What are the treatments for different types of jaundice?

Treatment of Different Types of Jaundice

The treatment of jaundice must be tailored to its specific etiology, with the primary goal of addressing the underlying cause while managing symptoms and preventing complications that affect morbidity, mortality, and quality of life. 1

Classification of Jaundice Types

• Jaundice results from accumulation of bilirubin in body tissues and can be classified based on laboratory findings into unconjugated and conjugated hyperbilirubinemia 2, 1
• Common causes in the United States include: hepatitis, alcoholic liver disease, common bile duct obstruction (by gallstones or tumors), and toxic reactions to drugs or herbs 2, 1
• Initial laboratory testing must include total and fractionated bilirubin, complete blood count, liver enzymes, and synthetic function tests to determine the type of jaundice 1, 3

Treatment of Obstructive Jaundice

• For common bile duct obstruction due to stones:

  • Endoscopic retrograde cholangiopancreatography (ERCP) is the standard treatment with 80-95% success rate for clearing CBD stones 2
  • ERCP also allows for stent placement in cases of obstructive jaundice with >90% success rate for distal CBD strictures 2
  • Risks include 4-5.2% rate of major complications (pancreatitis, cholangitis, hemorrhage, perforation) and 0.4% mortality risk 2

• For malignant biliary obstruction:

  • Endoscopic or percutaneous transhepatic biliary drainage is appropriate for patients who are not surgical candidates 2
  • If ERCP fails (due to gastric outlet/duodenal obstruction or altered anatomy), percutaneous transhepatic cholangiography or EUS-guided biliary drainage are effective alternatives 2

Treatment of Hepatocellular Jaundice

• For alcoholic liver disease:

  • Primary intervention is alcohol cessation 2, 1
  • Supportive care with nutritional support and management of complications 1

• For viral hepatitis:

  • Treatment depends on the specific virus (antiviral therapy for hepatitis B and C) 1, 3
  • Supportive care while the immune system clears the infection in cases of hepatitis A and E 3

• For drug-induced liver injury:

  • Immediate discontinuation of the offending agent 2, 1
  • Supportive care until liver function normalizes 3

Treatment of Hemolytic Jaundice

• For hemolysis-induced unconjugated hyperbilirubinemia:
  • Treatment focuses on addressing the underlying cause of hemolysis 1, 3
  • Phototherapy may be used in severe cases, particularly in neonates 4, 5

Treatment of Neonatal Jaundice

• For physiological jaundice:

  • Phototherapy is the primary treatment for elevated bilirubin levels 4, 5
  • Most term babies respond to a short period of phototherapy 4

• For pathological jaundice:

  • Urgent treatment with intensive phototherapy for rapidly rising bilirubin levels to prevent kernicterus 4
  • Exchange transfusion may be necessary for severe cases unresponsive to phototherapy 4, 5
  • Bilisphere phototherapy is an effective alternative to exchange transfusion for indirect pathological hyperbilirubinemia 6
  • Treatment of the underlying cause (e.g., hemolytic disease, infection) 4

Treatment of Genetic Cholestatic Disorders

• For progressive familial intrahepatic cholestasis (PFIC) and other genetic cholestatic disorders:
  • Ursodeoxycholic acid (UDCA) at 8-10 mg/kg/day helps dissolve gallstones and improves bile flow 7, 8
  • UDCA works by suppressing hepatic synthesis and secretion of cholesterol and inhibiting intestinal absorption of cholesterol 7
  • For inborn errors of bile acid metabolism, oral primary bile acid replacement (cholic acid or chenodeoxycholic acid) may effectively reverse liver failure 8
  • Surgical options include partial biliary diversion and liver transplantation for advanced cases 8
  • Symptomatic treatment for pruritus and nutritional therapy with fat-soluble vitamin supplementation 8

Special Considerations

• Abdominal ultrasound is the recommended initial imaging study for jaundiced patients to differentiate between obstructive and non-obstructive causes 1
• Additional imaging studies (CT with IV contrast, MRCP) may be necessary based on ultrasound findings 1
• Liver biopsy may be required when the etiology remains unclear despite laboratory testing and imaging 3
• For conjugated jaundice in term infants, urgent evaluation is needed to rule out biliary atresia 4
• Preterm infants on long-term parenteral nutrition may develop conjugated jaundice that improves with enteral feeding 4