Introduction to Jaundice
Jaundice is a common clinical state of varying etiologies. It is classified as haemolytic, hepatic or obstructive.
Clinical jaundice occurs when the level of serum bilirubin exceeds 2.5 mg/dL. The bilirubin may be conjugated, unconjugated or mixed
Important causes of Jaundice
Diseases of the liver and the biliary tract
Conditions that cause excessive red cells haemolysis: infections, haemoglobinopathies
Clinical features of Jaundice
- Discolouration of the sclerae and other mucus membranes
- Associated general pruritus (especially with cholestatic jaundice)
- Associated features of the underlying disease
Investigations
- LFTS: determine levels and nature of bilirubin, liver enzymes (AST, ALT, Alkaline phosphotase)
- Abdominal ultrasound scan: look out for canalicular dilatations, biliary stones
Treatment objectives
- Treat underlying cause
- Prevent complications
Drug treatment for Jaundice
- Specific treatment depends on the identified cause
- Colestyramine: 3 to 6 g orally 6 hour in severe obstructive jaundice
- Phenobarbital in neonatal jaundice: 5-8mg/kg orally daily
Notable adverse drug reactions
- Colestyramine: diarrhoea
- Phenobarbital may cause dose-dependent respiratory depression
Surgical treatment
- Obstructive jaundice
- ERCP sphincterotomy with stone removal Stent insertion
- Pancreatic head/duodenal head realignment
Supportive measures
- Reassurance and monitoring
- Phototherapy in neonatal jaundice