Jaundice - Overview

Jaundice (icterus) is yellow discoloration of skin, sclerae, and mucous membranes caused by hyperbilirubinemia (typically serum bilirubin >2-3 mg/dL). It's a sign, not a diagnosis, and points to an underlying disorder of bilirubin production, hepatic handling, or biliary excretion.

Core physiology: Bilirubin comes from heme breakdown (mostly senescent RBCs). Unconjugated bilirubin is carried to the liver bound to albumin, taken up by hepatocytes, conjugated by UDP-glucuronosyltransferase, and excreted into bile. Hyperbilirubinemia results from (1) overproduction, (2) impaired hepatic uptake/conjugation, or (3) regurgitation of bilirubin from damaged hepatocytes or obstructed bile ducts (Harrison's Principles of Internal Medicine, 22E, p. 366).

Broad classification:

Prehepatic (unconjugated) - hemolysis, ineffective erythropoiesis, Gilbert/Crigler-Najjar syndromes
Hepatic (hepatocellular) - viral hepatitis, alcoholic/drug-induced liver injury, cirrhosis, sepsis
Posthepatic (obstructive/cholestatic) - gallstones, pancreatic/biliary malignancy, strictures, primary sclerosing cholangitis

The diagnostic workup hinges on determining whether the hyperbilirubinemia is conjugated or unconjugated, whether other liver tests (AST/ALT/ALP) are abnormal, and if cholestatic, whether the obstruction is intra- or extrahepatic (via ultrasound, MRCP, or ERCP).

A "report" on jaundice could go in several directions. Which would you like me to develop in full depth?

Asking for Preferences

Which aspect of jaundice should the detailed report focus on?

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