Jaundice in adults

Jaundice in adults is characterized by yellowing of the skin and eyes due to elevated bilirubin levels. It can result from various underlying conditions, which are broadly categorized into three main types: pre-hepatic, hepatic, and post-hepatic causes.

1. Pre-Hepatic Causes (Excessive Bilirubin Production)

• Hemolytic Anemia: Increased breakdown of red blood cells (RBCs) leads to excess bilirubin production. Causes include:
  • Autoimmune disorders
  • Sickle cell anemia
  • Thalassemia
  • G6PD deficiency
• Ineffective Erythropoiesis: Conditions like megaloblastic anemia.
• Blood Transfusion Reactions: Hemolysis due to incompatible blood.
• Infections: Malaria or other infections causing RBC destruction.

2. Hepatic Causes (Liver Dysfunction)

• Hepatitis: Inflammation of the liver due to:
  • Viral hepatitis (A, B, C, D, E)
  • Alcoholic hepatitis
  • Autoimmune hepatitis
• Cirrhosis: Chronic liver damage from alcohol, hepatitis, or fatty liver disease.
• Liver Toxins: Drug-induced liver injury (e.g., acetaminophen, antibiotics, statins).
• Non-Alcoholic Fatty Liver Disease (NAFLD): Fat accumulation in the liver.
• Genetic Disorders:
  • Gilbert’s syndrome (mild, benign condition)
  • Wilson’s disease (copper accumulation)
  • Hemochromatosis (iron overload)
• Liver Cancer: Hepatocellular carcinoma or metastatic cancer.

3. Post-Hepatic Causes (Biliary Obstruction)

• Gallstones: Blockage of the bile ducts.
• Pancreatic Cancer: Tumors compressing the bile duct.
• Biliary Strictures: Narrowing of the bile ducts due to inflammation or surgery.
• Cholangiocarcinoma: Cancer of the bile ducts.
• Pancreatitis: Inflammation of the pancreas causing bile duct obstruction.
• Primary Biliary Cholangitis (PBC): Autoimmune destruction of bile ducts.
• Primary Sclerosing Cholangitis (PSC): Chronic inflammation and scarring of bile ducts.

Other Causes:

• Sepsis: Systemic infection affecting liver function.
• Congestive Heart Failure: Reduced liver perfusion leading to dysfunction.
• Pregnancy-Related Conditions: Intrahepatic cholestasis of pregnancy or HELLP syndrome.

Diagnostic Approach:

• History and Physical Exam: Assess for risk factors (alcohol, medications, travel, family history).
• Lab Tests: Liver function tests (ALT, AST, ALP, bilirubin), hepatitis serology, and hemolysis markers.
• Imaging: Ultrasound, CT, or MRI to evaluate liver and bile ducts.
• Liver Biopsy: If the cause remains unclear.

Treatment depends on the underlying cause, ranging from managing infections to surgical intervention for obstructions. Early diagnosis is crucial to prevent complications.