Jaundice

Introduction to Jaundice

Jaundice is a common clinical state of varying etiologies. Classified as haemolytic, hepatic or obstructive Clinical jaundice occurs when the level of serum bilirubin exceeds 2.5 mg/dL.
The bilirubin may be conjugated, unconjugated or mixed

Important causes of Jaundice

Diseases of the liver and the biliary tract
Conditions that cause excessive red cells haemolysis: infections, haemoglobinopathies

Clinical features of Jaundice

  • Discolouration of the sclerae and other mucus membranes
  • Associated general pruritus (especially with cholestatic jaundice)
  • Associated features of the underlying disease

Investigations

  1. LFTS: determine levels and nature of bilirubin, liver enzymes (AST, ALT, Alkaline phosphotase)
  2. Abdominal ultrasound scan: look out for canalicular dilatations, biliary stones

Treatment objectives

  • Treat underlying cause
  • Prevent complications

Drug treatment for Jaundice

  • Specific treatment depends on the identified cause
  • Colestyramine: 3-6g orally 6 hour in severe obstructive jaundice
  • Phenobarbital in neonatal jaundice: 5-8mg/kg orallydaily

Notable adverse drug reactions

  • Colestyramine: diarrhoea
  • Phenobarbital may cause dose-dependent respiratory depression

Surgical treatment

  • Obstructive jaundice
  • ERCP sphincterotomy with stone removal Stent insertion
  • Pancreatic head/duodenal head realignment

Supportive measures

  • Reassurance and monitoring
  • Phototherapy in neonatal jaundice