What is the treatment for jaundice in adults?

Treatment of Jaundice in Adults

Treatment of jaundice in adults is directed at the underlying cause, not the jaundice itself—identify whether the etiology is obstructive (mechanical) or non-obstructive through initial laboratory testing and abdominal ultrasound, then proceed with cause-specific interventions. 1

Initial Diagnostic Framework

The treatment pathway begins with categorizing jaundice type through laboratory evaluation:

• Measure conjugated versus unconjugated bilirubin to distinguish prehepatic (hemolysis), intrahepatic (hepatocellular), or posthepatic (obstructive) causes 2, 3
• Obtain liver chemistry panel including alkaline phosphatase, aminotransferases, albumin, and prothrombin time to assess hepatocellular function and cholestasis 3
• Perform abdominal ultrasound as first-line imaging with sensitivity of 32-100% and specificity of 71-97% for detecting biliary obstruction 4, 1

Treatment Based on Etiology

Obstructive (Mechanical) Jaundice

For choledocholithiasis (bile duct stones):

• ERCP with sphincterotomy and stone extraction is the standard treatment, successfully clearing stones in 80-95% of cases 4, 1
• Endoscopic internal biliary catheter with removable plastic stent is the preferred initial therapeutic approach 1
• Stones >15 mm often require advanced endoscopic techniques beyond standard ERCP 4

Common pitfall: ERCP carries 3-10% complication risk and 0.1-1% mortality risk, so ensure appropriate indication before proceeding 4

For malignant obstruction:

• CT abdomen with IV contrast or MRI/MRCP are equivalent alternatives for characterizing the obstruction 1
• Treatment depends on tumor type and resectability (surgical resection, biliary stenting, or palliative care)

Non-Obstructive Jaundice

For alcoholic hepatitis:

• Abstinence from alcohol is the cornerstone of treatment 1
• Patients with severe alcoholic hepatitis (Maddrey discriminant function >32 or MELD >20) may receive methylprednisolone 32 mg daily if no contraindications exist 1
• Obtain cultures of blood, urine, and ascites to rule out bacterial infections, as infection precedes acute kidney injury and multi-organ failure with high mortality 1

For autoimmune hepatitis:

• Conventional therapy continues until remission, treatment failure, incomplete response, or drug toxicity 4
• 90% of adults show improvement in aminotransferases, bilirubin, and γ-globulin within 2 weeks of starting corticosteroids 4
• Treatment duration averages 22 months, with 65% achieving remission within 18 months 4

For viral hepatitis:

• Treatment is primarily supportive for acute viral hepatitis 4
• Antiviral therapy for chronic hepatitis B or C based on specific guidelines

For drug-induced jaundice:

• Discontinue the offending medication immediately 4, 2
• Provide supportive care and monitor liver function

Critical Safety Considerations

• Use caution with iodinated contrast in jaundiced patients due to increased risk of acute kidney injury 1
• Monitor for infection aggressively in patients with severe jaundice, particularly alcoholic hepatitis, as infection often precedes multi-organ failure 1
• EUS with FNA has 6.3% complication rate (most commonly pancreatitis) and should be reserved for specific indications like tissue diagnosis 4

Prognostic Context

Survival varies dramatically by etiology: alcoholic cirrhosis shows 81% survival at 3 months and 35% at 5 years, while pancreatic carcinoma shows 54% at 3 months and 4% at 5 years 5. This underscores the importance of rapid diagnosis and cause-specific treatment to impact morbidity and mortality.