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Types and Causes of Jaundice Explained

This document outlines different types and potential causes of jaundice based on whether it is pre-hepatic, hepatic, or post-hepatic in origin. Pre-hepatic causes include hematological disorders and drugs that can cause hemolysis. Hepatic jaundice presents with tea-colored urine and coagulopathy and is caused by toxic insults, viruses, alcohol use, cirrhosis, and genetic disorders. Post-hepatic jaundice causes dark urine and pale stools and includes gallstone disease, periampullary masses, and autoimmune conditions. Additional considerations in pregnancy include intrahepatic cholestasis, acute fatty liver, and HELLP syndrome.

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35 views2 pages

Types and Causes of Jaundice Explained

This document outlines different types and potential causes of jaundice based on whether it is pre-hepatic, hepatic, or post-hepatic in origin. Pre-hepatic causes include hematological disorders and drugs that can cause hemolysis. Hepatic jaundice presents with tea-colored urine and coagulopathy and is caused by toxic insults, viruses, alcohol use, cirrhosis, and genetic disorders. Post-hepatic jaundice causes dark urine and pale stools and includes gallstone disease, periampullary masses, and autoimmune conditions. Additional considerations in pregnancy include intrahepatic cholestasis, acute fatty liver, and HELLP syndrome.

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zhijiegoh357
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We take content rights seriously. If you suspect this is your content, claim it here.
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Duration

Acute - consider hepatic (drug injury) or post-hepatic (gallstone - choledocholithiasis or


cholangitis)
Chronic intermittent - perhaps triggered by stress, perhaps by illness, consider pre-hepatic
Chronic persistent and progressive - consider malignancy

Pre-Hepatic Jaundice
Normal urine (may be dark due to haemoglobinuria), normal stools, signs of symptomatic
anaemia
-G6PD deficiency: drugs, fava beans
-Thalassemia
-Haematological malignancy (CLL)
-Drugs (eg Bactrim)
-Recent transfusion

Hepatic Jaundice
Tea-coloured urine, ascites, coagulopathy, encephalopathy

Acute
-Toxic: Drugs such as paracetamol, TB drugs, anti-epileptics, traditional medicine
-Ischaemic: Hypotensive episode (sepsis), occurs 1-3 days after insult
-Acute viral (Hep A, B, E, CMV, EBM, HSV, dengue)

Chronic with acute flares


-Alcoholic: Longstanding heavy alcohol use, tender hepatomegaly, fever
-Hep B and C: Vertical transmission, sexually transmitted, blood-borne (IV drug use)

Chronic
-Cirrhosis: splenomegaly, ascites, thrombocytopenia, hyperoestrogenism
-Congestive: Severe right heart failure, tricuspid regurgitation
-NAFLD: Metabolic risk factors
-Haemochromatosis: Hereditary; or secondary to chronic iron overload (thalassemia), other
endocrine disease (diabetes, hypopituitarism, hypogonadism), cardiomyopathy,
pseudogout/arthropathy and bronzing of skin
-A1AT deficiency: history of young COPD
-Congenital: eg biliary atresia

Anything
-Autoimmune: Other autoimmune disease symptoms
-Wilson’s disease: Young patient, neurologic features (dysarthria, cerebellar, extrapyramidal
and psychiatric), and haemolytic anaemia
-Budd-Chiari syndrome: RHC pain, hepatomegaly and acute liver failure (acute), ascites and
features of cirrhosis (chronic).

Additional considerations in pregnancy:

• Intrahepatic cholestasis of pregnancy: Presents in second to third trimester with pruritus and
raised bilirubin, but women are otherwise well.

• Acute fatty liver of pregnancy: Presents in third trimester with liver dysfunction (jaundice,
elevated AST/ALT, coagulopathy), abdominal pain, nausea/vomiting and often renal
impairment.

• HELLP syndrome: Presents in the third trimester with haemolysis, elevated LFTs and low
platelets. This is thought to be a severe form of pre-eclampsia, often with hypertension,
proteinuria, abdominal pain and vomiting.

Post-Hepatic Jaundice
Dark urine and pale stools, pruitus

Painful causes
Painful obstructive jaundice is almost always due to gallstone disease.

-Cholangitis: RHC pain, jaundice and fever (Charcot’s triad), obstruction usually due to
gallstones, or possibly tumour, PBC etc.

-Choledocholithiasis:

-Hepatic abscess: RHC pain and jaundice, spiking fever with chills, anorexia and weight loss,
jaundice and vomiting

Painless causes

-Periampullary mass: Painless progressive jaundice, constitutional symptoms

-AIDS cholangiopathy (CD4 < 1000)

-PBC and PSC: Autoimmune disease


PSC - inflammatory bowel conditions

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