Jaundice: classification, causes and differential diagnosis.

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Jaundice is a yellow discoloration of the skin, mucous membranes, and sclera of the eyes due to elevated levels of bilirubin in the blood. Bilirubin is a yellow pigment produced during the breakdown of red blood cells. Jaundice can be classified into three main types based on the underlying causes:

  1. Prehepatic (Hemolytic) Jaundice:

    • Causes:
      • Increased breakdown of red blood cells (hemolysis), leading to elevated unconjugated bilirubin.
      • Conditions such as hemolytic anemia, sickle cell disease, and certain genetic disorders.
    • Features:
      • Elevated unconjugated bilirubin levels.
      • Hemolysis markers such as increased lactate dehydrogenase (LDH) and decreased haptoglobin.

  2. Hepatic (Hepatocellular) Jaundice:

    • Causes:
      • Liver dysfunction impairs the processing and conjugation of bilirubin.
      • Conditions such as viral hepatitis, alcoholic liver disease, cirrhosis, drug-induced liver injury, and certain inherited liver disorders.
    • Features:
      • Elevated levels of both conjugated and unconjugated bilirubin.
      • Liver function test abnormalities, including elevated transaminases (AST, ALT).

  3. Posthepatic (Obstructive) Jaundice:

    • Causes:
      • Impaired excretion of conjugated bilirubin due to obstruction of bile flow.
      • Conditions such as gallstones, tumors, or strictures in the bile ducts.
    • Features:
      • Elevated conjugated bilirubin levels.
      • Elevated alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT).
      • Dark urine and pale stools.

Differential Diagnosis:

  • Hemolysis: Increased unconjugated bilirubin, elevated LDH, decreased haptoglobin.
  • Hepatocellular Dysfunction: Elevated transaminases, impaired liver function tests.
  • Biliary Obstruction: Elevated conjugated bilirubin, elevated ALP and GGT, dark urine, pale stools.
  • Hepatitis: Elevated transaminases, presence of viral markers.
  • Cirrhosis: Features of chronic liver disease, including elevated bilirubin and signs of portal hypertension.
  • Alcoholic Liver Disease: Elevated transaminases, elevated gamma-glutamyl transferase, history of alcohol abuse.
  • Hemochromatosis: Iron overload leading to liver damage and jaundice.
  • Wilson's Disease: Accumulation of copper in the liver leading to hepatocellular dysfunction.

Diagnosing the underlying cause of jaundice involves a thorough medical history, physical examination, and various laboratory and imaging tests. Management depends on addressing the specific cause of jaundice, and treatment may include addressing underlying liver disease, removing obstructions, or managing hemolysis. Patients with jaundice should seek medical attention for proper evaluation and diagnosis.


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