Background: Jaundice is a common clinical finding in clinical practice of hepatologists and general practitioners. It occurs when serum bilirubin levels exceed 3 mg/dL. Summary: In this review, we summarize the pathophysiological mechanism of jaundice, clinical approach to the patient with jaundice, and laboratory and imaging techniques. Clinical presentation of jaundice manifests through yellow skin and sclera coloration. Evaluation of every patient includes detailed medical history and examination. In the laboratory, evaluation of enzymes of hepatic inflammation as well as cholestatic enzymes with serum bilirubin must be included. Additional laboratory analysis and imaging modalities are needed in order to differentiate jaundice etiology. Moreover, imaging is available and needed in further evaluation, and treatment is dependent on the underlying cause. Key Messages: In this review, we will outline the pathophysiological mechanism of jaundice, clinical approach to the patient with jaundice, and diagnostic and treatment approach to these patients.

1.
Seifert
B
,
Rubin
G
,
de Wit
N
,
Lionis
C
,
Hall
N
,
Hungin
P
,
The management of common gastrointestinal disorders in general practice A survey by the European Society for Primary Care Gastroenterology (ESPCG) in six European countries
.
Dig Liver Dis
.
2008 Aug
;
40
(
8
):
659
66
. .
2.
Roche
SP
,
Kobos
R
.
Jaundice in the adult patient
.
Am Fam Physician
.
2004 Jan
;
69
(
2
):
299
304
.
3.
Porter
ML
,
Dennis
BL
.
Hyperbilirubinemia in the term newborn
.
Am Fam Physician
.
2002 Feb
;
65
(
4
):
599
.
4.
Purohit
T
,
Cappell
MS
.
Primary biliary cirrhosis: pathophysiology, clinical presentation and therapy
.
World J Hepatol
.
2015 May
;
7
(
7
):
926
41
. .
5.
Fevery
J
.
Bilirubin in clinical practice: a review
.
Liver Int
.
2008 May
;
28
(
5
):
592
605
. .
6.
Vítek
L
,
Schwertner
HA
.
The heme catabolic pathway and its protective effects on oxidative stress-mediated diseases
.
Adv Clin Chem
.
2007
;
43
:
1
57
. .
7.
Fargo
MV
,
Grogan
SP
,
Saguil
A
.
Evaluation of jaundice in adults
.
Am Fam Physician
.
2017 Feb
;
95
(
3
):
164
8
.
8.
Vítek
L
,
Ostrow
JD
.
Bilirubin chemistry and metabolism; harmful and protective aspects
.
Curr Pharm Des
.
2009
;
15
(
25
):
2869
83
. .
9.
Haley
K
.
Congenital hemolytic anemia
.
Med Clin North Am
.
2017 Mar
;
101
(
2
):
361
74
. .
10.
Tátrai
P
,
Krajcsi
P
.
Prediction of drug-induced hyperbilirubinemia by in vitro testing
.
Pharmaceutics
.
2020 Aug
;
12
(
8
):
755
. .
11.
Radoi
VE
,
Ursu
RI
,
Poenaru
E
,
Arsene
C
,
Bohiltea
CL
,
Bohiltea
R
.
Frequency of the UGT1A1*28 polymorphism in a Romanian cohort of Gilbert syndrome individuals
.
J Gastrointestin Liver Dis
.
2017 Mar
;
26
(
1
):
25
8
. .
12.
Miranda
PS
,
Bosma
PJ
.
Towards liver-directed gene therapy for Crigler-Najjar syndrome
.
Curr Gene Ther
.
2009 Apr
;
9
(
2
):
72
82
. .
13.
Bertino
G
,
Privitera
G
,
Purrello
F
,
Demma
S
,
Crisafulli
E
,
Spadaro
L
,
Emerging hepatic syndromes: pathophysiology, diagnosis and treatment
.
Intern Emerg Med
.
2016 Oct
;
11
(
7
):
905
16
. .
14.
Tong
DP
,
Wu
LQ
,
Chen
XP
,
Li
Y
.
Post-operative care of interventional therapy for 40 liver cancer patients with obstructive jaundice
.
Eur J Cancer Care
.
2018 Jul
;
27
(
4
):
e12858
. .
15.
Gadia
CLB
,
Manirakiza
A
,
Tekpa
G
,
Konamna
X
,
Vickos
U
,
Nakoune
E
.
Identification of pathogens for differential diagnosis of fever with jaundice in the Central African Republic: a retrospective assessment, 2008–2010
.
BMC Infect Dis
.
2017 Nov
;
17
(
1
):
735
.
16.
Bassari
R
,
Koea
JB
.
Jaundice associated pruritis: a review of pathophysiology and treatment
.
World J Gastroenterol
.
2015 Feb
;
21
(
5
):
1404
13
. .
17.
Chen
HL
,
Wu
SH
,
Hsu
SH
,
Liou
BY
,
Chen
HL
,
Chang
MH
.
Jaundice revisited: recent advances in the diagnosis and treatment of inherited cholestatic liver diseases
.
J Biomed Sci
.
2018 Oct
;
25
(
1
):
75
. .
18.
Holmes
RS
,
Goldberg
E
.
Computational analyses of mammalian lactate dehydrogenases: human, mouse, opossum and platypus LDHs
.
Comput Biol Chem
.
2009 Oct
;
33
(
5
):
379
85
. .
19.
Huang
X-J
,
Choi
Y-K
,
Im
H-S
,
Yarimaga
O
,
Yoon
E
,
Kim
H-S
.
Aspartate aminotransferase (AST/GOT) and alanine aminotransferase (ALT/GPT) detection techniques
.
Sensors
.
2006 Jul
;
6
(
7
):
756
82
. .
20.
Gondal
B
,
Aronsohn
A
.
A systematic approach to patients with jaundice
.
Semin Intervent Radiol
.
2016 Dec
;
33
(
4
):
253
8
. .
21.
Lee
DS
,
Evans
JC
,
Robins
SJ
,
Wilson
PW
,
Albano
I
,
Fox
CS
,
Gamma glutamyl transferase and metabolic syndrome, cardiovascular disease, and mortality risk
.
Arterioscler Thromb Vascu Biol
.
2007 Jan
;
27
(
1
):
127
33
.
22.
Gunarathne
LS
,
Rajapaksha
H
,
Shackel
N
,
Angus
PW
,
Herath
CB
.
Cirrhotic portal hypertension: from pathophysiology to novel therapeutics
.
World J Gastroenterol
.
2020 Oct
;
26
(
40
):
6111
40
. .
23.
Pimpin
L
,
Cortez-Pinto
H
,
Negro
F
,
Corbould
E
,
Lazarus
JV
,
Webber
L
,
Burden of liver disease in Europe: epidemiology and analysis of risk factors to identify prevention policies
.
J Hepatol
.
2018 Sep
;
69
(
3
):
718
35
. .
24.
Milovanovic Alempijevic
T
,
Stojkovic Lalosevic
M
,
Dumic
I
,
Jocic
N
,
Pavlovic Markovic
A
,
Dragasevic
S
,
Diagnostic accuracy of platelet count and platelet indices in noninvasive assessment of fibrosis in nonalcoholic fatty liver disease patients
.
Can J Gastroenterol Hepatol
.
2017
;
2017
:
6070135
. .
25.
Friedrich-Rust
M
,
Poynard
T
,
Castera
L
.
Critical comparison of elastography methods to assess chronic liver disease
.
Nat Rev Gastroenterol Hepatol
.
2016 Jul
;
13
(
7
):
402
11
. .
26.
Buckholz
AP
,
Brown
RS
.
Cholangiocarcinoma: diagnosis and management
.
Clin Liver Dis
.
2020 Aug
;
24
(
3
):
421
36
. .
27.
Gurusamy
KS
,
Giljaca
V
,
Takwoingi
Y
,
Higgie
D
,
Poropat
G
,
Štimac
D
,
Endoscopic retrograde cholangiopancreatography versus intraoperative cholangiography for diagnosis of common bile duct stones
.
Cochrane Database Syst Rev
.
2015 Feb
;
2015
(
2
):
CD010339
. .
28.
Mauro
E
,
Gadano
A
.
What’s new in portal hypertension?
Liver Int
.
2020
;
40
(
Suppl 1
):
122
7
. .
29.
Woreta
TA
,
Alqahtani
SA
.
Evaluation of abnormal liver tests
.
Med Clin North Am
.
2014 Jan
;
98
(
1
):
1
16
. .
30.
Erlinger
S
,
Arias
IM
,
Dhumeaux
D
.
Inherited disorders of bilirubin transport and conjugation: new insights into molecular mechanisms and consequences
.
Gastroenterology
.
2014 Jun
;
146
(
7
):
1625
38
. .
31.
Gottesman
LE
,
Del Vecchio
MT
,
Aronoff
SC
.
Etiologies of conjugated hyperbilirubinemia in infancy: a systematic review of 1692 subjects
.
BMC Pediatr
.
2015 Nov
;
15
:
192
. .
32.
Vuppalanchi
R
,
Liangpunsakul
S
,
Chalasani
N
.
Etiology of new-onset jaundice: how often is it caused by idiosyncratic drug-induced liver injury in the United States?
Am J Gastroenterol
.
2007 Mar
;
102
(
3
):
558
693
; quiz 693. .
33.
Modha
K
.
Clinical approach to patients with obstructive jaundice
.
Tech Vasc Interv Radiol
.
2015 Dec
;
18
(
4
):
197
200
. .
34.
Petrovic
M
,
Radoman
I
,
Artiko
V
,
Stojkovic
M
,
Stojkovic
M
,
Durutovic
D
,
Gallbladder motility disorders estimated by non-invasive methods
.
Hepatogastroenterology
.
2012 Feb
;
59
(
113
):
13
6
. .
35.
Martínez Rivera
C
,
Andreo García
F
,
Ribas Solà
J
,
Ruiz Manzano
J
.
[Pseudojaundice caused by rifabutine]
.
Med Clin
.
1997 May
;
109
(
1
):
38
.
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