Makindo Medical Notes

🌟 Jaundice = yellow discolouration of skin, sclera, and mucous membranes due to bilirubin deposition. 👉 Becomes clinically visible when serum bilirubin > 40 µmol/L. 🔎 Always classify by level of pathology: Pre-hepatic (before liver), Hepatic (within liver), Post-hepatic (after liver).

🟥 Pre-Hepatic (Haemolytic) Jaundice

• ⚡ Causes: Increased RBC breakdown → haemolytic anaemia, sickle cell disease, thalassaemia, malaria, autoimmune haemolysis.
• 🩸 Features: Anaemia, pallor, dark urine (urobilinogen ↑), splenomegaly. No pale stools.
• 🔬 Investigations: FBC + reticulocytes (↑), blood smear, LDH ↑, haptoglobin ↓, unconjugated bilirubin ↑, Coombs test if autoimmune.
• 💊 Treatment: Cause-specific (transfusions, folate, hydroxyurea in SCD, splenectomy if severe haemolysis).

🟨 Hepatic (Hepatocellular) Jaundice

• ⚡ Causes: Viral hepatitis (A–E), alcoholic liver disease, NAFLD/NASH, cirrhosis, autoimmune hepatitis, hepatocellular carcinoma.
• 😴 Features: Malaise, anorexia, nausea, dark urine, pale stools, tender hepatomegaly, stigmata of chronic liver disease.
• 🔬 Investigations: LFTs (AST/ALT ↑ > ALP), viral serology, autoimmune screen, ultrasound/CT/MRI, ± liver biopsy.
• 💊 Treatment: Antivirals (HBV, HCV), alcohol cessation, nutrition, transplant if decompensated liver failure.

🟩 Post-Hepatic (Obstructive/Cholestatic) Jaundice

• ⚡ Causes: Gallstones, biliary strictures, pancreatic cancer, cholangiocarcinoma, PSC/PBC.
• 🤢 Features: Dark urine, pale stools, pruritus (bile salts), RUQ/epigastric pain, Courvoisier’s sign (palpable gallbladder in pancreatic cancer).
• 🔬 Investigations: LFTs (ALP & GGT ↑ > ALT), ultrasound (first-line), MRCP/ERCP, CT pancreas if malignancy suspected.
• 💊 Treatment: ERCP ± stenting/stone removal, cholecystectomy, oncological management (Whipple procedure in pancreatic cancer).

🧬 Inherited Jaundice

• ⚡ Conditions: Gilbert’s syndrome (benign, common), Crigler–Najjar syndrome, Dubin–Johnson syndrome.
• 🙂 Features: Intermittent mild jaundice (Gilbert’s) triggered by stress/fasting; usually incidental finding.
• 🔬 Investigations: Bilirubin (unconjugated ↑), normal LFTs, genetic tests if unclear.
• 💊 Treatment: Gilbert’s = reassurance. Crigler–Najjar may need phototherapy, liver transplant if severe.

💊 Drug-Induced Jaundice

• ⚡ Causes: Hepatotoxic drugs (paracetamol overdose, isoniazid, statins, amiodarone, antibiotics like flucloxacillin).
• 🤢 Features: Jaundice, nausea, fatigue, ± hepatitis features (RUQ tenderness, hepatomegaly).
• 🔬 Investigations: LFTs (mixed hepatocellular/cholestatic), careful drug history, ± biopsy if diagnostic uncertainty.
• 💊 Treatment: Stop drug, supportive care, antidotes where available (e.g. N-acetylcysteine for paracetamol).

👶 Neonatal Jaundice

• ⚡ Causes: Physiological (common, 1st week) or pathological (Rh/ABO incompatibility, sepsis, G6PD deficiency, breast milk jaundice).
• 🙂 Features: Yellow skin/sclera, usually within 1st week. Kernicterus risk if bilirubin very high.
• 🔬 Investigations: Serum bilirubin, Coombs test, G6PD assay, blood type/crossmatch.
• 💊 Treatment: Phototherapy, exchange transfusion if severe, treat underlying cause, ensure hydration and feeding support.

📊 Patterns of Jaundice – Quick Comparison

💡 Clinical Pearls

• 🌟 Gilbert’s syndrome is very common — mild intermittent jaundice with normal LFTs.
• 🟩 Post-hepatic jaundice + painless mass + palpable gallbladder = think pancreatic head cancer.
• ⚡ Always distinguish conjugated vs unconjugated bilirubin in workup.
• 👶 In neonates, prolonged jaundice (>14 days) = always pathological → investigate.
• 🧪 First-line imaging for obstructive jaundice = ultrasound (look for dilated ducts, gallstones, masses).