Internal Medicine (Practical) · MU Sofia

30. Jaundice

Covers the definition of jaundice as yellow discolouration from raised bilirubin, then sorts its causes into pre-hepatic, hepatic and post-hepatic groups. A summary table compares the three types, and a second table sets out the expected laboratory pattern for each. The note also lists clinical symptoms, physical examination signs such as Courvoisier's and Murphy's signs, imaging options from ultrasound to ERCP, and the signs specific to obstructive jaundice.

Inside: 9 sections · 5 labelled pictures · 2 tables · 15 flashcards · 2 min

Topic 29 of 30 in the MU Sofia syllabus for Internal Medicine (Practical) (Medicine, Year 3). The free AceMed note covers it in 9 sections, about 234 words (2 min of reading), with 15 flashcards.

In this note

  1. 30 – Jaundice
  2. I. Definition
  3. II. Types of Jaundice
  4. III. Causes of Jaundice (With Classification)
  5. IV. Clinical Symptoms of Jaundice
  6. V. Physical Examination Findings
  7. VI. Laboratory Diagnosis of Jaundice
  8. VII. Imaging Methods
  9. VIII. Special Signs in Obstructive Jaundice

I. Definition

Jaundice (Icterus) is a yellowish discoloration of the skin, sclerae, and mucous membranes due to elevated levels of bilirubin in the blood, usually above 2–2.5 mg/dL.

III. Causes of Jaundice (With Classification)

➤ A. Pre-hepatic Causes (Unconjugated hyperbilirubinemia)

  • Hemolytic anemia (hereditary spherocytosis, G6PD def.)
  • Ineffective erythropoiesis (thalassemia, megaloblastic anemia)
  • Transfusion reactions
  • Malaria, autoimmune hemolysis

➤ B. Hepatic Causes (Mixed or conjugated)

  • Infectious: Viral hepatitis (A, B, C), leptospirosis
  • Toxic: Alcohol, paracetamol, isoniazid, amanita mushroom
  • Metabolic/genetic: Wilson’s disease, hemochromatosis, Gilbert’s, Crigler-Najjar
  • Autoimmune: Autoimmune hepatitis

➤ C. Post-hepatic Causes (Conjugated hyperbilirubinemia)

  • Intraluminal: Gallstones in CBD
  • Mural: Cholangiocarcinoma, sclerosing cholangitis
  • Extramural: Pancreatic cancer, head of pancreas mass, lymph node compression

IV. Clinical Symptoms of Jaundice

  • Yellow skin and sclerae
  • Dark-colored urine (due to conjugated bilirubin)
  • Pale (clay-colored) stool (in obstructive)
  • General symptoms: Fatigue, pruritus, nausea
  • Pain:
  • RUQ pain in hepatitis, gallstones
  • Painless in pancreatic cancer
  • Hepatomegaly, splenomegaly
  • Fever with chills → cholangitis

V. Physical Examination Findings

  • Scleral icterus (most sensitive early sign)
  • Scratch marks (due to pruritus)
  • Liver span measurement (enlarged, tender in hepatitis)
  • Murphy's sign → cholecystitis
  • Courvoisier’s sign (palpable gallbladder + painless jaundice → suspect malignancy)
  • Asterixis (hepatic encephalopathy in severe liver disease)
  • Ascites, spider nevi, palmar erythema in chronic liver disease

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