Jaundice classification

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

Overview

Jaundice is classified in two categories including unconjugated hyperbilirubinemia and conjugated hyperbilirubinema. Unconjugated hypebilirubinemia can be caused by either increased production, reduced reuptake or defects in conjugation of bilirubin. While conjugated hyperbilirubinemia is further classified into obstruction of biliary tract, interahepatic cholestasis, injury to hepatocellular parenchyma, and defects of hepatocellular canalicular excretion or re-uptake in sinusoids.

Classification

Jaundice is classified into two subtypes:^[1]^[2]^[3]^[4]

Conjugated hyperbilirubinemia
Unconjugated hyperbilirubinemia

Jaundice classification

Predominately conjugated hyperbilirubenemia

Mixed conjugated and unconjugated hyperbilirubinemia

Predominately unconjugated hyperbilirubinemia

Obstruction of biliary tract

Intra-hepatic cholestasis

Injury to hepatocellular parenchyma

Defects of hepatocellular
canalicular excretion or re-uptake
in sinusoids

Increased production

Reduced uptake

Defects in conjugation

Acquired

Inherited

• Cholangiocarcinoma
• Pancreatic cancer
• Gallbladder cancer
• Ampullary cancer
• Choledocholithiasis
• Choledocholithiasis
•Postoperative biliary strictures
•Primary sclerosing cholangitis
• Chronic pancreatitis
• AIDS cholangiopathy
• Parasitic disease ascariasis

• Primary biliary cholangitis
•Primary sclerosing cholangitis
• Viral hepatitis (ocassionally)
• Progressive familial intrahepatic cholestasis
• Intrahepatic Cholestasis of Pregnancy
•Corticosteroids

Infiltrative liver disorders like
• Hemochromatosis
•Amyloidosis

• Dubin-Johnson syndrome
• Rotor syndrome

• Wilson’s disease
•Viral hepatitis
•Alcoholic hepatitis
• Drug toxicity
• Autoimmune hepatitis

• Hemolysis
• Hereditary spherocytosis
• G6PD deficiency
• Thalassemia
• Paroxysmal nocturnal hemoglobinuria
• Immune hemolysis
• Extravasation
• Shunt hyperbilirubinemia

• Portosystemic shunts
• Drugs
• Gilbert syndrome (some cases)

• Neonatal
• Maternal milk
• Lucy-Driscoll
•Hyperthyroidism
• Chronic persitent hepatitis
• Advanced cirrhosis

• Crigler-Najjar syndrome l
• Crigler-Najjar syndrome II
• Gilbert syndrome

References

↑ VanWagner LB, Green RM (2015). “Evaluating elevated bilirubin levels in asymptomatic adults”. JAMA. 313 (5): 516–7. doi:10.1001/jama.2014.12835. PMC 4424929. PMID 25647209.
↑ Gadia CLB, Manirakiza A, Tekpa G, Konamna X, Vickos U, Nakoune E (2017). “Identification of pathogens for differential diagnosis of fever with jaundice in the Central African Republic: a retrospective assessment, 2008-2010”. BMC Infect Dis. 17 (1): 735. doi:10.1186/s12879-017-2840-8. PMC 5707826. PMID 29187150.
↑ Kremer M (1940). “The Classification of Jaundice: With details of some of the causes of this condition”. Postgrad Med J. 16 (171): 11–7. PMC 2476810. PMID 21313179.
↑ Kasper, Dennis (2015). Harrison’s principles of internal medicine. New York: McGraw Hill Education. ISBN 978-0-07-180215-4.

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[pmid256472092-1] VanWagner LB, Green RM (2015). “Evaluating elevated bilirubin levels in asymptomatic adults”. JAMA. 313 (5): 516–7. doi:10.1001/jama.2014.12835. PMC 4424929. PMID 25647209.

[pmid29187150-2] Gadia CLB, Manirakiza A, Tekpa G, Konamna X, Vickos U, Nakoune E (2017). “Identification of pathogens for differential diagnosis of fever with jaundice in the Central African Republic: a retrospective assessment, 2008-2010”. BMC Infect Dis. 17 (1): 735. doi:10.1186/s12879-017-2840-8. PMC 5707826. PMID 29187150.

[pmid21313179-3] Kremer M (1940). “The Classification of Jaundice: With details of some of the causes of this condition”. Postgrad Med J. 16 (171): 11–7. PMC 2476810. PMID 21313179.

[4] Kasper, Dennis (2015). Harrison’s principles of internal medicine. New York: McGraw Hill Education. ISBN 978-0-07-180215-4.

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Jaundice classification

Overview

Classification

References

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