Jaundice classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fatima Shaukat, MD [2]

Overview

Jaundice is classified in two categories including unconjugated hyperbilirubinemia and conjugated hyperbilirubinema. Unconjugated hypebilirubinemia can be caused by either increased production, reduced reuptake or defects in conjugation of bilirubin. While conjugated hyperbilirubinemia is further classified into obstruction of biliary tract, interahepatic cholestasis, injury to hepatocellular parenchyma, and defects of hepatocellular canalicular excretion or re-uptake in sinusoids.

Classification

Jaundice is classified into two subtypes:[1][2][3][4]

  • Conjugated hyperbilirubinemia
  • Unconjugated hyperbilirubinemia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Jaundice classification
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Predominately conjugated hyperbilirubenemia
 
 
 
 
 
 
Mixed conjugated and unconjugated hyperbilirubinemia
 
 
 
 
 
 
Predominately unconjugated hyperbilirubinemia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Obstruction of biliary tract
 
Intra-hepatic cholestasis
 
 
Injury to hepatocellular parenchyma
 
Defects of hepatocellular
canalicular excretion or re-uptake
in sinusoids
 
 
 
 
 
Increased production
 
Reduced uptake
 
 
 
Defects in conjugation
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Acquired
 
Inherited
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Cholangiocarcinoma
Pancreatic cancer
Gallbladder cancer
Ampullary cancer
• Choledocholithiasis
 • Choledocholithiasis
•Postoperative biliary strictures
Primary sclerosing cholangitis
Chronic pancreatitis
AIDS cholangiopathy
Parasitic disease ascariasis
 
Primary biliary cholangitis
Primary sclerosing cholangitis
Viral hepatitis (ocassionally)
Progressive familial intrahepatic cholestasis
Intrahepatic Cholestasis of Pregnancy
Corticosteroids
 
Infiltrative liver disorders like
Hemochromatosis
Amyloidosis
 
Dubin-Johnson syndrome
Rotor syndrome
 
Wilson's disease
Viral hepatitis
Alcoholic hepatitis
Drug toxicity
Autoimmune hepatitis
 

Hemolysis
Hereditary spherocytosis
G6PD deficiency
Thalassemia
Paroxysmal nocturnal hemoglobinuria
• Immune hemolysis
• Extravasation
• Shunt hyperbilirubinemia
 
• Portosystemic shunts
Drugs
Gilbert syndrome (some cases)
 

• Neonatal
• Maternal milk
• Lucy-Driscoll
Hyperthyroidism
• Chronic persitent hepatitis
• Advanced cirrhosis
 
Crigler-Najjar syndrome l
Crigler-Najjar syndrome II
Gilbert syndrome

References

  1. VanWagner LB, Green RM (2015). "Evaluating elevated bilirubin levels in asymptomatic adults". JAMA. 313 (5): 516–7. doi:10.1001/jama.2014.12835. PMC 4424929. PMID 25647209.
  2. Gadia CLB, Manirakiza A, Tekpa G, Konamna X, Vickos U, Nakoune E (2017). "Identification of pathogens for differential diagnosis of fever with jaundice in the Central African Republic: a retrospective assessment, 2008-2010". BMC Infect Dis. 17 (1): 735. doi:10.1186/s12879-017-2840-8. PMC 5707826. PMID 29187150.
  3. Kremer M (1940). "The Classification of Jaundice: With details of some of the causes of this condition". Postgrad Med J. 16 (171): 11–7. PMC 2476810. PMID 21313179.
  4. Kasper, Dennis (2015). Harrison's principles of internal medicine. New York: McGraw Hill Education. ISBN 978-0-07-180215-4.




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