08/12/2025
JAUNDICE
Overview
Jaundice is yellow discoloration of the skin, mucous membranes, and sclera caused by elevated bilirubin in the blood (hyperbilirubinemia).
It becomes clinically visible when bilirubin is > 2–3 mg/dL.
Causes of Jaundice
Jaundice is classified into three main categories:
1. Pre-hepatic (Hemolytic) Jaundice
Due to increased bilirubin production from red blood cell breakdown.
Causes
Hemolytic anemia
Sickle cell disease
Thalassemia
G6PD deficiency
Malaria
Massive transfusion reactions
Key Features
↑ Unconjugated bilirubin
Normal liver enzymes
Dark stool & urine normal
Raised reticulocyte count
2. Hepatic (Hepatocellular) Jaundice
Due to impaired bilirubin uptake, conjugation, or excretion in the liver.
Causes
Viral hepatitis (A, B, C, E)
Alcoholic hepatitis
Cirrhosis
Drugs/toxins (paracetamol overdose, anti-TB drugs)
Autoimmune hepatitis
Liver tumors
Neonatal jaundice (physiologic, breastfeeding, prematurity)
Key Features
Mixed conjugated & unconjugated bilirubin
↑ AST, ALT
Possible tender hepatomegaly
3. Post-hepatic (Obstructive/Cholestatic) Jaundice
Due to blockage of bile flow.
Causes
Gallstones
Bile duct obstruction
Pancreatic cancer
Cholangiocarcinoma
Primary sclerosing cholangitis
Carcinoma of the head of pancreas
Key Features
↑ Conjugated bilirubin
Pale stool, dark urine
Severe pruritus
↑ ALP, GGT
Management of Jaundice
Management depends on identifying the underlying cause.
1. Pre-hepatic Jaundice
Treatment
Treat underlying hemolysis
Manage malaria with antimalarials
Stop causative drugs
Maintain hydration
Blood transfusion if severe anemia
Folic acid supplementation
2. Hepatic Jaundice
Treatment
Treat viral hepatitis
Hepatitis B → antivirals
Hepatitis C → direct-acting antivirals
Stop hepatotoxic drugs
Alcohol cessation