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Gastroenterology – Jaundice
Whiteboard Animation Transcript
with Kelly Burak, MD
https://medskl.com/Module/Index/jaundice


Jaundice is the yellow discoloration of the ocular conjunctiva, mucous membranes, and skin.

Jaundice is a clinical sign indicating hyperbilirubinemia and the terms are often used interchangeably.

Bilirubin is a normal breakdown product of hemoglobin and jaundice can be thought of as pre-hepatic, hepatic and post-hepatic causes.

The clinical evaluation of jaundice requires a step-wise approach.

Confirm and classify the hyperbilirubinemia

In general, jaundice doesn’t become apparent until serum bilirubin levels are two to three times the upper limit of normal (usually >50 mol/L or3mg/dL)

When checking bilirubin levels, it’s important to also check for conjugated (direct) and unconjugated (indirect) bilirubin levels

This, along with results of abdominal ultrasound, liver enzymes and function tests, will help you determine the underlying pathology

Consider the differential diagnosis

One way to categorize the causes of jaundice is by looking at whether the high bilirubin is unconjugated or conjugated

High levels of unconjugated bilirubin can be due to

increased bilirubin production secondary to hemolysis
impaired uptake of bilirubin by the liver
due to impaired conjugation of bilirubin by the liver

High conjugated bilirubin levels can be due to intrahepatic (hepatocellular or cholestatic liver disease) or extrahepatic biliary obstruction

Plan management

Determining the underlying cause of the jaundice will help direct you to the most appropriate therapy. The most common causes of jaundice are liver infections, liver insult secondary to alcohol and toxins, and obstruction due to gallstones.

Prevention is often better than cure and patients need to be educated on minimizing risk for viral hepatitis, safe alcohol consumption, and managing risks for non-alcoholic fatty liver disease.