levels of the chemical bilirubin in the blood (hyperbilirubinemia). The term jaundice is derived from the French word jaune, which means yellow. Jaundice is not a disease per se but a visible sign of an underlying disease process. […] Any adult who develops jaundice needs to undergo a comprehensive medical evaluation to determine its cause. […] The presence of jaundice requires a comprehensive medical evaluation to determine the cause. Initially, your health care professional will take a detailed history of your illness and perform a physical exam, which can sometimes determine the cause of jaundice. […] The treatment for jaundice depends entirely on the underlying cause. Once a diagnosis has been established, the appropriate course of treatment can then be initiated.

• #94 Neonatal jaundice – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/672

  Neonatal jaundice is usually noted clinically when serum bilirubin is 5 mg/dL. Occurs in 60% to 70% of term neonates. Most cases are physiologic. […] Jaundice in the first 24 hours of life is considered pathologic. […] Treatment for hyperbilirubinemia may include phototherapy and if more severe, exchange transfusion. […] Key diagnostic factors include presence of risk factors, cephalocaudal progression, decreasing gestational age, male, family history of jaundice, family history of anemia, family history of splenectomy, maternal exposure to sulfonamides or antimalarials, hepatosplenomegaly, microcephaly, chorioretinitis, small for gestational age, cephalhematoma, hypertonia, high-pitched cry, retrocollis, opisthotonus. […] 1st tests to order include transcutaneous bilirubin (TcB), total serum bilirubin, direct Coombs test, direct serum bilirubin.

• #95 Jaundice in early infancy

  https://www.rch.org.au/clinicalguide/guideline_index/jaundice_in_early_infancy/

  Jaundice in early infancy […] If significant jaundice is clinically suspected, a serum bilirubin level should be performed as visual estimation of jaundice is unreliable. […] The majority of jaundice in well infants is physiological, and does not require investigation and management. […] Features suggestive of pathological jaundice include: onset 24 hours old, unwell baby, elevated conjugated bilirubin component, prolonged jaundice, pale stool. These require prompt investigation and management. […] Jaundice (or hyperbilirubinaemia) occurs in approximately 60% of full term and 80% of pre-term babies within the first week of life. […] Hyperbilirubinaemia occurs when there is an imbalance between bilirubin production, conjugation and elimination. […] Kernicterus is a rare complication of neonatal unconjugated hyperbilirubinaemia that can lead to major long-term neurological sequelae. […] Total serum bilirubin (SBR): unconjugated (indirect) and conjugated (direct), then FBE and Coombs depending on clinical presentation. […] TCB/SBR should be plotted on an appropriate gestation-based chart/nomogram in order to determine need for treatment. […] If conjugated fraction 10% of total bilirubin, refer to a specialty unit. […] Extrahepatic obstruction: Biliary atresia, choledochal cyst, bile plug. […] May present with dark urine, pale stools conjugated hyperbilirubinaemia NOT excluded by negative abdominal US. […] Diagnosis of exclusion after considering above causes. […] Parents should be advised to seek medical review if: jaundice is present for 2-3 weeks and cause has not previously been established.

• #96 Jaundice in adults | healthdirect

  https://www.healthdirect.gov.au/jaundice

  If you have jaundice and sudden symptoms such as fever, confusion and intense abdominal pain, call triple zero (000) for an ambulance. […] Jaundice is when your skin and the whites of your eyes turn yellow. […] Its important to see your doctor as soon as possible if you think you might have jaundice. […] Jaundice is caused by the build-up of a substance called bilirubin in your blood. […] Jaundice can happen if there is: an increase in the breakdown of red blood cells (prehepatic causes), a problem with how your liver processes bilirubin (hepatocellular, or liver causes), a blockage that stops processed bilirubin from leaving your body (post-hepatic causes). […] Your doctor will talk with you about your symptoms. […] Your doctor may order some tests. These may include: blood tests, urine tests, scans of your abdomen, such as an ultrasound, MRI scan or CT scan. […] If you have jaundice, you should see your doctor as soon as possible. […] See your doctor or midwife straight away if you develop jaundice during pregnancy. […] Treatment depends on the underlying cause of jaundice. […] Talk with your doctor about the treatment options for your situation.

• #97 Jaundice | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/jaundice?lang=us

  Jaundice refers to a clinical sign of hyperbilirubinemia (serum bilirubin 2.5 mg/dL) which has many causes. It is often a clue to a diagnosis. It can be largely divided into two types: […] Imaging has a major role in detecting the obstructive causes. […] Painless jaundice is always very suspicious for an underlying obstructive malignant cause. […] Jaundice is a common indication for imaging. Often a specific cause will not be found, and the main role is differentiating between a non-obstructive and obstructive jaundice. In the latter, extrahepatic and/or intrahepatic bile duct dilatation can be expected, depending on the level of obstruction. […] Management depends on the underlying etiology. In jaundiced neonates, phototherapy and exchange transfusion should be considered.

• #98 Jaundice – Hepatic and Biliary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/hepatic-and-biliary-disorders/approach-to-the-patient-with-liver-disease/jaundice

  The following findings are of particular concern: marked abdominal pain and tenderness, altered mental status, gastrointestinal (GI) bleeding (occult or gross), ecchymoses, petechiae, or purpura. […] Severity of illness is indicated mainly by the degree (if any) of hepatic dysfunction. […] Treatment of causes and complications is necessary. Jaundice itself requires no treatment in adults. […] Symptoms may be attenuated or missed in the older patient; eg, abdominal pain may be mild or absent in acute viral hepatitis. […] Suspect acute viral hepatitis in patients, particularly young and healthy patients, who have acute jaundice, particularly with a viral prodrome. […] Suspect biliary obstruction due to cancer in older patients with painless jaundice, weight loss, an abdominal mass, and minimal pruritus.

• #99 Jaundice – Symptoms, Types, Causes & Diagnosis

  https://www.ganeshdiagnostic.com/blog/jaundice-symptoms-types-causes-and-diagnosis

  Unconjugated or conjugated bilirubin levels in the blood are rising. All jaundiced patients should undergo extra tests in addition to the liver panel, such as the albumin and prothrombin time tests, which are indicators of chronic and acute liver function, respectively. Prothrombin time’s failure to decrease after receiving parenteral vitamin K indicates severe hepatocellular dysfunction. […] The outcomes of the bilirubin, enzyme, and liver function tests will point the doctor in the direction of a hepatocellular or cholestatic cause and provide some insight into the length and intensity of the illness.

• #100 Jaundice: Symptoms, Causes, Diagnosis, Treatment & Prevention | Medcare

  https://www.medcare.ae/en/health-library/jaundice-symptoms-causes-diagnosis-treatment-prevention.html

  Tests must be performed to determine whether your infant has excessive amounts of a substance called bilirubin in their blood, as treatment is typically only required if this is the case. […] The majority of infants with jaundice do not require treatment since their blood bilirubin levels are reported to be low. In these situations, the problem often improves within 10 to 14 days and won’t harm your child. […] Your infant may need to be taken to the hospital and treated with phototherapy or an exchange transfusion if their jaundice does not go better on its own or if testing reveal elevated levels of bilirubin in their blood. […] Prevention of jaundice depends on the disorder causing it. Some of the illnesses might not be preventable. To lessen your risk of getting jaundice, follow these recommendations: Consume alcohol in moderation. No more than two drinks per day for men and one drink per day for women are considered moderate. Be cautious while combining alcohol and other drugs, such acetaminophen. Avoid coming into contact with industrial chemicals. Never exchange needles or nasal snorting supplies. Practice safe sex. Get the hepatitis A vaccine to lower your risk of contracting the disease. Get the hepatitis B vaccine to lower your risk of contracting the disease.

• #101 Jaundice: What’s the Diagnosis?

  https://www.medscape.co.uk/viewarticle/jaundice-what-s-diagnosis-2023a10009l4

  The challenge for the clinician is to establish the cause of jaundice and, as part of this, decide whether jaundice represents a benign and self-limiting condition or a serious underlying illness. […] The patients clinical presentation is suggestive of acute hepatitis. […] Although jaundice in neonates is common and normal, especially in breast-fed babies, both early jaundice (within the first week of life) and prolonged jaundice (jaundice persisting beyond the first 14 days) may be indicators of an underlying medical condition. […] In a child with prolonged jaundice, the clinician must always consider biliary atresia as a possible cause, and early diagnosis of this condition is crucial. […] Jaundice with predominantly raised ALP and only moderately raised ALT suggests a cholestatic or post-hepatic picture, in which the biliary tree external to the liver is blocked.

• #102 Jaundice: Causes, Symptoms, and Treatment Options

  https://www.webmd.com/hepatitis/jaundice-why-happens-adults

  Diagnosing Jaundice […] Your doctor will ask you about your symptoms and medical history. They’ll then give you a physical exam to see if there’s swelling in your liver. […] To get more information, your doctor will likely order blood tests to measure bilirubin and cholesterol levels and get a complete blood count (CBC). If you have jaundice, your level of bilirubin will be high. Your doctor may order other tests to find the cause of your jaundice and how severe it is, including: […] A hepatitis panel, which is a blood test that shows if you have, or have had, hepatitis. It tests for hepatitis A, hepatitis B, and hepatitis C. If there are no hepatitis antibodies in your blood, it means you don’t have the condition, or you had it in the past, but your body has cleared it. […] Tests to check enzyme levels in the liver to see how well it is functioning. If enzyme levels are higher or lower than normal, it can mean you have disease or damage to the liver or bile ducts. […] Imaging, like a CT scan, ultrasound, or magnetic resonance cholangiopancreatography, a type of MRI that checks for blocked ducts near the gallbladder […] A liver biopsy, to show if you have damage to, or disease in, your liver. During the test, a small piece of your liver is removed either with a needle inserted into the belly to the liver, through a vein in your neck, or through a cut in your belly. […] Prothrombin time, which measures how long it takes for blood plasma to clot. Your blood will be taken, and a laboratory will test it to see if it clots faster or slower than the normal range (which is between 10 and 13 seconds). If it clots too slowly, that may mean there are problems with your liver.

• #103 Jaundice: What’s the Diagnosis?

  https://www.medscape.co.uk/viewarticle/jaundice-what-s-diagnosis-2023a10009l4

  Jaundice, derived from the French word for yellow, jaune, can be a patients presenting symptom or a clinical sign identified by a clinician. It describes a yellow or sometimes greenish-yellow pigmentation of the skin, conjunctiva, and mucous membranes that is caused by raised plasma bilirubin. Jaundice usually becomes clinically apparent when a patients serum bilirubin concentration reaches 4050micromol/l. […] Jaundice can present at any age. It can be caused by a wide range of disorders that includes benign conditions, those that can result in permanent and irreversible liver damage, and those that are rapidly life threatening. Jaundice is the result of dysfunction in the bilirubin metabolism pathway, and its causes can be categorised as pre-hepatic (for example, excessive breakdown of red blood cells), intra-hepatic (for example, disease-related perturbation of liver function or intrahepatic anatomy), or post-hepatic (for example, obstruction of the bile ducts).

• #104

  https://journals.lww.com/co-gastroenterology/fulltext/2017/05000/diagnosis_and_evaluation_of_hyperbilirubinemia.10.aspx

  Jaundice, the physical finding associated with hyperbilirubinemia, results when the liver is unable to properly metabolize or excrete bilirubin. The purpose of this review is to examine some of the most common causes of jaundice in adults, provide insight into the diagnostic evaluation of jaundice, and review information on the outcomes of patients with jaundice. […] The best approach to evaluating a patient with jaundice is to start with a careful history and physical examination, followed by imaging assessment of the biliary tree and liver. […] Evaluation of patients with jaundice starts with a careful history and physical examination, followed by directed imaging of the biliary tree and liver.

• #105 What Is Jaundice? What Are The Causes, Diagnosis, And Treatment? – MyHealth

  https://redcliffelabs.com/myhealth/liver/what-is-jaundice-what-are-the-causes-diagnosis-and-treatment/

  In other cases, treatment may involve managing symptoms and preventing complications. […] If jaundice is caused by a medication, treatment may involve switching to a different medication. […] In conclusion, jaundice can be caused by an excess of bilirubin in the blood, which leads to the yellowing of the skin and whites of the eyes. Jaundice is not a life-threatening disease; it can be easily managed with the proper care, early diagnosis, and treatment. […] It’s also essential to note that jaundice can be a symptom of a more serious underlying condition, and it is essential to seek medical attention if you suspect you have jaundice. […] For reliable and affordable jaundice diagnosis, choose Redcliffe Labs. Our state-of-the-art, internationally recognized laboratory is equipped with trained experts and technologists to meet all testing needs. We offer a wide range of diagnostic tests, including blood tests and liver function tests, to help identify the underlying cause of jaundice. With our team of experts and state-of-the-art equipment, you get the most accurate and reliable results.

• #106 Jaundice in Adults: The Challenges of Diagnosis and Treatment

  https://www.ebmedicine.net/topics/hepatic-renal-genitourinary/jaundice-bilirubin

  This issue of Emergency Medicine Practice focuses on the pathophysiology, evaluation, and treatment of the jaundiced patient in the ED using the best available evidence from the literature. […] All patients with jaundice and hepatic encephalopathy should be admitted. […] Ascending cholangitis is a potentially fatal cause of jaundice. Many patients will resolve with antibiotics and supportive measures; however, some patients will require biliary drainage.

• #107 Jaundice revisited: recent advances in the diagnosis and treatment of inherited cholestatic liver diseases | Journal of Biomedical Science | Full Text

  https://jbiomedsci.biomedcentral.com/articles/10.1186/s12929-018-0475-8

  The traditional phenotypic diagnosis includes low GGT as a signature of PFIC1 (FIC1 defect) and PFIC2 (BSEP defect). […] For patients suspecting jaundice or cholestasis, routine liver biochemistry tests include total and direct bilirubin levels, aspartate transferase levels, ALT levels, GGT and alkaline phosphatase (ALP) levels. […] Genetic diagnosis is a definitive diagnosis for inherited genetic liver diseases, as many of these diseases lack adequate biomarkers. […] Liver transplantation is considered a curative treatment for various liver diseases. […] The disruption of bile acid transport not only causes PFIC but has also been associated with hepatocellular carcinoma and cholangiocarcinoma.

• #108

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