There are 3 main causes of jaundice : pre-hepatic (raised indirect unconjugated bilirubin), inter-hepatic (mixed picture of raised direct and indirect bilirubin) and post-hepatic (raised conjugated hyperbilirubinaemia).
The most common cause of an isolated high bilirubin level is Gilberts syndrome and haemolysis.
Pre-hepatic raised unconjugated/indirect bilirubin
- Haemolysis – check FBC also
- Gilbert’s syndrome
- Haematoma reabsorption
- Post viral hepatitis
- Mild chronic hepatitis
- Crigler-Najjar syndrome
Interhepatic causes of conjugated/direct hyperbilirubinaemia
- Hepatocellular disease
- Viral infections (hepatitis ABC, EBV, CMV)
- Chronic alcohol use
- Autoimmune disorders
- Drug toxicity
- Pregnancy
- Parental nutrition
- Sarcoidosis
- Inherited defects of excretion
- Dublin Johnson Syndrome
- Rotors Syndrome
- Primary biliary cirrhosis
- Primary sclerosing cholangitis
- Hepatocellular carcinoma
Post-hepatic causes of conjugated direct hyperbilirubinaemia
- Intra-luminal causes : gallstones, cholestasis from blocked common bile duct, Infection
- Mural causes : intrahepatic malignancy, cholangiocarcinoma, surgical strictures or drug-induced cholestasis
- Extra-mural causes: pancreatic cancer, lymphomas, pancreatitis
