TREATMENTS &
RESEARCH

Search the
latest
treatment
information
here.

Dr. Huntley's
Diagnosis
Checklist

Have a symptom?
See what questions
a doctor would ask.
 
Next
Diseases » Jaundice » Causes
 

Causes of Jaundice

Contents
  1. Jaundice: Introduction
  2. List of Causes
  3. Causes Discussion
  4. Drugs/substances (401 causes)
  5. Drug interaction (105 causes)
  6. Hidden causes
  7. Risk factors
  8. Excerpts from book chapters
  9. Complication causes
  10. Causes of symptoms
  11. Related cause information

List of causes of Jaundice

Following is a list of causes or underlying conditions (see also Misdiagnosis of underlying causes of Jaundice) that could possibly cause Jaundice includes:

More causes: see full list of causes for Jaundice

Causes of Jaundice (Diseases Database):

The follow list shows some of the possible medical causes of Jaundice that are listed by the Diseases Database:

Source: Diseases Database

Jaundice Causes: Book Excerpts

Jaundice as a complication of other conditions:

Other conditions that might have Jaundice as a complication may, potentially, be an underlying cause of Jaundice. Our database lists the following as having Jaundice as a complication of that condition:

Jaundice as a symptom:

Conditions listing Jaundice as a symptom may also be potential underlying causes of Jaundice. Our database lists the following as having Jaundice as a symptom of that condition:

Medications or substances causing Jaundice:

The following drugs, medications, substances or toxins are some of the possible causes of Jaundice as a symptom. This list is incomplete and various other drugs or substances may cause your symptoms. Always advise your doctor of any medications or treatments you are using, including prescription, over-the-counter, supplements, herbal or alternative treatments.

See full list of 401 medications causing Jaundice


Drug interactions causing Jaundice:

When combined, certain drugs, medications, substances or toxins may react causing Jaundice as a symptom.

The list below is incomplete and various other drugs or substances may cause your symptoms. Always advise your doctor of any medications or treatments you are using, including prescription, over-the-counter, supplements, herbal or alternative treatments.

  • Fusidic Acid and Ritonavir, Saquinavir interaction
  • Rifampin and Pyrazinamide interaction
  • Troleandomycin and Oral Contraceptive Agents interaction
  • Oral Contraceptive and TAO interaction
  • Birth Control Pill and TAO interaction
  • more interactions...»

See full list of 105 drug interactions causing Jaundice

What causes Jaundice?

Causes: Jaundice: Bile materials (bilirubin) in the blood, often from liver diseases such as hepatitis.

Related information on causes of Jaundice:

As with all medical conditions, there may be many causal factors. Further relevant information on causes of Jaundice may be found in:

Causes of Jaundice: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the causes of Jaundice.

Jaundice: Differential Diagnosis
(In a Page: Signs and Symptoms)

  • Viral hepatitis
    –Fatigue, anorexia, fever, nausea, vomiting, dark urine, light-colored (acholic) loose stools, RUQ pain, hepatomegaly, and/or pruritis
  • Alcoholic hepatitis
    –Associated with fever, leukocytosis, and AST:ALT ratio >2
  • Nonalcoholic steatohepatitis or nonalchoholic fatty liver disease
    –Associated with obesity, diabetes, hyperlipidemia and medications
  • Cholecystitis
    –RUQ pain, fever, leukocytosis
    –Female, fertile, fat, forty
    –Murphy's sign: Pain upon palpation of the
    gallbladder while taking a deep breath
  • Drugs and toxins
    –Acetaminophen, alcohol, estrogens, isoniazid, chlorpromazine, erythromycin, nitrofurantoin, rifampin
  • Gilbert's syndrome

    –Decreased conjugation of bilirubin, especially with dehydration, fasting, infection
  • Sepsis
  • Malignancy (liver, pancreas, gallbladder/common bile duct, metastatic)
    • Liver infiltration
      –Amyloidosis, lymphoma, sarcoidosis, tuberculosis
  • Total parenteral nutrition (usually requires at least 2 weeks of therapy)
  • Intravascular hemolysis
    • Cholangitis
      –Charcot's triad of fever, RUQ pain, and jaundice
  • Sickle cell disease
    –Chronic hemolysis, hepatic dysfunction
    • Autoimmune hepatitis
      –May mimic viral hepatitis
      –Females >> males, often 10–30 years old
      –Associated with autoimmune disease
      (e.g., RA, UC, Sjögren's syndrome, thyroiditis)
  • Intrahepatic cholestasis of pregnancy
    –Pruritus in third trimester
    –Resolves after delivery
  • Hereditary cholestatic disorders (e.g., Dubin-Johnson syndrome, Rotor syndrome)
  • Physiologic jaundice of newborn

    • » READ BOOK EXCERPT ONLINE »

    Source: In a Page: Signs and Symptoms, 2004

    Jaundice in Infants – Direct: Differential Diagnosis
    (In A Page: Pediatric Signs and Symptoms)

    • Bile duct obstruction
      –Biliary atresia: Represents the most frequent cause for liver transplantation in the pediatric patient; prompt diagnosis is crucial, as patient outcome is better if intervention comes before 60 days of life
      –Choledochal cyst
      –Common bile duct gallstone
      –Choledochocele
      –Bile duct stricture
      –Alagille syndrome
      –Caroli disease
      –Congenital hepatic fibrosis
    • Neonatal hepatitis
      –Idiopathic hepatitis: Diagnosis of exclusion that should be made only when other causes are excluded; accounts for 60% of patients with neonatal cholestasis
      –Infections: TORCH, hepatitis B, HIV, E. coli, adenovirus, enterovirus, parvovirus B16, tuberculosis, listeriosis, malaria
      • Metabolic disorders
        –α-1 antitrypsin deficiency
        –Cystic fibrosis
        –Hypothyroidism
        –Neonatal iron storage disease
        –Amino acids: tyrosinemia
        –Carbohydrates: Galactosemia, fructosemia
        –Lipids: Niemann-Pick, Gaucher, Wolman, cholesterol ester storage disease
        –Mitochondropathies
        –Bile acid synthetic disorders
        –Peroxisomal: Zellweger syndrome
        –Urea cycle defects
      • Toxins
        –Total parenteral nutrition
        –Drugs: Trimethaprim-sulfamethoxazole, anticonvulsants
    • Miscellaneous
      –Sepsis/hypoperfusion
      –Erythrophagocytic lymphohistiocytosis
      –Extracorporeal membrane oxygenation
      –Trisomy 17, 18, 21
      –Neonatal lupus erythematosus
      –Donohue syndrome
      –Rotor syndrome
      –Dubin-Johnson syndrome
      –Byler disease (PFIC type 1)
      –Cholestasis of North-American Indians
      –Nielsen syndrome

    » READ BOOK EXCERPT ONLINE »

    Source: In A Page: Pediatric Signs and Symptoms, 2007

    Jaundice in Infants – Indirect: Differential Diagnosis
    (In A Page: Pediatric Signs and Symptoms)

      • Icterus neonatorum (physiologic jaundice)
        –The most common form of indirect jaundice in infants under 14 days of age
        –Caused by increased bilirubin production with transient limited conjugation abilities
      • Breast-feeding jaundice
        –Occurs in first week of life in 13% of breast-fed infants
        –Secondary to poor volume intake
      • Breast-milk jaundice
        –Occurs in about 2% of breast-fed infants after day 7 of life
        –Secondary to glucuronidase in breast milk
      • Hematologic: Hemolysis increases bili load
        –Rh incompatability
        –ABO incompatability
        –Glucose-6-phosphate dehydrogenase (G6PD) deficiency
        –Pyruvate kinase deficiency
        –Hereditary spherocytosis
        –Elliptocytosis
        –Thalassemia
        –Polycythemia
    • Extravascular blood
      –Cephalohematoma
      –Trauma
      –Swallowed maternal blood
    • Endocrinologic
      –Hypothyroidism
      –Maternal diabetes
    • Sepsis
    • Metabolic
      –Crigler-Najjar I
      –Crigler-Najjar II (Arias syndrome)
      –Crigler-Najjar III
    • Cardiopulmonary
      –Congestive heart failure
      –Patent ductus arteriosus
      –Portal vein thrombosis
    • Anatomic
      –Pyloric stenosis
      –Duodenal atresia/stenosis
      –Duodenal web
    • Drugs
      –Oxytocin
      –Sulfonamides
      –Ceftriaxone
      –Chuen-Lin
    • Lucey-Driscoll syndrome

    » READ BOOK EXCERPT ONLINE »

    Source: In A Page: Pediatric Signs and Symptoms, 2007

    Jaundice: Medical causes
    (Handbook of Signs & Symptoms (Third Edition))

    Carcinoma

    Cancer of the ampulla of Vater initially produces fluctuating jaundice, mild abdominal pain, a recurrent fever, and chills

    Occult bleeding may be its first sign. Other findings include weight loss, pruritus, and back pain.

    Hepatic cancer (primary liver cancer or another cancer that has metastasized to the liver) may cause jaundice by causing obstruction of the bile duct. Even advanced cancer causes nonspecific signs and symptoms, such as right upper quadrant discomfort and tenderness, nausea, weight loss, and a slight fever. Examination may reveal irregular, nodular, firm hepatomegaly; ascites; peripheral edema; a bruit heard over the liver; and a right upper quadrant mass.

    Withpancreatic cancer,progressive jaundice — possibly with pruritus — may be the only sign. Related early findings are nonspecific, such as weight loss and back or abdominal pain. Other signs and symptoms include anorexia, nausea and vomiting, a fever, steatorrhea, fatigue, weakness, diarrhea, pruritus, and skin lesions (usually on the legs).

    Cholangitis

    Obstruction and infection in the common bile duct cause Charcot’s triad: jaundice, right upper quadrant pain, and a high fever with chills.

    Cholecystitis

    Cholecystitis produces nonobstructive jaundice in about 25% of patients

    Biliary colic typically peaks abruptly, persisting for 2 to 4 hours. The pain then localizes to the right upper quadrant and becomes constant. Local inflammation or passage of stones to the common bile duct causes jaundice. Other findings include nausea, vomiting (usually indicating the presence of a stone), a fever, profuse diaphoresis, chills, tenderness on palpation, a positive Murphy’s sign and, possibly, abdominal distention and rigidity.

    Cholelithiasis

    Cholelithiasis commonly causes jaundice and biliary colic

    It’s characterized by severe, steady pain in the right upper quadrant or epigastrium that radiates to the right scapula or shoulder and intensifies over several hours. Accompanying signs and symptoms include nausea and vomiting, tachycardia, and restlessness. Occlusion of the common bile duct causes a fever, chills, jaundice, clay-colored stools, and abdominal tenderness. After consuming a fatty meal, the patient may experience vague epigastric fullness and dyspepsia.

    Cirrhosis

    With Laënnec’s cirrhosis, mild to moderate jaundice with pruritus usually signals hepatocellular necrosis or progressive hepatic insufficiency

    Common early findings include ascites, weakness, leg edema, nausea and vomiting, diarrhea or constipation, anorexia, weight loss, and right upper quadrant pain. Massive hematemesis and other bleeding tendencies may also occur. Other findings include an enlarged liver and parotid gland, clubbed fingers, Dupuytren’s contracture, mental changes, asterixis, fetor hepaticus, spider angiomas, and palmar erythema. Males may exhibit gynecomastia, scanty chest and axillary hair, and testicular atrophy; females may experience menstrual irregularities.

    With primary biliary cirrhosis,fluctuating jaundice may appear years after the onset of other signs and symptoms, such as pruritus that worsens at bedtime (commonly the first sign), weakness, fatigue, weight loss, and vague abdominal pain. Itching may lead to skin excoriation. Associated findings include hyperpigmentation; indications of malabsorption, such as nocturnal diarrhea, steatorrhea, purpura, and osteomalacia; hematemesis from esophageal varices; ascites; edema; xanthelasmas; xanthomas on the palms, soles, and elbows; and hepatomegaly.

    Dubin-Johnson syndrome

    With Dubin-Johnson syndrome, which is a rare, chronic inherited syndrome, fluctuating jaundice that increases with stress is the major sign, appearing as late as age 40

    Related findings include slight hepatic enlargement and tenderness, upper abdominal pain, nausea, and vomiting.

    Heart failure

    Jaundice due to liver dysfunction occurs in patients with severe right-sided heart failure

    Other effects include jugular vein distention, cyanosis, dependent edema of the legs and sacrum, steady weight gain, confusion, hepatomegaly, nausea and vomiting, abdominal discomfort, and anorexia due to visceral edema. Ascites are a late sign. Oliguria, marked weakness, and anxiety may also occur. If left-sided heart failure develops first, other findings may include fatigue, dyspnea, orthopnea, paroxysmal nocturnal dyspnea, tachypnea, arrhythmias, and tachycardia.

    Hepatic abscess

    Multiple abscesses may cause jaundice, but the primary effects are a persistent fever with chills and sweating

    Other findings include steady, severe pain in the right upper quadrant or midepigastrium that may be referred to the shoulder; nausea and vomiting; anorexia; hepatomegaly; an elevated right hemidiaphragm; and ascites.

    Hepatitis

    Dark urine and clay-colored stools usually develop before jaundice in the late stages of acute viral hepatitis

    Early systemic signs and symptoms vary and include fatigue, nausea, vomiting, malaise, arthralgia, myalgia, a headache, anorexia, photophobia, pharyngitis, a cough, diarrhea or constipation, and a low-grade fever associated with liver and lymph node enlargement. During the icteric phase (which subsides within 2 to 3 weeks unless complications occur), systemic signs subside, but an enlarged, palpable liver may be present along with weight loss, anorexia, and right upper quadrant pain and tenderness.

    Pancreatitis (acute)

    Edema of the head of the pancreas and obstruction of the common bile duct can cause jaundice; however, the primary symptom of acute pancreatitis is usually severe epigastric pain that commonly radiates to the back

    Lying with the knees flexed on the chest or sitting up and leaning forward brings relief. Early associated signs and symptoms include nausea, persistent vomiting, abdominal distention, and Turner’s or Cullen’s sign. Other findings include a fever, tachycardia, abdominal rigidity and tenderness, hypoactive bowel sounds, and crackles.

    Severe pancreatitis produces extreme restlessness; mottled skin; cold, diaphoretic extremities; paresthesia; and tetany — the last two being symptoms of hypocalcemia. Fulminant pancreatitis causes massive hemorrhage.

    Sickle cell anemia

    Hemolysis produces jaundice in the patient with sickle cell anemia

    Other findings include impaired growth and development, increased susceptibility to infection, life-threatening thrombotic complications and, commonly, leg ulcers, swollen (painful) joints, a fever, and chills. Bone aches and chest pain may also occur. Severe hemolysis may cause hematuria and pallor, chronic fatigue, weakness, dyspnea (or dyspnea on exertion), and tachycardia. The patient may also have splenomegaly. During a sickle cell crisis, the patient may have severe bone, abdominal, thoracic, and muscular pain; a low-grade fever; and increased weakness, jaundice, and dyspnea.

    Other causes

    Drugs

    Many drugs may cause hepatic injury and resultant jaundice

    Examples include acetaminophen, phenylbutazone, I.V. tetracycline, isoniazid, hormonal contraceptives, sulfonamides, mercaptopurine, erythromycin estolate, niacin, troleandomycin, androgenic steroids, 3-hydroxy-3-methylglutaryl reductase inhibitors, phenothiazines, ethanol, methyldopa, rifampin, and dilantin.

    Treatments

    Upper abdominal surgery may cause postoperative jaundice, which occurs secondary to hepatocellular damage from the manipulation of organs, leading to edema and obstructed bile flow; from the administration of halothane; or from prolonged surgery resulting in shock, blood loss, or blood transfusion.

    A surgical shunt used to reduce portal hypertension (such as a portacaval shunt) may also produce jaundice.

    » READ BOOK EXCERPT ONLINE »

    Source: Handbook of Signs & Symptoms (Third Edition), 2006

    Jaundice [Icterus]: Medical causes
    (Professional Guide to Signs & Symptoms (Fifth Edition))

    Agnogenic myeloid metaplasia

    This myeloproliferative disorder of the bone marrow may cause jaundice. Its typical effects, however, are associated with anemia, including fatigue, weakness, anorexia, massive splenomegaly, hepatomegaly, purpura, and bleeding tendencies.

    Carcinoma

    Cancer of the ampulla of Vater initially produces fluctuating jaundice, mild abdominal pain, recurrent fever, and chills. Occult bleeding may be its first sign. Other findings include weight loss, pruritus, and back pain.

    Hepatic cancer (primary liver cancer or another cancer that has metastasized to the liver) may cause jaundice by causing obstruction of the bile duct. Even advanced cancer causes nonspecific signs and symptoms, such as right-upper-quadrant discomfort and tenderness, nausea, weight loss, and slight fever. Examination may reveal irregular, nodular, firm hepatomegaly, ascites, peripheral edema, a bruit heard over the liver, and a right-upper-quadrant mass.

    With pancreatic cancer, progressive jaundice—possibly with pruritus—may be the only sign. Related early findings are nonspecific, such as weight loss and back or abdominal pain. Other signs and symptoms include anorexia, nausea and vomiting, fever, steatorrhea, fatigue, weakness, diarrhea, pruritus, and skin lesions (usually on the legs).

    Cholangitis

    Obstruction and infection in the common bile duct cause Charcot’s triad: jaundice, right-upper-quadrant pain, and high fever with chills.

    Cholecystitis

    This disorder produces nonobstructive jaundice in about 25% of patients. Biliary colic typically peaks abruptly, persisting for 2 to 4 hours. The pain then localizes to the right upper quadrant and becomes constant. Local inflammation or passage of stones to the common bile duct causes jaundice. Other findings include nausea, vomiting (usually indicating the presence of a stone), fever, profuse diaphoresis, chills, tenderness on palpation, a positive Murphy’s sign, and, possibly, abdominal distention and rigidity.

    Cholelithiasis

    This disorder commonly causes jaundice and biliary colic. It’s characterized by severe, steady pain in the right upper quadrant or epigastrium that radiates to the right scapula or shoulder and intensifies over several hours. Accompanying signs and symptoms include nausea and vomiting, tachycardia, and restlessness. Occlusion of the common bile duct causes fever, chills, jaundice, clay-colored stools, and abdominal tenderness. After consuming a fatty meal, the patient may experience vague epigastric fullness and dyspepsia.

    Cholestasis

    With benign, recurrent intrahepatic cholestasis, the patient experiences prolonged attacks of jaundice (sometimes spaced several years apart) accompanied by pruritus. Other signs and symptoms are similar to those of hepatitis—fatigue, nausea, weight loss, anorexia, pale stools, and right-upper-quadrant pain.

    Cirrhosis

    With Laënnec’s cirrhosis, mild to moderate jaundice with pruritus usually signals hepatocellular necrosis or progressive hepatic insufficiency. Common early findings include ascites, weakness, leg edema, nausea and vomiting, diarrhea or constipation, anorexia, weight loss, and right-upper-quadrant pain. Massive hematemesis and other bleeding tendencies may also occur. Other findings include an enlarged liver and parotid gland, clubbed fingers, Dupuytren’s contracture, mental changes, asterixis, fetor hepaticus, spider angiomas, and palmar erythema. Males may exhibit gynecomastia, scanty chest and axillary hair, and testicular atrophy; females may experience menstrual irregularities.

    With primary biliary cirrhosis, fluctuating jaundice may appear years after the onset of other signs and symptoms, such as pruritus that worsens at bedtime (commonly the first sign), weakness, fatigue, weight loss, and vague abdominal pain. Itching may lead to skin excoriation. Associated findings include hyperpigmentation; indications of malabsorption, such as nocturnal diarrhea, steatorrhea, purpura, and osteomalacia; hematemesis from esophageal varices; ascites; edema; xanthelasmas; xanthomas on the palms, soles, and elbows; and hepatomegaly.

    Dubin-Johnson syndrome

    With this rare, chronic inherited syndrome, fluctuating jaundice that increases with stress is the major sign, appearing as late as age 40. Related findings include slight hepatic enlargement and tenderness, upper abdominal pain, nausea, and vomiting.

    Glucose-6-phosphate dehydrogenase deficiency

    Acute intravascular hemolysis following ingestion of such drugs as quinine or aspirin causes jaundice, pallor, dyspnea, tachycardia, and malaise. Palpation may reveal splenomegaly and hepatomegaly.

    Heart failure

    Jaundice due to liver dysfunction occurs in patients with severe right-sided heart failure. Other effects include jugular vein distention, cyanosis, dependent edema of the legs and sacrum, steady weight gain, confusion, hepatomegaly, nausea and vomiting, abdominal discomfort, and anorexia due to visceral edema. Ascites is a late sign. Oliguria, marked weakness, and anxiety may also occur. If left-sided heart failure develops first, other findings may include fatigue, dyspnea, orthopnea, paroxysmal nocturnal dyspnea, tachypnea, arrhythmias, and tachycardia.

    Hemolytic anemia (acquired)

    This disorder may produce prominent jaundice along with dyspnea, fatigue, pallor, tachycardia, and palpitations. Rapid hemolysis causes chills, fever, irritability, headache, and abdominal pain; severe hemolysis causes signs of shock.

    Hepatic abscess

    Multiple abscesses may cause jaundice, but the primary effects are persistent fever with chills and sweating. Other findings include steady, severe pain in the right upper quadrant or midepigastrium that may be referred to the shoulder; nausea and vomiting; anorexia; hepatomegaly; elevated right hemidiaphragm; and ascites.

    Hepatitis

    Dark urine and clay-colored stools usually develop before jaundice in the late stages of acute viral hepatitis. Early systemic signs and symptoms vary and include fatigue, nausea, vomiting, malaise, arthralgias, myalgias, headache, anorexia, photophobia, pharyngitis, cough, diarrhea or constipation, and a low-grade fever associated with liver and lymph node enlargement. During the icteric phase (which subsides within 2 to 3 weeks unless complications occur), systemic signs subside, but an enlarged, palpable liver may be present along with weight loss, anorexia, and right-upper-quadrant pain and tenderness.

    Leptospirosis

    Severe leptospirosis (Weil’s disease) may cause jaundice. This disorder begins suddenly with a frontal headache, severe muscle aches in the thighs and lumbar area, cutaneous hyperesthesia, abdominal pain, nausea, conjunctival suffusion, and vomiting. Chills and a rapidly rising fever follow. Signs and symptoms of meningeal irritation include drowsiness, decreased mentation, stiff neck, and positive Kernig’s and Brudzinski’s signs. Right-upper-quadrant tenderness, hepatomegaly, and jaundice indicate hepatic involvement; proteinuria, pyuria, and hematuria indicate renal involvement. Epistaxis, hematemesis, melena, and hemoptysis may also occur.

    Pancreatitis (acute)

    Edema of the head of the pancreas and obstruction of the common bile duct can cause jaundice; however, this disorder’s primary symptom is usually severe epigastric pain that commonly radiates to the back. Lying with the knees flexed on the chest or sitting up and leaning forward brings relief. Early associated signs and symptoms include nausea, persistent vomiting, abdominal distention, and Turner’s or Cullen’s sign. Other findings include fever, tachycardia, abdominal rigidity and tenderness, hypoactive bowel sounds, and crackles.

    Severe pancreatitis produces extreme restlessness; mottled skin; cold, diaphoretic extremities; paresthesia; and tetany—the last two being symptoms of hypocalcemia. Fulminant pancreatitis causes massive hemorrhage.

    Sickle cell anemia

    Hemolysis produces jaundice in patients with this disorder. Other findings include impaired growth and development, increased susceptibility to infection, life-threatening thrombotic complications and, commonly, leg ulcers, (painful) swollen joints, fever, and chills. Bone aches and chest pain may also occur. Severe hemolysis may cause hematuria and pallor, chronic fatigue, weakness, dyspnea (or dyspnea on exertion), and tachycardia. The patient may also have splenomegaly. During a sickle cell crisis, the patient may have severe bone, abdominal, thoracic, and muscular pain; low-grade fever; and increased weakness, jaundice, and dyspnea.

    Zieve syndrome

    Caused by alcohol abuse, this relatively rare disorder produces abdominal pain and a sudden onset of severe jaundice. However, spider angiomas, ascites, and other signs of advanced liver disease are absent.

    Other causes

    Drugs

    Many drugs may cause hepatic injury and resultant jaundice. Examples include acetaminophen, I.V. tetracycline, isoniazid, hormonal contraceptives, sulfonamides, mercaptopurine, erythromycin estolate, niacin, troleandomycin, androgenic steroids, HMG-CoA reductase inhibitors, phenothiazines, ethanol, methyldopa, rifampin, and phenytoin.

    Treatments

    Upper abdominal surgery may cause postoperative jaundice, which occurs secondary to hepatocellular damage from the manipulation of organs, leading to edema and obstructed bile flow; from the administration of halothane; or from prolonged surgery resulting in shock, blood loss, or blood transfusion.

    A surgical shunt used to reduce portal hypertension (such as a portacaval shunt) may also produce jaundice.

    » READ BOOK EXCERPT ONLINE »

    Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

    Jaundice: Differential Overview
    (Field Guide to Bedside Diagnosis)

    Conjugated

    ❑ Viral hepatitis

    ❑ Gallstone obstruction

    ❑ Drugs

    ❑ Carotinemia

    ❑ Alcohol-induced hepatitis

    ❑ Cirrhosis

    ❑ Pregnancy (cholestatic)

    ❑ Postoperative

    ❑ Metastatic cancer

    ❑ Pancreatic cancer

    ❑ Ampullary carcinoma

    ❑ Hepatoma

    ❑ Sclerosing cholangitis

    ❑ Primary biliary cirrhosis

    ❑ Leptospirosis

    ❑ Hepatic vein obstruction (Budd-Chiari)

    ❑ Hemochromatosis

    Unconjugated

    ❑ Hemolysis

    ❑ Gilbert syndrome

    ❑ Sepsis

    » READ BOOK EXCERPT ONLINE »

    Source: Field Guide to Bedside Diagnosis, 2007

    Jaundice: Medical causes
    (Signs & Symptoms: A 2-in-1 Reference for Nurses)

    Carcinoma

    Cancer of the ampulla of Vater initially produces fluctuating jaundice, mild abdominal pain, recurrent fever, and chills. Occult bleeding may be its first sign. Other findings include weight loss, pruritus, and back pain.

    Hepatic cancer (primary liver cancer or metastases to the liver) may cause jaundice by causing obstruction of the bile duct. Even advanced cancer causes nonspecific signs and symptoms, such as right-upper-quadrant discomfort and tenderness, nausea, weight loss, and slight fever. Examination may reveal irregular, nodular, firm hepatomegaly, ascites, peripheral edema, a bruit heard over the liver, and a right-upper-quadrant mass.

    With pancreatic cancer, progressive jaundice — possibly with pruritus — may be the only sign. Related early findings are nonspecific, such as weight loss and back or abdominal pain. Other signs and symptoms include anorexia, nausea and vomiting, fever, steatorrhea, fatigue, weakness, diarrhea, pruritus, and skin lesions (usually on the legs).

    Cholangitis

    Obstruction and infection in the common bile duct cause Charcot’s triad: jaundice, right-upper-quadrant pain, and high fever with chills. The patient may also report pruritus. Acholic or hypocholic stools may be present.

    Cholecystitis

    Cholecystitis produces nonobstructive jaundice in about 25% of patients. Biliary colic typically peaks abruptly, persisting for 2 to 4 hours. The pain then localizes to the right upper quadrant and becomes constant. Local inflammation or passage of stones to the common bile duct causes jaundice. Other findings include nausea, vomiting (usually indicating the presence of a stone), fever, profuse diaphoresis, chills, tenderness on palpation, a positive Murphy’s sign and, possibly, abdominal distention and rigidity.

    Cholelithiasis

    Cholelithiasis commonly causes jaundice and biliary colic. It’s characterized by severe, steady pain in the right upper quadrant or epigastrium that radiates to the right scapula or shoulder and intensifies over several hours. Accompanying signs and symptoms include nausea and vomiting, tachycardia, and restlessness. Occlusion of the common bile duct causes fever, chills, jaundice, clay-colored stools, and abdominal tenderness. After consuming a fatty meal, the patient may experience vague epigastric fullness and dyspepsia.

    Cholestasis

    With benign, recurrent intrahepatic cholestasis, the patient experiences prolonged attacks of jaundice (sometimes spaced several years apart) accompanied by pruritus. Other signs and symptoms are similar to those of hepatitis — fatigue, nausea, weight loss, anorexia, pale stools, and right-upper-quadrant pain.

    Cirrhosis

    With Laënnec’s cirrhosis, mild to moderate jaundice with pruritus usually signals hepatocellular necrosis or progressive hepatic insufficiency. Common early findings include ascites, weakness, leg edema, nausea and vomiting, diarrhea or constipation, anorexia, weight loss, and right-upper-quadrant pain. Massive hematemesis and other bleeding tendencies may also occur. Other findings include an enlarged liver and parotid gland, clubbed fingers, Dupuytren’s contracture, mental changes, asterixis, fetor hepaticus, spider angiomas, and palmar erythema. Males may exhibit gynecomastia, scanty chest and axillary hair, and testicular atrophy; females may experience menstrual irregularities.

    With primary biliary cirrhosis, fluctuating jaundice may appear years after the onset of other signs and symptoms, such as pruritus that worsens at bedtime (commonly the first sign), weakness, fatigue, weight loss, and vague abdominal pain. Itching may lead to skin excoriation. Associated findings include hyperpigmentation; indications of malabsorption, such as nocturnal diarrhea, steatorrhea, purpura, and osteomalacia; hematemesis from esophageal varices; ascites; edema; xanthelasmas; xanthomas on the palms, soles, and elbows; and hepatomegaly.

    Glucose-6-phosphate dehydrogenase deficiency

    Acute intravascular hemolysis following ingestion of such drugs as quinine or aspirin causes jaundice, pallor, dyspnea, tachycardia, and malaise. Palpation may reveal splenomegaly and hepatomegaly.

    Heart failure

    Jaundice due to liver dysfunction occurs in patients with severe right-sided heart failure. Other effects include jugular vein distention, cyanosis, dependent edema of the legs and sacrum, steady weight gain, confusion, hepatomegaly, nausea and vomiting, abdominal discomfort, and anorexia due to visceral edema. Ascites is a late sign. Oliguria, marked weakness, and anxiety may also occur. If left-sided heart failure develops first, other findings may include fatigue, dyspnea, orthopnea, paroxysmal nocturnal dyspnea, tachypnea, arrhythmias, and tachycardia.

    Hemolytic anemia (acquired)

    Acquired hemolytic anemia may produce prominent jaundice along with dyspnea, fatigue, pallor, tachycardia, and palpitations. Rapid hemolysis causes chills, fever, irritability, headache, and abdominal pain; severe hemolysis causes signs of shock.

    Hepatitis

    Dark urine and clay-colored stools usually develop before jaundice in the late stages of acute viral hepatitis. Early systemic signs and symptoms vary and include fatigue, nausea, vomiting, malaise, arthralgias, myalgias, headache, anorexia, photophobia, pharyngitis, cough, diarrhea or constipation, and a low-grade fever associated with liver and lymph node enlargement. During the icteric phase (which subsides within 2 to 3 weeks unless complications occur), systemic signs subside, but an enlarged, palpable liver may be present along with weight loss, anorexia, and right-upper-quadrant pain and tenderness.

    Pancreatitis (acute)

    Pancreatitis can cause jaundice; however, this disorder’s primary symptom is usually severe epigastric pain that commonly radiates to the back. Lying with the knees flexed on the chest or sitting up and leaning forward brings relief. Early associated signs and symptoms include nausea, persistent vomiting, abdominal distention, and Turner’s or Cullen’s sign. Other findings include fever, tachycardia, abdominal rigidity and tenderness, hypoactive bowel sounds, and crackles.

    Severe pancreatitis produces extreme restlessness; mottled skin; cold, diaphoretic extremities; paresthesia; and tetany — the last two being symptoms of hypocalcemia. Fulminant pancreatitis causes massive hemorrhage.

    Sickle cell anemia

    Hemolysis produces jaundice in patients with sickle cell anemia. Other findings include impaired growth and development, increased susceptibility to infection, life-threatening thrombotic complications and, commonly, leg ulcers, swollen joints (sometimes painful), fever, and chills. Bone aches and chest pain may also occur. Severe hemolysis may cause hematuria and pallor, chronic fatigue, weakness, dyspnea (or dyspnea on exertion), and tachycardia. The patient may also have splenomegaly. During a sickle cell crisis, the patient may have severe bone, abdominal, thoracic, and muscular pain; low-grade fever; and increased weakness, jaundice, and dyspnea.

    Other causes

    Drugs

    Many drugs may cause hepatic injury and resultant jaundice. Examples include acetaminophen, phenylbutazone, I.V. tetracycline, isoniazid, hormonal contraceptives, sulfonamides, mercaptopurine, erythromycin estolate, niacin, troleandomycin, androgenic steroids, HMG-CoA reductase inhibitors, phenothiazines, ethanol, methyldopa, rifampin, and dilantin.

    Treatments

    Upper abdominal surgery may cause postoperative jaundice, which occurs secondary to hepatocellular damage from the manipulation of organs. Postoperative jaundice may lead to edema and obstructed bile flow from the administration of halothane or from prolonged surgery resulting in shock, blood loss, or blood transfusion. A surgical shunt used to reduce portal hypertension (such as a portacaval shunt) may also produce jaundice.

    » READ BOOK EXCERPT ONLINE »

    Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

    Jaundice: Principal Causes of Unconjugated Hyperbilirubinemia
    (The Diagnostic Approach to Symptoms and Signs in Pediatrics)

    1. Neonatalonset
      1. Increasedbilirubin production
        1. Physiologic
        2. Hemolytic anemia
          1. Isoimmunization
          2. Red cell enzyme defects
            1. Glucose-6-phosphatedehydrogenase deficiency
            2. Pyruvate kinase deficiency
            3. Other enzyme defects
          3. Red cell membrane defects
            1. Hereditaryspherocytosis
            2. Hereditary elliptocytosis
            3. Hereditary stomatocytosis
            4. Infantile pyknocytosis
          4. Septicemia
        3. Polycythemia
        4. Enclosed hematoma
      2. Decreased bilirubin uptake, storage,or metabolism
        1. Physiologic
        2. Hypoxia and acidosis
        3. Hypoalbuminemia
        4. Increased serum fatty acids
        5. Septicemia
        6. Drugs
        7. Hypothyroidism
        8. Lucey-Driscoll syndrome (transientfamilial neonatal hyperbilirubinemia)
        9. Crigler-Najjar syndrome (types I andII)
      3. Increased enterohepatic circulation
        1. Physiologic
        2. Breast-feeding–related jaundice
        3. Intestinal obstruction
    2. Postneonatal onset
      1. Increasedbilirubin production
        1. Hemolytic anemia
        2. Septicemia
      2. Decreased bilirubin uptake, storage,or metabolism
        1. Gilbertsyndrome
        2. Septicemia

    » READ BOOK EXCERPT ONLINE »

    Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006

    Jaundice [Icterus]: Medical causes
    (Nursing: Interpreting Signs and Symptoms)

    Carcinoma.Cancer of the ampulla of Vater initially produces fluctuating jaundice, mild abdominal pain, a recurrent fever, and chills. Occult bleeding may be its first sign. Other findings include weight loss, pruritus, and back pain.

    Hepatic cancer (primary liver cancer or another cancer that has metastasized to the liver) may cause jaundice by causing obstruction of the bile duct. Even advanced cancer causes nonspecific signs and symptoms, such as right upper quadrant discomfort and tenderness, nausea, weight loss, and a slight fever. Examination may reveal irregular, nodular, firm hepatomegaly; ascites; peripheral edema; a bruit heard over the liver; and a right upper quadrant mass.

    With pancreatic cancer, progressive jaundice—possibly with pruritus—may be the only sign. Related early findings are nonspecific, such as weight loss and back or abdominal pain. Other signs and symptoms include anorexia, nausea and vomiting, a fever, steatorrhea, fatigue, weakness, diarrhea, pruritus, and skin lesions (usually on the legs).

    Cholangitis.Obstruction and infection in the common bile duct cause Charcot's triad: jaundice, right upper quadrant pain, and a high fever with chills.

    Cholecystitis.Cholecystitis produces nonobstructive jaundice in about 25% of patients. Biliary colic typically peaks abruptly, persisting for 2 to 4 hours. The pain then localizes to the right upper quadrant and becomes constant. Local inflammation or passage of stones to the common bile duct causes jaundice. Other findings include nausea, vomiting (usually indicating the presence of a stone), a fever, profuse diaphoresis, chills, tenderness on palpation, a positive Murphy's sign and, possibly, abdominal distention and rigidity.

    Cholelithiasis.Cholelithiasis commonly causes jaundice and biliary colic. It's characterized by severe, steady pain in the right upper quadrant or epigastrium that radiates to the right scapula or shoulder and intensifies over several hours. Accompanying signs and symptoms include nausea and vomiting, tachycardia, and restlessness. Occlusion of the common bile duct causes a fever, chills, jaundice, clay-colored stools, and abdominal tenderness. After consuming a fatty meal, the patient may experience vague epigastric fullness and dyspepsia.

    Cirrhosis.With Laënnec's cirrhosis, mild to moderate jaundice with pruritus usually signals hepatocellular necrosis or progressive hepatic insufficiency. Common early findings include ascites, weakness, leg edema, nausea and vomiting, diarrhea or constipation, anorexia, weight loss, and right upper quadrant pain. Massive hematemesis and other bleeding tendencies may also occur. Other findings include an enlarged liver and parotid gland, clubbed fingers, Dupuytren's contracture, mental changes, asterixis, fetor hepaticus, spider angiomas, and palmar erythema. Males may exhibit gynecomastia, scanty chest and axillary hair, and testicular atrophy; females may experience menstrual irregularities.

    With primary biliary cirrhosis, fluctuating jaundice may appear years after the onset of other signs and symptoms, such as pruritus that worsens at bedtime (commonly the first sign), weakness, fatigue, weight loss, and vague abdominal pain. Itching may lead to skin excoriation. Associated findings include hyperpigmentation; indications of malabsorption, such as nocturnal diarrhea, steatorrhea, purpura, and osteomalacia; hematemesis from esophageal varices; ascites; edema; xanthelasmas; xanthomas on the palms, soles, and elbows; and hepatomegaly.

    Dubin-Johnson syndrome.With Dubin-Johnson syndrome, which is a rare, chronic inherited syndrome, fluctuating jaundice that increases with stress is the major sign, appearing as late as age 40. Related findings include slight hepatic enlargement and tenderness, upper abdominal pain, nausea, and vomiting.

    Heart failure.Jaundice due to liver dysfunction occurs in patients with severe right-sided heart failure. Other effects include jugular vein distention, cyanosis, dependent edema of the legs and sacrum, steady weight gain, confusion, hepatomegaly, nausea and vomiting, abdominal discomfort, and anorexia due to visceral edema. Ascites is a late sign. Oliguria, marked weakness, and anxiety may also occur. If left-sided heart failure develops first, other findings may include fatigue, dyspnea, orthopnea, paroxysmal nocturnal dyspnea, tachypnea, arrhythmias, and tachycardia.

    Hepatic abscess.Multiple liver abscesses may cause jaundice, but the primary effects are a persistent fever with chills and sweating. Other findings include steady, severe pain in the right upper quadrant or midepigastrium that may be referred to the shoulder; nausea and vomiting; anorexia; hepatomegaly; an elevated right hemidiaphragm; and ascites.

    Hepatitis.Dark urine and clay-colored stools usually develop before jaundice in the late stages of acute viral hepatitis. Early systemic signs and symptoms vary and include fatigue, nausea, vomiting, malaise, arthralgia, myalgia, a headache, anorexia, photophobia, pharyngitis, a cough, diarrhea or constipation, and a low-grade fever associated with liver and lymph node enlargement. During the icteric phase (which subsides within 2 to 3 weeks unless complications occur), systemic signs subside, but an enlarged, palpable liver may be present along with weight loss, anorexia, and right upper quadrant pain and tenderness.

    Pancreatitis (acute).Edema of the head of the pancreas and obstruction of the common bile duct can cause jaundice; however, the primary symptom of acute pancreatitis is severe epigastric pain that commonly radiates to the back. Lying with the knees flexed on the chest or sitting up and leaning forward brings relief. Early associated signs and symptoms include nausea, persistent vomiting, abdominal distention, and Turner's or Cullen's sign. Other findings include a fever, tachycardia, abdominal rigidity and tenderness, hypoactive bowel sounds, and crackles.

    Severe pancreatitis produces extreme restlessness; mottled skin; cold, dia-phoretic extremities; paresthesia; and tetany—the last two being symptoms of hypocalcemia. Fulminant pancreatitis causes massive hemorrhage.

    Sickle cell anemia.Hemolysis produces jaundice in the patient with sickle cell anemia. Other findings include impaired growth and development, increased susceptibility to infection, life-threatening thrombotic complications and, commonly, leg ulcers, swollen (painful) joints, a fever, and chills. Bone aches and chest pain may also occur. Severe hemolysis may cause hematuria and pallor, chronic fatigue, weakness, dyspnea (or dyspnea on exertion), and tachycardia. The patient may also have splenomegaly. During a sickle cell crisis, the patient may have severe bone, abdominal, thoracic, and muscular pain; a low-grade fever; and increased weakness, jaundice, and dyspnea.

    Other causes

    Drugs.Many drugs may cause hepatic injury and resultant jaundice. Examples include acetaminophen, phenylbutazone, I.V. tetracycline, isoniazid, hormonal contraceptives, sulfonamides, mercaptopurine, erythromycin estolate, niacin, troleandomycin, androgenic steroids, 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, phenothiazines, ethanol, methyldopa, rifampin, and dilantin.

    Treatments.Upper abdominal surgery may cause postoperative jaundice, which occurs secondary to hepatocellular damage from the manipulation of organs, leading to edema and obstructed bile flow; from the administration of halothane; or from prolonged surgery resulting in shock, blood loss, or blood transfusion.

    A surgical shunt used to reduce portal hypertension (such as a portacaval shunt) may also produce jaundice.

    » READ BOOK EXCERPT ONLINE »

    Source: Nursing: Interpreting Signs and Symptoms, 2007

    Jaundice - Case 15-3: 2-Month-Old Boy: I. Differential Diagnosis
    (Pediatric Complaints and Diagnostic Dilemmas)

    The susceptibility of neonates to unconjugated hyperbilirubinemia is favored by a number of factors, including relative increases in bilirubin production and enterohepatic circulation along with relative decreases in hepatic uptake and conjugation. Unconjugated hyperbilirubinemia is a very common occurrence in the newly born and is usually self-limited and benign. However, if the serum concentration of bilirubin exceeds 17 mg/dL, the jaundice can no longer be regarded as physiologic.
    Given this predisposition of newborns to an imbalance between bilirubin generation and hepatic excretory capacity, pathologic or prolonged neonatal hyperbilirubinemia is often attributable to conditions that exacerbate the imbalance. For instance, hemolytic diseases (e.g., ABO incompatibility), polycythemia, and extravascular blood collections (e.g., cephalohematoma, subgaleal blood, ecchymoses) are conditions that favor increased bilirubin production. Decreased bilirubin clearance can result from inherited bilirubin metabolism disorders (e.g., Crigler-Najjar syndrome, Gilbert disease), hypothyroidism, and circumstances that increase enterohepatic reuptake (e.g., breast-feeding, delayed meconium passage). As for older children, Gilbert syndrome (a genetic disorder of the uridine diphosphoglucuronate glucuronosyltransferase enzyme system that occurs in about 6% of adults) and hemolytic anemias are the most common causes of unconjugated bilirubinemia.

    » READ BOOK EXCERPT ONLINE »

    Source: Pediatric Complaints and Diagnostic Dilemmas, 2003

    Jaundice - Case 15-4: 6-Week-Old Girl: I. Differential Diagnosis
    (Pediatric Complaints and Diagnostic Dilemmas)

    The differential diagnosis for cholestatic jaundice in the infant is quite broad, and many excellent and detailed reviews exist. General categories of disease entities to be considered include infections, such as hepatitis viruses, TORCH infections, and serious bacterial infections; idiopathic neonatal hepatitis; a long list of metabolic and endocrine diseases, including galactosemia, α1-antitrypsin deficiency, cystic fibrosis, hypothyroidism, hypopituitarism, and bile acid synthesis defects; genetic cholestatic syndromes, such as Byler disease; obstructions to bile flow, including biliary atresia, Alagille syndrome, choledochal cysts, and cholelithiasis; and iatrogenic causes, such as drug-induced cholestasis or cholestasis related to total parenteral nutrition.

    » READ BOOK EXCERPT ONLINE »

    Source: Pediatric Complaints and Diagnostic Dilemmas, 2003

    Jaundice - Case 15-6: 5-Week-Old Girl: I. Differential Diagnosis
    (Pediatric Complaints and Diagnostic Dilemmas)

    This infant presented with the following signs: a nonobstructive conjugated hyperbilirubinemia; renal insufficiency with a mild, non –anion gap metabolic acidosis; poor weight gain; and a heart murmur. Her liver biopsy revealed cholestasis and bile duct paucity.
    Interlobular bile duct paucity is the characteristic, but not unvarying, pathologic finding in Alagille syndrome; biopsies performed early in the disease 's course might simply reveal findings of cholestasis, inflammation, or even ductal proliferation. In addition, bile duct paucity is sometimes seen in diseases other than Alagille syndrome. So-called nonsyndromic bile duct paucity can be a feature of congenital infections (e.g., CMV, rubella, syphilis), metabolic disorders (e.g., α 1-antitrypsin deficiency, defects of bile acid synthesis), sclerosing cholangitis, and idiopathic cholestasis.

    » READ BOOK EXCERPT ONLINE »

    Source: Pediatric Complaints and Diagnostic Dilemmas, 2003

    Jaundice: Jaundice - etiology
    (The 5-Minute Pediatric Consult)

    The most common causes of pathologic jaundice:

    • Newborn period: Biliary atresia, idiopathic neonatal hepatitis, α1-antitrypsin deficiency, infection
    • Older child: Autoimmune hepatitis, viral hepatitis, Wilson disease, biliary obstruction

    » READ BOOK EXCERPT ONLINE »

    Source: The 5-Minute Pediatric Consult, 2008


     » Next page: Risk Factors for Jaundice

    Rate This Website

    What do you think about the features of this website? Take our user survey and have your say:

    Website User Survey

    Medical Tools & Articles:

    Next articles:

    Tools & Services:

    Medical Articles:

    Forums & Message Boards
     
    HONcode We subscribe to the HONcode principles

    By using this site you agree to our Terms of Use. Information provided on this site is for informational purposes only; it is not intended as a substitute for advice from your own medical team. The information on this site is not to be used for diagnosing or treating any health concerns you may have - please contact your physician or health care professional for all your medical needs. Please see our Terms of Use.

    Home | Symptoms | Diseases | Diagnosis | Videos | Tools | Forum | About Us | Terms of Use | Privacy Policy | Site Map | Advertise

    Copyright © 2010 Health Grades Inc. All rights reserved.