Jaundice

If bilirubin unconjugated consider Gilbert's or haemolysis.
If bilirubin increase is both conjugated and unconjugated - liver disease, cholestasis.

In This Section

Ultrasound is investigation of choice to exclude bile duct dilatation.
Check coagulation and if necessary correct with parenteral vitamin K (absorption will be reduced).
If extra hepatic cholestasis (dilated ducts), consider common bile duct stones, stricture and tumours. Appropriate investigations would include CT, MRCP, ERCP. Consult Gastroenterology.
If no duct dilatation, consider intrahepatic cholestasis. Check drug history, especially antibiotic use, NSAIDs and antipsychotics.

Infectious causes - Hepatitis A, B, C, EBV, CMV, and rarely other viruses including Hepatitis D and E.
Acute alcoholic hepatitis.
Chronic liver disease - alcohol, autoimmune hepatitis, primary biliary cirrhosis, sclerosing cholangitis, Wilson's Disease.
Drugs, toxins.


Information about this CDHB document (1423):
Document Owner:	Blue Book Editorial Committee (see Who's Who)
Issue Date:	December 2013
Next Review:	December 2015
Keywords:
Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document.
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Topic Code: 1423