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Jaundice Differential Diagnosis

Many different diseases may present with jaundice. These patients will have yellowing of the skin and sclera or white area of the eye. It occurs with the elevation of bilirubin, a chemical found in red blood cells. Physicians have to consider many conditions when diagnosing jaundice.

  1. Hemolytic Anemia

    • Hemolytic anemia is the breakdown of red blood cells. The breakdown of red blood cells causes the release of bilirubin, leading to jaundice. Some conditions to consider include increased bleeding and hematomas, which are collections of blood underneath the skin. Hemolytic anemia can also be due to blood disorders such as sickle cell anemia and thalassemia.

    Gilbert's disease

    • Gilbert's disease is the result of a genetic disorder caused by abnormalities in the liver enzyme that converts bilirubin to its water soluble form. If bilirubin is not water soluble, it cannot be excreted in stool, blood levels rise, and jaundice arises. According to UptoDate for Patients, Gilbert's disease occurs in anywhere from 5 to 10 percent of the population. Stress, infection and menstrual periods can cause jaundice in these patients. This condition is benign, non-threatening, and symptoms clear on their own.

    Bile Duct Abnormalities

    • Obstruction or inflammation of bile ducts can also lead to increased levels of bilirubin. For example, gallstones can block the ducts, stop the flow of bile and elimination of bilirubin. Pancreatic cancer can cause jaundice if it infiltrates the common bile duct. Examples of inflammation of the bile ducts include primary sclerosing cholangitis and primary biliary cirrhosis.

    Hepatitis

    • Hepatitis or inflammation of the liver also can cause jaundice. The liver is involved with the chemical processes that eliminate bilirubin. If the liver is impaired, these processes are not performed and bilirubin levels rise in the blood. Examples of diseases that cause hepatitis include alcoholic hepatitis, viral hepatitis and Tylenol-induced hepatitis.

    Neonatal jaundice

    • Many new mothers may have to delay bringing their little ones home due to neonatal jaundice. There are two main types of neonatal jaundice: physiologic jaundice and breast milk jaundice. Physiologic jaundice arises from increased breakdown of red blood cells that happens after birth. In the womb, babies have a special type of hemoglobin that is different from adults. After birth, their bodies work to eliminate those cells, leading to jaundice. This is a normal process and usually decreases in two to three weeks. Breast milk jaundice may occur in breast-fed babies. The proposed mechanism is that proteins in breast milk interfere with the elimination of bilirubin, which leads to jaundice for a longer period of time than most babies.

    Pregnancy

    • Pregnancy causes many hormonal and chemical changes in the body. Cholestasis of pregnancy is a condition in which the flow of bile is limited, bilirubin is not excreted, and jaundice arises. Increased estrogens may lead to cholestasis. Pregnant women are also at increased risk for gallstones. Acute fatty liver of pregnancy (AFLP) is another complication of pregnancy that produces jaundice. The mechanism of AFLP is unknown. This is often associated with preeclampsia which is a syndrome of high blood pressure, elevated urine proteins, and elevated liver enzymes. Treatment is delivery of the fetus as soon as possible.

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