CLASSIFICATION AND CAUSES OF

JAUNDICE
Jaundice
• Jaundice is a yellowish pigmentation of the skin,
the conjunctival membranes over the sclerae and
other mucous membranes caused
by hyperbilirubinemia (increased levels of bilirubin in
the blood). This hyperbilirubinemia subsequently
causes increased levels of bilirubin in
the extracellular fluid.

• Concentration of bilirubin in blood plasma is

normally below 1.2 mg/dL (<25µmol/L). A
concentration higher than 2.5 mg/dL (>50µmol/L)
leads to jaundice
Pre-Hepatic or Hemolytic Jaundice

• E.g Hereditary spherocytosis, G6PD deficiency,

Acquired autoimmune haemolytic, Anaemia,
Haemoglobinopathies

Hepatic or Hepatocellular Jaundice

• Hereditary/congenital: Impaired hepatic bilirubin

transport
• E.g Gilbert’s syndrome, Crigler-Najjar, Dubin-Johnson,
Rotor
• Acquired: hepatocellular dysfunction
• E.g Hepatitis (viral, bacterial, alcohol, drugs, poisons),
cirrhosis, metabolic diseases (Wilson’s)

Post-Hepatic or Obstructive Jaundice

Pre-Hepatic or Hemolytic Jaundice
• Pre-hepatic jaundice is caused by anything which
causes an increased rate of hemolysis (breakdown
of red blood cells)

• In jaundice secondary to hemolysis, the increased

production of bilirubin, leads to the increased
production of urine-urobilinogen. Bilirubin is not
usually found in the urine because unconjugated
bilirubin is not water-soluble, so, the combination of
increased urine-urobilinogen with no bilirubin (since,
unconjugated) in urine is suggestive of hemolytic
jaundice.
• Occurs prior to the liver.

• Diagnosis : LFT (normal). Urine colour (Normal).

Spleenomegaly (May present). Urobilinogen
(Increase).

• Common conditions: Hereditary spherocytosis,

G6PD deficiency, Acquired autoimmune
haemolytic, Anaemia, Haemoglobinopathies

• C/F: Anaemia, Fatigue.

Hepatic or Hepatocellular Jaundice
• Hepatocellular (hepatic) jaundice can be caused
by acute or chronic hepatitis, hepatotoxicity,
cirrhosis, drug induced hepatitis and alcoholic
liver disease.

• Cell necrosis reduces the liver's ability to

metabolize and excrete bilirubin leading to a
build up of unconjugated bilirubin in the blood.
• Occurs within the liver.

• Concentration of both unconjugated and

conjugated bilirubin rises in the blood.

• Common conditions: Hepatitis, Liver CA,

Alcoholic Liver Disease, Liver Cirrhosis.

• C/F : Pain in RHC, ascites, varicose vein.

Post-Hepatic or Obstructive Jaundice
• Post-hepatic jaundice, also called obstructive
jaundice, is caused by an interruption to the
drainage of bile in the biliary system.

• In complete obstruction of the bile duct, no

urobilinogen is found in the urine, since bilirubin has
no access to the intestine and it is in the intestine
that bilirubin gets converted to urobilinogen to be
later released into the general circulation. In this
case, presence of bilirubin (conjugated) in the urine
without urine-urobilinogen suggests obstructive
jaundice, either intra-hepatic or post-hepatic.
• Occurs after the conjugation of bilirubin in the liver.
• Due to the obstruction to the drainage of conjugated
bilirubin in the biliary system.
• Common condition: Gallstone, liver fluke infestation,
cholangitis, pancreatic cancer,
• Courvoisier's law applied.
• C/F: Colicky pain in RHC.
 Post-hepatic
Function test Pre-hepatic Jaundice Hepatic Jaundice
Jaundice
Total bilirubin Normal / Increased Increased

Conjugated bilirubin Normal Increased Increased

Unconjugated
Normal / Increased Increased Normal
bilirubin
Urobilinogen Normal / Increased Decreased Decreased / Negative

Dark (urobilinogen + Dark (conjugated

Urine Color Normal
conjugated bilirubin) bilirubin)

Stool Color Normal Normal/Pale Pale

Alkaline phosphatase
Increased
levels

Alanine transferase Normal

and Aspartate Increased
transferase levels

Conjugated Bilirubin
Not Present Present
in Urine

Splenomegaly Present Present Absent