Jaundice refers to a clinical sign of hyperbilirubinemia (>2.5 mg/dl) which has many causes. It is often a clue to a diagnosis. It can be largely divided into two types:
- non-obstructive, i.e. pre-hepatic and hepatic causes
- obstructive, i.e. post-hepatic causes
Imaging has a major role in detecting the obstructive causes.
Jaundice is the yellowing of the skin and/or sclera. Patients may present painless or painful jaundice. Painless jaundice is always very suspicious for an underlying obstructive malignant cause 3.
Categories of causes 3:
- haemolytic anaemia
- mechanical heart valve
- acute hepatitis / acute liver failure
- Gilbert syndrome
post-hepatic (a.k.a. obstructive jaundice)
- benign causes
- malignant causes
Patients presenting with jaundice is a common indication for imaging. Often a specific cause will not be found, and the main role is differentiating between non-obstructive and obstructive jaundice. In the latter, extrahepatic and/or intrahepatic bile duct dilatation can be expected, depending on the level of obstruction.
Treatment and prognosis
Management depends on the underlying aetiology. In jaundiced neonates, phototherapy and exchange transfusion should be considered.
- 1. Shanser JD, Korobkin M, Goldberg HI et-al. Computed tomographic diagnosis of obstructive jaundice in the absence of intrahepatic ductal dilatation. AJR Am J Roentgenol. 1978;131 (3): 389-92. doi:10.2214/ajr.131.3.389 - Pubmed citation
- 2. Weinstein DP, Weinstein BJ, Brodmerkel GJ. Ultrasonography of biliary tract dilatation without jaundice. AJR Am J Roentgenol. 1979;132 (5): 729-34. doi:10.2214/ajr.132.5.729 - Pubmed citation
- 3. Fundamentals of surgical practice. Cambridge University Press. ISBN:0521677068. Read it at Google Books - Find it at Amazon