Jaundice resident survival guide

Jaundice Resident Survival Guide
Overview
Causes
Diagnosis
Treatment
Do's
Don'ts

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

Synonyms and keywords:

Overview

The classic definition of Jaundice is a serum bilirubin level higher than 2.5 to 3 mg per dL (42.8 to 51.3 μper L) in conjunction with a clinical picture of yellow skin and sclera. Bilirubin metabolism takes place in three phases; "prehepatic", "intrahepatic", and "posthepatic". The causes of jaundice can be classified under these categories by measuring total bilirubin and its conjugated and unconjugated levels determine where is the dysfunction of bilirubin metabolism.

Causes

Life Threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.

• Life threatening cause 1
• Life threatening cause 2
• Life threatening cause 3

Common Causes

of acute Jaundice[2]

• Gilbert syndrome
• Alcoholic hepatitis
• Viral hepatitis
• Obstructive Jaundice due to Choledocholithiasis or Malignancy
• Decompensated chronic liver disease

of chronic progressive Jaundice

• Cirrhosis
• Pancreatic cancer

Diagnosis

Shown below is an algorithm summarizing the diagnosis of [[disease name]] according the the [...] guidelines.

Characterize the jaundice Duration: short Hx vs long Hx Episodic vs. Constant

Assoaciated symptoms Abdominal pain(episodic or constant) and/or distension fever clay colored stool dark urine weight gain or loss Anorexia dyspepsia arthralgia myalgia Back pain Rash confusion

Inquire about past medical history blood disorder,Liver, biliary, pancreatic disease,Cardiac disease,Infectious disease( HIV, Malaria,...) family history(hemolytic anemias, congenital hyperbilirubinemias, wilson disease) medication history Parentral exposure(Blood transfusion, Iv drug abuse) Recent travel history(e.g. Malaria,HAV,ascaris, liver flukes social history(excess alcohol intake) Sexual history( HBV,HIV risk factors)

Examine the patient General Appearance pale(hemolysis/ca/cirrhosis) Gross weight loss( ca/severe malabsorption) Fetor hepaticus flapping tremor(impending hepatic coma) Skin exam scratch marks, melanin pigmentation, xanthoma of eyelids(chronic cholestasis) signs of liver disease: spider nevi, palmar erythema bruising, purpuric spots, clotting defects due to thrombocytopenia of cirrhosis Cariac exam JVP(right sided heart failure) full abdominal exam Size and consistency of liver and spleen a grossly enlarged nodular liver or an obvious abdominal mass suggests malignancy Small liver can be seen in( severe hepatitis/cirrhosis) an enlarged tender liver could be due to (viral or alcoholic hepatitis an infiltrative process such as amyloidosis; or, acutely congested liver secondary to right-sided heart failure) Gall bladder area if it is tender; + murphy sign due to Choledocholithiasis /Palpable, visibly enlarged GB can be due to pancreatic ca Splenomegaly can be seen in hemolytic states, hodgkin’s, portal hypertension ascites due to cirrhosis/ abdominal malignancy caput medosa Extremity examination Ankle edema due to cirrhosis/ IVC obstruction due to hepatic or pancreatic malignancy

Order labs and tests that are used to determine if jaundice is prehepatic, intrahepatic or posthepatic which will determine further investigations Blood tests CBC Total Bilirubin Conjugated or unconjugated bilirubin Metabolic panel LFT INR Urine Bilirubin, Urobilinogen

Isolated conjugated billirubin

Treatment

Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.

Do's

• The content in this section is in bullet points.

Don'ts

• The content in this section is in bullet points.

References