What is the treatment for jaundice?

Treatment of Jaundice

The treatment of jaundice must be tailored to the underlying cause, with abstinence from alcohol being the cornerstone of treatment for alcoholic hepatitis-related jaundice, endoscopic procedures for biliary obstruction, and phototherapy for neonatal jaundice. 1, 2, 3

Diagnosis Before Treatment

• Proper diagnosis is essential before initiating treatment, requiring evaluation of:
  • Total and direct/conjugated bilirubin levels to differentiate between conjugated and unconjugated hyperbilirubinemia 2
  • Liver function tests including alkaline phosphatase, ALT, AST, and total protein 4
  • Abdominal ultrasound as the first-line imaging study for evaluating jaundice (sensitivity 32-100%, specificity 71-97%) 2

Treatment Based on Etiology

Alcoholic Hepatitis-Related Jaundice

• Abstinence from alcohol is the cornerstone of treatment for alcoholic hepatitis 1, 2
• For severe alcoholic hepatitis (Maddrey discriminant function >32 or MELD score >20):
  • Methylprednisolone 32 mg daily if no contraindications exist 2
  • Nutritional support to address common deficiencies 1
• Screen for and promptly treat infections, as they can precipitate acute kidney injury and multi-organ failure 2

Biliary Obstruction-Related Jaundice

• For choledocholithiasis (bile duct stones):
  • ERCP with sphincterotomy and stone extraction is the standard treatment 1, 2
  • Endoscopic internal biliary catheter with removable plastic stent is the preferred initial therapeutic approach 2
• Initial medical management is indicated to stabilize hemodynamic status and treat infection before decompression 1

Neonatal Jaundice

• Phototherapy is the primary treatment for hyperbilirubinemia in neonates 2, 3
  • Use special blue fluorescent tubes or LED lights that deliver irradiance of >30 mW/cm²/nm for intensive phototherapy 3, 5
  • Expect a decrease of more than 2 mg/dL in serum bilirubin within 4-6 hours of initiating effective phototherapy 3
• Maximize skin exposure by removing clothing except for a diaper and providing eye protection 5
• Change infant's posture every 2-3 hours to maximize area exposed to light 3
• Consider exchange transfusion if phototherapy fails to reduce bilirubin levels adequately 3, 5

Special Considerations

• Hydration status should be assessed in all patients with jaundice 5
  • For infants: supplemental fluids should be considered if dehydration is present 5
  • For adults with alcoholic hepatitis: fluid management is critical to prevent complications 1
• Early follow-up is essential after initial treatment:
  • For neonates: follow-up within 24-48 hours to reassess bilirubin levels 3, 5
  • For adults with alcoholic hepatitis: continued monitoring for infection and organ dysfunction 1

Treatment Pitfalls to Avoid

• Failing to identify and treat underlying infections in patients with alcoholic hepatitis, which can lead to further decompensation 1, 2
• Delaying ERCP for choledocholithiasis, which has a success rate of 90% when performed promptly 1
• Administering iodinated contrast in jaundiced patients without considering the increased risk of acute kidney injury 2
• Suboptimal phototherapy setup in neonates (incorrect distance, inadequate skin exposure, or physical obstruction of light) 3
• Overlooking the need for exchange transfusion in neonates with rapidly rising bilirubin levels despite phototherapy 3, 5