Jaundice natural history, complications, and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fatima Shaukat, MD [2]

Natural history of jaundice varies greatly and symptoms can manifest at any age of life depending on the underlying cause. The type and the severity of complications depends on the underlying cause leading to jaundice. Certain individuals may not suffer any long-term complications and recovers fully, while for others the appearance of jaundice may be the first indication of a life-threatening situation.

• Jaundice may develop as early as neonatal period to any decade of life depending on the underlying cause, and presents as yellowish discoloration of skin and sclera.^[1]
• Typically, jaundice is not evident clinically until serum bilirubin level reaches 2.5 mg/dL. It is first seen in the conjunctiva or oral mucous membranes such as the hard palate or under the tongue. As the serum concentration of bilirubin rises, jaundice proceeds cephalo-caudally.
• Jaundice appearing over a few days to couple of week implies an acute course (hepatitis, whether drug or toxin induced, viral or bacterial i.e., leptospirosis).^[2]
• Jaundice appearing over the course of few weeks points towards a subacute hepatitis or extrahepatic obstruction (malignancy, gallstone, chronic pancreatitis, or stricture in the common bile duct).
• Jaundice of fluctuating intensity implicates gallstones, ampullary carcinoma, or possible drug hepatitis.^[3][4]
• If left untreated, approximately 2 out of 100,000 patients in USA with jaundice may progress to develop acute liver failure leading to heptocyte dysfunction, which imanifests as sudden onset of encephalopathy and coagulopathy in a healthy person with no known underlying liver disease.^[5]

Common complications of jaundice include:^[6]

• Electrolyte abnormalities
• Anemia
• Infection/sepsis
• Chronic hepatitis
• Cancer
• Liver failure
  • Bleeding and coagulopathy
  • Hepatic encephalopathy (brain dysfunction)
  • Death
• Kidney failure

• The prognosis for individuals with jaundice varies with the underlying cause of the condition.
• There are certain conditions that has the most favorable prognosis leading to full recovery.
• However, more serious causes of jaundice like acute suppurative cholangitis or fulminant hepatic failure can sometimes be fatal despite medical or surgical intervention. The mortality can be as high as 80% .^[7]
• The development and severity of complications as well as patient’s underlying health and comorbidities have a huge impact on the prognosis of patients.

Template:WH Template:WS