Jaundice is clinically detectable when plasma bilirubin (BR) is 40μmol/L (2.5mg/dl)
Pre-hepatic Jaundice
- Hemolysis
- Congenital hyperbilirubinemia – Gilbert’s syn is MC (Fig 1)
Hepatocellular Jaundice
- Results from inability of liver to transport BR into bile
- Due to parenchymal disease
- ↑concentration of both conjugated and unconjugated BR
- Can be due to acute or chronic liver injury (Fig 2)
- ↑AST + ALT, GGT/ALP normal
Obstructive (cholestatic) jaundice
- Can be caused by
- Failure of hepatocytes to initiate bile flow
- Obstruction of bile ducts/portal tracts
- Obstruction of bile flow in extra-hepatic bile ducts
- Without tx, jaundice becomes progressively severe
- CBR is unable to enter bile canaliculi and passes back into the blood
- Causes – (Fig 3)
- Obstruction of bile duct drainage due to blockage of extrahepatic biliary tree – associated with pale stools, dark urine
- ↑ALP + GGT
