What is the treatment for jaundice (yellow eyes) in a 17-year-old male?

Treatment for Yellow Eyes (Jaundice) in a 17-Year-Old Male

The treatment for jaundice in a 17-year-old male depends on the underlying cause, with initial evaluation requiring laboratory testing and imaging to determine whether it is obstructive or non-obstructive jaundice, followed by cause-specific treatment. 1

Initial Evaluation

• Laboratory testing is essential to determine the type of jaundice and should include:

  • Total and fractionated bilirubin (to distinguish between conjugated and unconjugated hyperbilirubinemia) 2
  • Complete blood count (to assess for hemolysis) 1
  • Liver function tests (AST, ALT, alkaline phosphatase, GGT) 2
  • Albumin, prothrombin time, and INR (to assess liver synthetic function) 3
  • Viral hepatitis serologies 2

• Imaging is crucial for determining if biliary obstruction is present:

  • Abdominal ultrasound is the first-line imaging modality for evaluating jaundice 1
  • CT abdomen with IV contrast or MRI abdomen with MRCP may be needed based on initial findings 1

Treatment Based on Cause

1. Viral Hepatitis

• For viral hepatitis (a common cause in adolescents):
  • Supportive care with rest, adequate hydration, and proper nutrition 1
  • Avoid hepatotoxic medications including acetaminophen 1
  • For hepatitis B infection: Consider antiviral therapy with entecavir in chronic cases 4
  • Monitor liver function tests regularly 1

2. Obstructive Jaundice

• If biliary obstruction is identified:
  • Endoscopic intervention may be required to place a stent if there is biliary tract blockage 1
  • Surgical intervention may be necessary for conditions like choledocholithiasis (gallstones) 1

3. Drug-Induced Jaundice

• Immediately discontinue any potentially hepatotoxic medications 1
• Provide supportive care while liver function recovers 1

4. Alcoholic Hepatitis

• Though less common in adolescents, if present:
  • Complete abstinence from alcohol is essential 1
  • Nutritional support with 1-1.5g protein/kg body weight 1
  • Severe cases may require hospitalization 1

5. Wilson's Disease

• Important consideration in adolescents with jaundice:
  • Copper chelation therapy should be initiated promptly if diagnosed 1
  • Lifelong treatment is necessary even if symptoms resolve 1
  • Liver transplantation may be required in fulminant cases 1

6. Hemolytic Jaundice

• If jaundice is due to hemolysis:
  • Identify and treat the underlying cause of hemolysis 1
  • Supportive care with hydration 1
  • Monitor for complications 1

Important Considerations

• Jaundice in adolescents can indicate serious underlying liver disease and should never be ignored 1
• The presence of jaundice with fever and right upper quadrant pain suggests cholangitis, which requires urgent antibiotic treatment 1
• Rapidly rising bilirubin levels require immediate intervention to prevent complications 1
• Patients with severe jaundice should be monitored for signs of hepatic encephalopathy 1

Common Pitfalls to Avoid

• Assuming jaundice in an adolescent is always due to viral hepatitis without complete evaluation 1
• Failing to consider Wilson's disease, which often presents in adolescents and young adults 1
• Delaying evaluation of persistent jaundice, which could represent serious underlying conditions 1
• Not measuring conjugated bilirubin, which is essential to differentiate between obstructive and non-obstructive causes 2

Follow-up

• Regular monitoring of liver function tests until resolution 2
• Long-term follow-up may be necessary depending on the underlying cause 1
• Patient education about avoiding hepatotoxic substances 1