Jaundice : Adults initial approach

Jaundice, also known as hyperbilirubinemia, is characterized by a yellowish discoloration of the skin, sclerae (the white of the eyes), and other tissues due to elevated levels of bilirubin in the blood. Bilirubin is a byproduct of the normal breakdown of red blood cells; it is processed in the liver, converted into a form that can be excreted through bile, and eliminated from the body in stool. Jaundice occurs when there is an imbalance between the production and excretion of bilirubin.

This imbalance can result from several factors, including increased production of bilirubin due to excessive breakdown of red blood cells, impaired liver function that hinders bilirubin processing, or obstructions in the bile ducts that prevent bilirubin from being excreted. The clinical manifestation of jaundice varies depending on the underlying cause and severity of bilirubin accumulation.

Normal and Elevated Bilirubin Levels

The normal range for total serum bilirubin is typically less than ( this may vary slighlty between labs and regions ) 17 micromoles per liter (μmol/L) or 1 milligram per deciliter (mg/dL). Jaundice becomes clinically noticeable when serum bilirubin levels exceed approximately 51 μmol/L (3 mg/dL). At these levels, the sclera may appear yellow—a condition referred to as scleral...