Jaundice is yellow discoloration of tissues due to accumulation of bilirubin. Normal serum bilirubin ranges from 7-32 mmol/L but jaundice may not be detected clinically until the level exceeds 40mmol/L. Various mechanisms can contribute to jaundice, such as excess bilirubin production, impaired intrahepatic conjugation and secretion, or obstruction in bile flow.
Symptoms may not be specific. A history of hepatitis, drug intake, injection, alcohol intake, sexual contact, and ingestion of raw shellfish and wild mushrooms are some of the causes. In addition to yellow discoloration of skin and sclera, patient may present with upper abdominal pain or discomfort, fever, weight loss, loss of appetite, nausea and vomiting, tea-colored urine, clay-colored stool or skin itchiness.
Initial investigations aim to establish the diagnosis of hyperbilirubinaemia and to differentiate whether the jaundice is prehepatic, hepatocellular or cholestatic.
The following tests may be performed:
Treatment of jaundice is tailored to identifying and treating the underlying cause. For medical jaundice, the treatment is generally supportive and avoidance of further liver insult. Acute liver failure carries high mortality rate and may require liver transplant if supportive measure failed.
Patients presenting with obstructive jaundice and sepsis requires close monitoring and antibiotic treatment. Biliary decompression via percutaneous transhepatic biliary drainage (PTBD) or endoscopic drainage may be required urgently for sepsis control. Emergency surgery is rarely required in acute setting. Subsequently surgery maybe planned for gallstones/ ductal stone disease in the form of cholecystectomy, laparoscopic or open, with or without CBD exploration.
Definitive surgery, curative or palliative bypass maybe be arranged for suitable candidate with underlying malignancy after proper evaluation and study.
In general, jaundice is a hallmark of underlying syndrome that requires collative management in multidisciplinary approach.
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