Day #46 - Jaundice

Today we discussed a patient with jaundice and the approach to a patient with jaundice. One can think of the causes of jaundice by looking anatomically:

Obstructive causes:

• Pancreatic mass -- i.e. cancer of the head of the pancreas
• Mass at the porta hepatis -- i.e. lymph nodes
• Obstructing stone in the biliary tree
• Biliary duct pathology -- primary biliary cirrhosis, primary sclerosis cholangitis, cholangiocarcinoma, HIV cholangiopathy
• Parasitic -- Clonorchis sinensis, Fasciola hepatica, Schistosomiasis
  

Intrahepatic causes

• Viral hepatitis
• ETOH/toxin hepatitis
• Non-alcoholic steatohepatitis
  
• Paraneoplastic (Stauffer's syndrome -- RCC)
• Infiltration by tumor -- HCC, mets, lymphoma
  
• Infiltrating Infection -- E.g. TB
• Drugs -- e.g. beta-lactams, ethinyl estradiol, jamaican bush tea
• Sepsis
• Cirrhosis
• Cholestasis of Pregnancy
  

Non-obstructive causes:

• Hemolysis
• Resorption of a large hematoma
  
• Drug effects on conjugation -- e.g. atazanavir
• Genetic deficiencies of bilirubin metabolism -- Gilbert's syndrome, Crigler-Najjar syndrome