Jaundice refers to a clinical sign of hyperbilirubinemia (serum bilirubin >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. prehepatic and hepatic causes
- obstructive, i.e. posthepatic causes
Imaging has a major role in detecting the obstructive causes.
Clinically, jaundice presents with yellowing of the skin, conjunctiva (often incorrectly attributed to the sclerae) 5, and mobile oral tissues (e.g. frenulum, palate) 6. These structures are affected due to their high elastin content, which bilirubin has a high affinity for 6.
It may be painless, painful, or pruritic. Painless jaundice is always very suspicious for an underlying obstructive malignant cause 3.
Categories of causes 3:
- hemolytic anemia
- mechanical heart valve
post-hepatic (or obstructive jaundice)
- benign causes
- malignant causes
Jaundice is a common indication for imaging. Often a specific cause will not be found, and the main role is differentiating between a 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 etiology. 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
- 4. Dadhwal US, Kumar V. Benign bile duct strictures. (2012) Medical journal, Armed Forces India. 68 (3): 299-303. doi:10.1016/j.mjafi.2012.04.014 - Pubmed
- 5. Tripathi RC, Sidrys LA. 'Conjunctival icterus,' not 'scleral icterus'. (1979) JAMA. 242 (23): 2558. Pubmed
- 6. Daley TD, Armstrong JE. Oral manifestations of gastrointestinal diseases. (2007) Canadian journal of gastroenterology = Journal canadien de gastroenterologie. 21 (4): 241-4. Pubmed