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Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.

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Jaundice classification scheme

Introduction

Overview

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

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

References

  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.
  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.
  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.

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