From the Guidelines
Painless jaundice is most commonly caused by obstruction of the bile ducts, liver dysfunction, or hemolytic disorders, with the most frequent etiologies including hepatitis, alcoholic liver disease, blockage of the common bile duct by a gallstone or tumor, and toxic reaction to a drug or medicinal herb 1.
Causes of Painless Jaundice
The causes of painless jaundice can be broadly categorized into:
- Obstructive causes: blockage of the common bile duct by a gallstone or tumor, pancreatic cancer, cholangiocarcinoma, and ampullary carcinoma
- Non-obstructive causes: hepatitis, alcoholic liver disease, toxic reaction to a drug or medicinal herb, and hemolytic disorders such as sickle cell disease or autoimmune hemolytic anemia
- Genetic conditions: Gilbert's syndrome or Crigler-Najjar syndrome
- Liver diseases: cirrhosis due to alcoholic liver disease or non-alcoholic fatty liver disease
Evaluation and Diagnosis
Evaluation of painless jaundice typically requires:
- Blood tests to assess liver function
- Imaging studies like ultrasound or CT scan
- Possibly endoscopic procedures such as ERCP to identify the underlying cause and determine appropriate treatment 1
Key Considerations
It is essential to note that the most common causes of jaundice can vary by geography, type of hospital, and demographics, and a detailed history, targeted physical examination, and pertinent laboratory studies are necessary to categorize the type of jaundice and determine the underlying cause 1.
From the Research
Causes of Painless Jaundice
The causes of painless jaundice can be attributed to various factors, including:
- Obstructive jaundice, which can be caused by bile duct stones, chronic pancreatitis, pancreatic carcinoma, or other lesions in the bile ducts 2, 3
- Benign or malignant diseases, such as choledocholithiasis, chronic pancreatitis, or pancreatic carcinoma 3, 4
- Intrahepatic or extrahepatic obstruction, which can be caused by various factors, including tumors, stones, or strictures 3, 4
Diagnostic Approaches
The diagnosis of painless jaundice often involves the use of imaging studies, such as:
- Ultrasound, which can be used to detect bile duct dilatation or stones, and has a sensitivity of 90% and specificity of 86% for choledocholithiasis 2
- Computed Tomography (CT), which can be used to diagnose malignant extrahepatic obstruction, and has a sensitivity of 80% and specificity of 95% for pancreatic carcinoma 3
- Magnetic Resonance Cholangiopancreatography (MRCP), which has a high diagnostic accuracy for benign and malignant diseases, with a sensitivity of 98% and specificity of 98% 4
- Endoscopic Retrograde Cholangiopancreatography (ERCP), which is an invasive procedure that can be used to diagnose and treat obstructive jaundice, and has a high sensitivity and specificity for detecting bile duct stones and other lesions 2, 3
Clinical Evaluation
The clinical evaluation of painless jaundice involves a combination of laboratory tests, imaging studies, and physical examination. The choice of diagnostic approach depends on the clinical presentation and the suspected underlying cause of the jaundice. A simple and rational algorithm for the diagnosis of obstructive jaundice has been proposed, which involves the use of laboratory tests, imaging studies, and invasive procedures such as ERCP 5. Ultrasound is recommended as the initial examination, which provides a guide to choose patients for either a more advanced noninvasive imaging like MRCP or to an invasive procedure like ERCP 6.