JAUNDICE

(Hyperbilirubinemia)

Yellowish discoloration of sclera and skin due to raised levels of bilirubin in the body. Bilirubin is a by-product of red cell  breakdown, processed in the liver and excreted mainly in bile. Jaundice may be benign or life threatening.

Causes

  • Pre hepatic – haemolysis e.g sepsis, sickle cell disease, pregnancy (HELLP syndrome), disseminated
    intravascular coagulation (DIC), vascular
  • Hepatic – hepatitis, drugs, tumors, alcohol, toxins, herbs, autoimmune disease, pregnancy, cholangitis
  • Post hepatic – gall stones, strictures, tumors, surgery, pancreatitis, biliary disease

Complications

  • Renal failure , coagulopathy
  • Sepsis

Investigations

  • Liver function tests (AST, ALT, bilirubin), Coomb’s tests, low haptoglobin, LDH
  • Hepatitis A, B, C
  • Malaria, sickle cell screen
  • Ultrasound shows dilated bile ducts and gall bladder
  • CBC, INR, RFTS, LDH, Endoscopic retrograde cholangiopancreatogram (ERCP)
  • Liver biopsy

Management

  • Refer and/or consult as appropriate
  • Treat the underlying cause
  • Discontinue offfending factors
  • Use phototherapy with UV light for newborn babies