Jaundice is a light yellowing of the skin, mucous membranes, and sclera; it is generally detectable when bilirubin levels are about 3.0 mg/dL. Many patients may not be aware of the faint yellowing and present with seemingly unrelated symptoms. Up to 50% of patients with jaundice will have pruritus. The most important diagnoses to rule out are hemolytic anemias, viral hepatitis, chronic alcohol abuse, autoimmune hepatitis, medications, primary biliary cirrhosis, primary sclerosing cholangitis, cholelithiasis, surgical strictures, and obstructive malignancies. Acetaminophen, penicillins, and oral contraceptives are some of the more common medications associated with jaundice.
Management and Disposition
As the etiology is broad, a thorough history focusing on associated symptoms (fever, pruritus, vomiting, hematochezia, melena, and abdominal pain), previous surgical procedures, and medication history (including over-the-counter medications) is essential. Physical findings of fever, abdominal tenderness, and hepatomegaly should be sought. Workup should include white blood cell count and differential, liver function tests including bilirubin levels, hepatitis viral screening, and imaging studies.
Patients who consume large amounts of β-carotene (found in squash and carrots) may have mild yellowing of their skin (especially palms and soles) but will lack scleral icterus or elevations in bilirubin.
Women starting oral contraceptives may experience cholestasis in the first few months that may cause jaundice.
Jaundice. Mild palmar jaundice in a dark-skinned patient. (Photo contributor: Kevin J. Knoop, MD, MS.)
Jaundice, Scleral Icterus. Yellowing of the sclera in a patient with liver disease. (Photo contributor: R. Jason Thurman, MD.)