From the Guidelines
Jaundice is primarily caused by an accumulation of conjugated (direct) bilirubin in the body, which is often a result of obstructive causes such as bile duct blockages, rather than unconjugated (indirect) bilirubin, which is more commonly associated with hemolytic or liver cell dysfunction causes. The distinction between conjugated and unconjugated hyperbilirubinemia is crucial for determining the underlying cause of jaundice and guiding appropriate management 1. Conjugated bilirubin is water-soluble and can be excreted into the bile, whereas unconjugated bilirubin is not water-soluble and must be converted to conjugated bilirubin by the liver before it can be excreted.
Causes of Jaundice
Jaundice can result from various causes, including:
- Hepatitis
- Alcoholic liver disease
- Blockage of the common bile duct by a gallstone or tumor
- Toxic reaction to a drug or medicinal herb
- Hemolysis
- Intrahepatic or inherited biliary disorders
- Medication toxicity
- Choledocholithiasis
- Sepsis or low perfusion states
- Tumor- or malignancy-related causes of biliary obstruction
Management of Jaundice
Management of jaundice depends on the underlying cause and may involve:
- Treating the primary condition, such as antiviral medications for hepatitis or abstaining from alcohol for alcoholic liver disease
- Procedures like endoscopic retrograde cholangiopancreatography (ERCP) to remove gallstones or stents to bypass blockages
- Surgery for severe cases
- Addressing the underlying blood disorder for hemolytic causes
- Phototherapy for newborn jaundice, or exchange transfusion in severe cases
- Supportive care, including maintaining hydration, proper nutrition, and monitoring liver function tests
- Avoiding hepatotoxic substances, including alcohol and certain medications, to prevent further liver damage while recovering 1.
Diagnostic Approach
Clinically, differentiating between the various potential etiologies of jaundice requires a detailed history, targeted physical examination, and pertinent laboratory studies, including a hepatic profile, conjugated versus unconjugated bilirubinemia, and complete blood count 1. Imaging modalities such as abdominal ultrasound, CT, MR cholangiopancreatography, and endoscopic US may also be used to evaluate the jaundiced patient.
From the Research
Causes of Jaundice
- Jaundice is caused by derangements in bilirubin metabolism, specifically when serum bilirubin levels exceed 3 mg/dL 2
- It can be caused by either direct (conjugated) or indirect (unconjugated) bilirubin
- Indirect bilirubin is the primary cause of jaundice in neonates, as seen in studies on neonatal hyperbilirubinemia 3, 4, 5
- In adults, jaundice can be caused by a variety of underlying diseases, including liver disease, biliary tract disease, and hemolysis 2
Management of Jaundice
- Phototherapy is a common treatment for neonatal jaundice, and the addition of ursodeoxycholic acid (UDCA) has been shown to be effective in reducing bilirubin levels and shortening the duration of phototherapy 3, 4, 5
- In adults, the management of jaundice depends on the underlying cause, and may involve laboratory evaluation, imaging studies, and liver biopsy 2
- Measuring fractionated bilirubin can help determine whether the hyperbilirubinemia is conjugated or unconjugated, which can inform treatment decisions 2