Skip to Main Content




The disease is produced by black bile when it flows into the liver. The symptoms are these: ‘an acute pain in the liver, also below the breast, a feeling of suffocation is strong during these days and becomes less strong later’. The liver is tender to palpation and the complexion of the patient is somewhat livid. These are symptoms that occur in the beginning but as the disease progresses, the fever diminishes in strength and the patient feels sated after ingesting a little amount of food. He must drink melikration [a mixture of water and honey].

Hippocrates on hepatitis


Jaundice is a yellow discolouration of the skin and mucosal surfaces caused by the accumulation of excessive bilirubin.1 It is a cardinal symptom of hepatobiliary disease and haemolysis. Important common causes include gallstones, hepatitis A, hepatitis B, hepatitis C, drugs, alcohol and Gilbert syndrome. The commonest clinical encounter with jaundice, especially physiological jaundice, is in the newborn. As for all patients, the history and examination are paramount, but investigations are essential to clinch the diagnosis of jaundice.


The three major categories of jaundice are (see FIG. 58.1):


  • obstructive:

    • extrahepatic

    • intrahepatic

  • hepatocellular

  • haemolytic


Key facts and checkpoints

  • Jaundice is defined as a serum bilirubin level exceeding 19 μmol/L.2

  • Clinical jaundice manifests only when the bilirubin level exceeds 50 μmol/L.1

  • However, jaundice is difficult to detect visually below 85 μmol/L if lighting is poor.

  • It can be distinguished from yellow skin due to hypercarotenaemia (due to dietary excess of carrots, pumpkin, mangoes or pawpaw) and hypothyroidism by involving the sclera.

  • The most common causes of jaundice recorded in a general practice population are (in order) viral hepatitis, gallstones, pancreatic cancer, cirrhosis, pancreatitis and drugs.3

  • Always take a full travel, drug and hepatitis contact history in any patient presenting with jaundice.

  • Acute hepatitis is usually self-limiting in patients with hepatitis A and in adults with hepatitis B but progresses to chronic infections with hepatitis C and children with hepatitis B.4

  • A fatty liver (steatosis) can occur not only with alcohol excess but also with obesity, diabetes and starvation. There is usually no liver damage and thus no jaundice.

Table Graphic Jump Location
Table 58.1

Abbreviations used in this chapter


A diagnostic approach


Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

Murtagh Collection Full Site: One-Year Subscription

Connect to a suite of general practice resources from one of the most influential authors in the field. Learn the breadth of general practice, including up-to-date information on diagnosis and treatment, as well as key clinical skills like communication.

$145 USD
Buy Now

Pay Per View: Timed Access to all of Murtagh Collection

48 Hour Subscription $34.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.