ABSTRACT
Jaundice is usually detectable when the serum bilirubin concentration is > 35mmol/l. It is commonly divided into three categories on the basis of bilirubin metabolism, namely prehepatic jaundice, hepatocellular jaundice and cholestatic jaundice. The management of jaundice depends on its cause. The most common presentations to hospital in the UK are the result of alcoholic hepatitis, decompensated cirrhosis of all aetiologies, and common bile duct stones. Decompensation refers to the onset of one or more of jaundice, ascites, encephalopathy or coagulopathy in a patient with chronic liver disease. Documentation of a full medical, alcohol, sexual and drug history is extremely important in the context of a jaundiced patient. Bilirubin is formed by the breakdown of haemoglobin in the spleen. It is then conjugated with glucoronic acid in hepatocytes to become water soluble. This water-soluble conjugated bilirubin is secreted into the bile and enters the small intestine.
