Jaundice: Investigations & Treatment

JaundiceWhat is Jaundice

Yellowish discoloration of body mainly sclera of eye is jaundice and generally indicate liver disease. It occur due to accumulation of bilirubin pigment in the body. Bilirubin pigment is formed after destruction of old red blood cells in the body and after that it is secreted through bile in to stool. Hyperbilirubinemia occur either due to excessive production because of excessive hemolysis. It also occur if there is obstruction in the passage of bilirubin pigment through liver in to small intestine

Blood Investigations

Liver Function Test: Most common blood investigation done in jaundice patient. Bilirubin is raised. In case of obstructive jaundice conjugated part of bilirubin is raised while in hemolysis or other medical cause such as hepatitis  unconjugated bilirubin is raised. If the cause is hepatitis then enzymes SGOT/SGPT are also raised. Serum alkaline phosphate is marker for obstructive jaundice
Most common cause of hepatitis are alcoholic hepatitis, Viral hepatitis and steatohepatitis. Most common viral infections are Hepatitis A, E, B and C infection. Blood test for the presence of these infections should be done in case of acute hepatitis
Complete Blood Count: Total Leucocyte counts is raised in patient with cholangitis. Renal function tests should also be done as these patients have dehydration and low blood pressure and RFT can be deranged

Radiological Investigations

USG Abdomen: The most common first investigation done is Ultrasound abdomen. The dilatation of biliary channels on ultrasound suggest biliary tract obstruction. The level of bile duct dilatations indicate the site of obstruction. CBD stones or mass can be visualized on ultrasound as cause of obstruction
MRI/MRCP: It is more helpful to delineate biliary anatomy before any intervention. There are guidelines which recommend EUS in these patients before ERCP


Gastroenterologist are Liver Specialist and should be consulted first when there is jaundice, as the commonest cause is medical jaundice

Jaundice: Should I Consult Physician or Surgeon?

 Jaundice occur when there is excess biliary pigments in our blood; Bile is produced in the liver and through the bile duct it reaches to duodenum where its main function is fat digestion, The cause of jaundice is Surgical or Obstructive when there is obstruction in the bile duct and bile does not reach up to duodenum and get accumulated in our blood; It can be due to external compression of bile ducts or internal obstruction due to stone, cancer or stricture

Clinically patient has itching and pale colored stools in obstructive jaundice; Blood tests show high direct bilirubin level and increased alkaline phosphatase levels; Dilated biliary channels on ultrasound confirm obstruction as cause of jaundice and also show site and cause of obstruction; MRI and Endoscopic Ultrasound are done when in doubt

Treatment depends on the cause of obstruction, Most common cause is CBD stone and the treatment of choice is ERCP and stone removal


Leave a Reply

Your email address will not be published.