Jaundice

Causes of Jaundice

Medical

• Haemolysis
  Examples of haemolysis include sickle cell disease, spherocytosis, thalassaemia, where the pathological breakdown of red blood cells results in excessive bilirubin production.
• Hepatitis: Acute and Chronic
  Acute hepatocellular inflammation can be due to a variety of causes, the most common etiology is due to virus. Majority of acute inflammation is self limiting without long term sequelae. Some form of hepatitis such as hepatitis B and C, can lead to chronic carrier state, which may maintain normal liver function or progress to chronic liver disease or liver cirrhosis. Other common causes of acute hepatitis are drugs and alcohol abuse.
• Drug induced liver damage
  A wide spectrum of drugs may cause liver damage. Usually they are dose dependent or due to prolonged therapy and most are reversible once the insulting medication is discontinued. Examples are paracetamol, anabolic steroids, isoniazid and cytotoxic medication such as methotrexate. However, some may progress to hepatic fibrosis or fulminant liver failure.
• Liver failure: Acute and Chronic
  Acute liver failure denotes massive hepatocellular necrosis in a previously normal liver resulting in altered mentation and coagulopathy. It carries high mortality. Chronic liver failure arises from a background of liver cirrhosis and is associated with portal hypertension, ascites, splenomegaly and gastrooesophageal varices.
• Cirrhosis
  A chronic disease of the liver marked by degeneration of cells, inflammation and fibrous thickening of tissue. Liver cirrhosis can be categorized according to its aetiology, such as posthepatitic (after hepatitis B or C), alcoholic and primary biliary cirrhosis, and cryptogenic if the cause is unknown.

Surgical (Cholestatic or Obstructive)

• Ductal stones
  This is the most common cause of obstructive jaundice. Most of the ductal stones are secondary to stone migration from gall bladder. Primary ductal stones are less common and are usually associated with bile duct/ sphincter complex dysfunction.
• Pancreatic or biliary malignancy
  Head of pancreas cancer, periampullary tumour and cholangiocarcinoma of the bile duct can cause biliary obstruction. Patients usually present with progressive worsening of painless jaundice or severe jaundice with or without constitutional symptoms. Some may present with sepsis due to ascending cholangitis. Patient with periampullary tumour may be associated with anaemia or upper gastrointestinal bleeding.
• Benign bile duct stricture
  Most of the benign bile duct strictures are due to bile duct injury during cholecystectomy or rarely instrumentational injury such as during endoscopic retrograde cholangiopancreatography. Bile duct stricture can also arise from chronic pancreatitis and sclerosing cholangitis.
• External compression of bile duct
  By tumour masses arises from liver, gallbladder, retroperitoneum or lymph nodes
• Parasitic infestations
  In addition to malignant bile duct obstruction due to biliary or pancreatic cancer, jaundice may also occur in association with extensive liver malignancy, either primary or secondary.