Jaundice is the yellow color of the skin, mucus membranes, or eyes.The yellow coloring occurs from by the excessive accumulation in the tissues of bilirubin, a byproduct of old red blood cells.The normal serum bilirubin is about 3-20 μmol/L.Jaundice is not normally obvious until serum bilirubin is over 35 μmol/L.Jaundice can be a symptom of many health disorders.The detection and differential diagnosis of jaundice are essential in medical evaluation.The types of bilirubin are:1. Un-conjugated bilirubin which is toxic, fat soluble and cannot be excreted by the kidneys2. Conjugated bilirubin which the hepatocytes in the liver has conjugated the un-conjugated bilirubin and excretes in the bile.Conjugated bilirubin is water soluble and in high levels is also excreted in the urine as dark tea colored urine.Bilirubin is created from the breakdown of hemoglobin in the reticuloendothelial system.95% of the circulating bilirubin is un-conjugated and attached to albumin.The bilirubin-albumin complex is broken down by hepatocytes allowing free albumin to circulate.Jaundice can happen if:1. Too many red blood cells are dying or breaking down and going to the liver2. The liver is overloaded or injured3. The bilirubin from the liver is not able to properly move into the digestive tractJaundice is often a sign of a disorder with the liver, gallbladder, or pancreas.The causes of jaundice are:1. Hemolytic anemia is due to the break up of red blood cellsHere the major form of bile pigment is un-conjugated2. Hepato-cellular or liver causes:Acute liver causes are:a. Viral hepatitis A to F,b. Alcoholism,c. Toxic chemical hepatitis including drugs andd. Bacterial infections such as leptospirosis.More of conjugated bilirubin at early stages is followed by un-conjugated bilirubin.Chronic liver causes are:a. Chronic liver cirrhosis – produces mostly un-conjugated bilirubin3. Obstructive jaundice: mainly conjugated bilirubin accumulatesa. Intra-hepatic cholestasis due to drug sensitivityb. Extra-hepatic gallstones, carcinoma of biliary systems or adjacent organs.Disorders that can cause jaundice are:1. Infections2. Use of certain drugs3. Cancer4. Blood disorders,5. Gallstones,6. Birth defects and7. A number of other medical disorders resulting in jaundice.The effects of jaundice are:1. Yellowing of the skin and white of eye and mucous membranes like inside of the lips2. Liver enlargement and palpable gallbladder in blockage3. Enlarged spleen especially in hemolytic anemia4. Dark colored urine due to presence of bilirubin in the urine5. Pale stools6. Prolonged tiredness from anemia, loss of blood,7. Encephalopathy from bilirubin affecting the brain8. Nausea and vomiting.9. Poor appetiteJaundice is not the same as carotenaemia (where the sclera remains white).Jaundice will be obvious if the total bilirubin is >35 μmol/L.In jaundice, the important rapid differentiation of the main causes (hepatitis, biliary stasis, hemolysis, resolution of hematoma or congenital causes) can often be obtained by doing:Urinary bilirubin and urobilinogenHepatitis serology should be done in all patients with cholestasis, as distinguishing hepatitis from extra-hepatic obstructive causes may be very difficult.Liver function testsSerum antinuclear antibodies (ANAs), anti-smooth muscle antibody (ASMA)MRCP may become the test of choice in obstructive jaundiceLiver biopsyTreatment will depend on the diagnosis and cause of the jaundice in each individual casea. Blood transfusion or platelet transfusion for hemolytic anemiab. Treatment of infectionsc. Surgery for obstructive lesionsOthers:a. Restb. Fluidsc. Vitamin BTABLE OF CONTENTIntroductionChapter 1 JaundiceChapter 2 CausesChapter 3 SymptomsChapter 4 DiagnosisChapter 5...