top of page


Study guide:

Listen to the study guide -
00:00 / 00:00


  • Jaundice (icterus):

    • Refers to the yellow coloring of the skin and sclera due to elevated levels of bilirubin in plasma.

    • It is detectable clinically when serum bilirubin is >3 mg/dL.

  • Bilirubin:

    • An orange-yellow pigment formed in the liver by the breakdown of hemoglobin and excreted in bile.

Normal metabolism of bilirubin:
n the spleen:

  • RBCs are broken down (by macrophages) into Heme & globin.

    • Globin is converted to → amino acids.

    • Heme is further broken down into:

      • Iron → recirculates to bone marrow.

      • Unconjugated bilirubin (water insoluble) → binds to albumin & travels to the liver.

In the liver:         

  • Unconjugated bilirubin + glucuronic acid → conjugated bilirubin (glucuronides) → excreted via bile into duodenum.

In the intestines:

  • Bilirubin converted to → stercobilinogin & stercobilin (brownish color of stool)

    • Stercobilinogin & stercobilin are partly reabsorbed and execreted in urine as urobilinogen & urobilin (yellowish color of the urine).

Types of jaundice:

Hemolytic jaundice (pre-hepatic jaundice)


Increased bilirubin load for hepatocytes


1. Hemolysis: Hemolytic anemia caused by: genetics, immune disorders, infections, hypersplenism, and reaction to drugs or blood transfusion.

2. Ineffective erythropoiesis

Cholestatic jaundice :

Intra-hepatic cholestasis (hepatocellular jaundice)


Failure of bile secretion


1. Hepatitis viruses (A, B, C, E, EBV, cytomegalovirus, HSV)

2. Leptospirosis/ toxoplasmosis

3. Liver cancer

4. Liver damage or liver cirrhosis of any cause (e.g. drugs*, alcohol)

Extra-hepatic cholestasis (obstructive jaundice)


Obstruction of bile flow at any point in the biliary tract distal to bile canaliculi


1. Gallstones

2. Pancreatic cancer

3. Gallbladder cancer or bile duct cancer

4. Pancreatitis (acute/ chronic)

Congenital (non-hemolytic) jaundice:



Gilbert’s syndrome: reduced activity levels of UDP-glucuronosyl transferase (UGT-1) due to a gene mutation.

Crigler-Najjar syndrome:

Type I: autosomal recessive→ absence of UGT-1

Type II: autosomal dominant→ decreased UGT-1



Dubin-Johnson syndrome

Rotor syndrome


Type of Jaundice



  • Hemolysis

  • Ineffective erythropoiesis

  • Gilbert and Crigler Najjar syndrome



  • Viruses: Hep A,B,C,E, EBV,HSV, VZV, and CMV

  • Leptosporiosis

  • Toxoplasmosis

  • Autoimmune hepatitis

  • Cirrhosis

  • Wilson’s disease

  • Rotor and Dubin Johnson syndrome



  • Intrahepatic:

  • Primary biliary cirrhosis

  • Primary sclerosing cholangitis

  • Cholangiocarcinoma

  • Extrahepatic:

  • Head of pancreas carcinoma

  • Gallstones 


  • Drugs that can cause jaundice are Isoniazid, paracetamol excess, chlorpromazine and drugs that cause cholestasis.

  • Gilbert’s syndrome is the most common familial hyperbilirubinaemia:

    • Features: Asymptomatic, is usually detected incidentally, & treatment is not necessary. 

    • Lab workup: normal LFTs, slightly raised unconjugated bilirubin (1-6 mg/dL).

  • Crigler-Najjar syndrome:

    • Very rare.

    • Only effective treatment is: Liver transplantation.

  • Prognosis of Dubin-Johnson syndrome and Rotor syndrome is good. 


  1. Hoffbrand A, Moss P, Pettit J. Essential haematology. Malden, Mass.: Wiley-Blackwell; 2011.

  2. Collins P, Fox C. Gastroenterology. Edinburgh: Mosby; 2008.

  3. Kumar P, Clark M. Kumar & Clark's clinical medicine.

  4. 1. Agabegi S, Agabegi E, Ring A. Step-up to medicine. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins; 2013.

  5. Walker B, Colledge N, Ralston S, Penman I. Davidson's principles and practice of medicine.

  6. Kidney Stone Treatment [Internet]. 2015 [cited 12 December 2015]. Available from: (Figure1).

  7. Part 1 - Bilirubin Metabolism [Internet]. 2015 [cited 12 December 2015]. Available from: (Figure2).

  8. Jaundice: DynaMed [Internet]. 2016 [cited 1 February 2016]. Available from:



Written by:         Haifa Al-Issa.

Reviewed by:      Roaa Amer
                          Lama Al Luhidan

Web publisher:   Adel Yasky

                          Bayan Alzomaili


Audio recording:
- Read by: Bayan Alzomaili
- Audio production: Bayan Alzomaili

bottom of page