Types of jaundice and their clinical features

 Gastroenterology  MRCP

stoolsnormalnormalnormal / palepale
total bilirubin+++/+++++
important historyjaundice with fasting or stress such as infection (Gilbert's)travel, family historydrug and alcohol historyhistory of pain (suggests cholelithiasis)
important signssplenomegaly may be presentsigns of chronic liver diseaseabsent splenomegaly
ALPnormalnormalraised (along with ALT, AST or GGT)raised (more than ALT, AST or GGT)
important causesneonatal jaundice, Gilbert syndrome, Crigler-Najjar syndromemalaria, sickle cell anaemia, G6PD, thalassemia, alpha methyldopaalcoholic liver disease, hepatotoxicity from drugsgallstone (cholelithiasis), cancer of the head of pancreas
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Differentiating causes of jaundice is based on clinical and laboratory features.

Total obstruction of the bile duct will lead to no urobilinogen in the urine since urobilinogen is made (and some is reabsorbed the 'enterohepatic urobilinogen cycle') in the gut.

Laboratory features of haemolytic anaemia include macrocytosis / reticulocytosis, raised 'unconjugated bilirubin', raised LDH, immature (left-shift) red cells (polychromasia).

Jaundice due to very heavy malaria infection can be associated with 'blackwater fever' although this is quite rare. The discolouration of the urine is due to haemoglobin.


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