Sclerosing cholangitis [top]

  • Obstructive jaundice
  • Elevated ALP
  • Fatigue, pruritus

Pre-hepatic jaundice [top]

  • Jaundice
  • Haemolytic anaemia
  • Normal stools, normal urine
  • Increased: unconjugated bilirubin, urine urobilinogen
  • Decreased: Serum haptoglobin

Malaria [top]

  • Intermittent fever
  • Rigors
  • Travel to tropical area
  • Vomiting
  • Pre-hepatic jaundice

Gallstones [top]

  • Colicky right upper quadrant abdominal pain / epigastric pain
  • Obstructive jaundice
  • Murphy's sign positive

Obstructive jaundice [top]

  • Pale stools, Dark urine
  • Increased: conjugated bilirubin, urine bilirubin, ALP, GGT
  • Absent: urine urobilinogen

Primary biliary cirrhosis [top]

  • Obstructive jaundice usually in females
  • Severe, progressive pruritus
  • Non-tender hepatomegaly
  • Xanthelasma, tendon xanthomas
  • Positive: anti-mitochondrial antibody, Elevated serum IgM

Carcinoma of head of pancreas [top]

  • Painless, progressive, severe obstructive jaundice
  • Palpable gall bladder
  • Weight loss

Dubin-Johnson syndrome [top]

  • Intermittent obstructive jaundice
  • Right upper quadrant pain
  • Normal: ALP, LFT
  • Increased: Urine bilirubin

Carotinaemia [top]

  • Yellow skin with white sclera
  • May be mistaken for jaundice
  • Normal stool, urine
  • Excessive consumption of vegetables such as carrots

Alcoholic hepatitis / cirrhosis [top]

  • Hepatic jaundice or obstructive jaundice
  • History of excessive alcohol consumption

Gilbert's syndrome [top]

  • Hepatic jaundice
  • Hyperbilirubinaemia on fasting
  • No other LFT abnormalites, asymptomatic

Hepatic jaundice [top]

  • Jaundice
  • Increased: conjugated and unconjugated bilirubin, urine bilirubin, ALT, AST
  • Normal: urine urobilinogen, serum haptoglobin
  • Abnormal LFTs

Haemolytic anaemia, hereditary [top]

  • Pre-hepatic jaundice
  • G6PD, pyruvate kinase deficiency
  • Haemolytic anaemia
  • Splenomegaly
  • Leg ulcers

Drug-induced jaundice [top]

  • Hepatic jaundice or obstructive jaundice
  • Hepatic: paracetamol, halothane
  • Obstructive: oral contraceptive pill, antibiotics etc.

Sepsis [top]

  • Pre-hepatic jaundice or hepatic jaundice
  • Fever, hypotension, tachycardia

Pregnancy [top]

  • Morning sickness, vomiting
  • Amenorrhoea
  • Obstructive jaundice
  • Amenorrhoea
  • Female of child-bearing age
  • History of sexual intercourse

Glandular fever [top]

  • Hepatic jaundice
  • Hepatomegaly, splenomegaly, lymphadenopathy
  • Sore throat, Malaise
  • Atypical lymphocytes

Haemolytic anaemia, acquired [top]

  • Pre-hepatic jaundice
  • Coombs' test positive

Viral hepatitis [top]

  • Hepatic jaundice
  • Hepatomegaly, right upper quadrantabdominal pain
  • Fever, vomiting
  • Hepatitis A: Faecal-oral spread
  • Hepatitis B, C: IVDU, blood transfusion, tattoos

Crigler-Najjar syndrome [top]

  • Hepatic jaundice
  • No elevation in LFTs on fasting