Causes of Jaundice

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Causes of Jaundice

Haemolytic

• spherocytosis
• pernicious anaemia
• incompatible blood transfusion

Congenital Hyperbilirubinaemia

Unconjugated

• Gilberts syndrome
• Crigler-Najjar Syndrome

Conjugated

• Dubin-Johnson
• Rotor

Cholestatic Jaundice

Intrahepatic

• Hepatitis (AST/ALT high, Alkaline phosphatase only slightly raised)
• Viral hepatitis

  • Hepatitis A, B, C, D, E

  • Cytomegalovirus (CMV) - rare except in immunocompromised

  • Epstein-Barr virus (EBV) - rare except in immunocompromised

  • Varicella-Zoster virus (VZV) - rare

  • Herpes Simplex virus (HSV)

  • Adenovirus - immunocompromised only

• Alcoholic Hepatitis
• Cirrhosis
• Pregnancy
• Drugs
  • chlorpromazine
  • 1 in 30,000 patients may have jaundice in response to halothane
• Liver poisons
• Liver tumours
• Recurrent idiopathic cholestasis
• Some congenital
• Infiltration
• Primary biliary cirrhosis
• Sepsis

Extrahepatic (Alk. Phos high, small rise in ALT/AST)

• Obstruction within the lumen
  • Common duct stones
• In the wall
  • congenital atresia of common bile duct
  • traumatic stricture
  • Iatrogenic lesions
  • tumour of bile duct
  • Extra-hepatic cholangiocarcinoma
  • Primary Sclerosing Cholangitis
  • chronic cholangitis
• External compression
  • Acute Pancreatitis +/- pseudocyst
  • Carcinoma
    • head of pancreas
    • around Ampulla of Vater
  • enlarged porta hepatis
• Liver metastases
  • Late
  • mixed pattern of obstructive and hepatic

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