Dr. J. Damodharan, MD*

Introduction

Jaundice is a common clinical problem that can be caused by a variety of disorders. For clinical purposes, the predominant type of bile pigments in the plasma is used to classify hyperbilirubinemia into two major categories.

Plasma elevation of predominantly unconjugated bilirubin due to

a. The overproduction of bilirubin,

b. Impaired bilirubin uptake by the liver, or c. abnormalities of bilirubin conjugation

Plasma elevation of both unconjugated and conjugated bilirubin due to

a. Hepatocellular diseases,

b. Impaired canalicular excretion, and

c. Biliary obstruction.

The diagnostic approach to the icteric patient begins with a careful history and physical examination, and screening laboratory studies. Although the evaluation is usually not urgent, jaundice can reflect a medical emergency in a few select situations. These include:

a. Massive hemolysis (eg, due to Clostridium perfringens sepsis or falciparum malaria),

b. Ascending cholangitis,

c. Unconjugated hyperbilirubinemia in the neonatal period (which can lead to kernicterus), and fulminant hepatic failure.

Expedient diagnosis and appropriate therapy can be lifesaving in these settings.