Jaundice

From Ganfyd

Jaundice refers to the yellow discolouration of tissues due to raised bilirubin levels. Jaundice becomes clinically detectable at about 2-3 times the upper limit of normal (approximate 34-50). People displaying Gilbert's syndrome have a sufficiently high bilirubin normally that dehydration and other minor events can make them jaundiced, it is less significant in these cases.

Classification

• pre-hepatic
• hepatic
• cholestatic

Presentation

The presentation of jaundice of various causes is less crisp than has been suggested, however the historic description of painless jaundice strongly suggesting malignant stricture of the common bile duct is useful.

Painless jaundice suggests malignancy Carcinoma of the head of the pancreas is likely

Gallstones are often an incidental finding, but when they cause trouble the clinical picture may include painless jaundice particularly in old patients. Severe pain with vomiting is however more common.

Investigations

• direct/conjugated vs indirect/unconjugated
• liver function tests