Cause Of Jaundice Research Articles

Hepatitis aguda viral durante el embarazo

Acute hepatitis has a very low incidence disease during pregnancy. However, it may be an important cause of jaundice during gestation which in cases of viral etiology can have a very high morbidity and mortality risk to the mother and the fetus. The purpose of this review is to update the available knowledge regarding viral hepatitis during pregnancy including description of the main etiologies, transmission route, maternal-fetal risk and possible management.

Acute viral hepatitis during pregnancy

Acute hepatitis has a very low incidence disease during pregnancy. However, it may be an important cause of jaundice during gestation which in cases of viral etiology can have a very high morbidity and mortality risk to the mother and the fetus. The purpose of this review is to update the available knowledge regarding viral hepatitis during pregnancy including description of the main etiologies, transmission route, maternal-fetal risk and possible management.

PP-239. Study of direct Coombs test (DAT) in the context of hemolytic disease of the newborn and in relation to the causes of jaundice

PP-239. Study of direct Coombs test (DAT) in the context of hemolytic disease of the newborn and in relation to the causes of jaundice

Underlying Etiologies of Prolonged Icterus in Neonates

The purpose of this study was to determine underlying causes of prolonged neonatal icterus. Icterus or jaundice is an important common problem in neonatology. When this condition persists beyond 14 days, it is called prolonged or protracted neonatal icterus. Determining underlying causes of this problem is a pivotal step for management, because a delay in treatment may lead to serious complications or even death. In a prospective study, newborns with diagnosis of prolonged icterus were evaluated during a six-month period in Tabriz Children Teaching Hospital. Data regarding the past medical history, physical examination and appropriate laboratory and paraclinical investigations were gathered and accordingly, the underlying cause of jaundice was documented. One hundred newborns, 67 males and 33 females with a mean age of 21.5 +/- 4.5 days were enrolled. Breastfeeding, urinary tract infection, glucose 6-phosphate dehydrogenase deficiency and hypothyroidism were found as the main underlying causes in 75, 7, 7 and 4% of the cases. The exact etiology was unknown in 4% of newborns. ABO incompatibility, sepsis and Down syndrome were underlying etiologies in remaining three patients. Present study showed that the underlying causes of prolonged neonatal jaundice could be determined in majority of cases and breastfeeding is the most common one in this regard.

Jaundice as a Presenting Manifestation of Pediatric Non-Hodgkin Lymphoma

There are few data available on the management and outcome of pediatric patients with non-Hodgkin lymphoma (NHL) presenting with jaundice. Controversies exist on biliary drainage and chemotherapy dose modifications to be carried out in such patients. The aim of this study was to analyze the causes of jaundice in, the various modalities of treatment administered to, and outcome of patients aged 18 years or less, with de novo NHL and jaundice treated at our center. A retrospective analysis show 9 such cases (11.2% of all NHL cases), all of whom were treated by a uniform protocol. Chemotherapy dose modifications were based on serum bilirubin and clinical status of the patients. Obstructive jaundice was the most common cause (7 of 9). Seven patients achieved normal serum bilirubin with chemotherapy alone. Only one had a biliary drainage procedure. Four patients were alive and disease-free at last follow-up. Although biliary obstruction is the commonest most cause of jaundice in pediatric and adolescent NHL, biliary drainage may be unnecessary and chemotherapy alone may suffice as initial treatment for these patients.

The infective causes of hepatitis and jaundice amongst hospitalised patients in Vientiane, Laos

SummaryThere is little information on the diverse infectious causes of jaundice and hepatitis in the Asiatic tropics. Serology (hepatitis A, B, C and E, leptospirosis, dengue, rickettsia), antigen tests (dengue), PCR assays (hepatitis A, C and E) and blood cultures (septicaemia) were performed on samples from 392 patients admitted with jaundice or raised transaminases (≥ × 3) to Mahosot Hospital, Vientiane, Laos over 3 years. Conservative definitions suggested diagnoses of dengue (8.4%), rickettsioses (7.3%), leptospirosis (6.8%), hepatitis B (4.9%), hepatitis C (4.9%), community-acquired septicaemia (3.3%) and hepatitis E (1.6%). Although anti-hepatitis A virus (HAV) IgM antibody results suggested that 35.8% of patients had acute HAV infections, anti-HAV IgG antibody avidity and HAV PCR suggested that 82% had polyclonal activation and not acute HAV infections. Scrub typhus, murine typhus or leptospirosis were present in 12.8% of patients and were associated with meningism and relatively low AST and ALT elevation. These patients would be expected to respond to empirical doxycycline therapy which, in the absence of virological diagnosis and treatment, may be an appropriate cost-effective intervention in Lao patients with jaundice/hepatitis.

Jaundice in typhoid patients: Differentiation from other common causes of fever and jaundice in the tropics

While typhoid fever is common in our environment, presentation with jaundice is unusual. The aim of this study has been to determine the clinical and laboratory features that allow early diagnosis of typhoid fever in patients that present with jaundice and differentiate it from other common causes of fever and jaundice in the tropics. This prospective study was conducted between May 1997 and October 1998 at Center Hopitalier Regional de Hombo Anjuoan, Comoros Islands. Patients with clinical and laboratory evidence of typhoid fever were included. Viral or toxic hepatitis, chronic liver disease, sickle cell disease and other causes of jaundice were excluded by clinical examination and appropriate investigations. Serial evaluation of liver function test and abdominal ultrasound were done. Patients were resuscitated with fluids and electrolytes and treated with appropriate antibiotics. Liver involvement was determined using clinical and laboratory parameters. Of the 254 patients with confirmed diagnosis of typhoid fever, 31 (12.2%) presented with jaundice. Their mean age was 24.6+/-9.2SD years. Fever preceded the appearance of jaundice by 8-27 days. In 27 (87.1%) patients, there was hepatosplenomegaly. Serum bilirubin ranged 38-165 micromol/l with mean of 117+/-14SD. Conjugated bilirubin ranged 31-150 micromol/l with mean of 95+/-8SD. Serum aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase were raised with mean values of 180, 105 and 136 IU, respectively. Six (19.4%) patients died compared to 12.1% of non-icteric patients. Typhoid patients may present with varying degrees of jaundice and fever that may be confused with viral, malarial or amebic hepatitis, diseases that are common in the tropics. Physical examination and simple biochemical tests would identify the typhoid patients who should be treated with appropriate antibiotics even before the results of blood culture are available.

An unusual cause of jaundice in pregnancy

An unusual cause of jaundice in pregnancy

Letters to the Editor

21 November 2008 Dear Editor, NEONATAL TESTICULAR TORSION OR NOT? Neonatal adrenal haemorrhage commonly manifests with anaemia, jaundice, vomiting and abdominal mass. It may be diagnosed incidentally if the haemorrhage is not significant. Neonatal adrenal haemorrhage can present as scrotal discoloration and swelling mimicking acute scrotum. Awareness of this clinical association helps in avoiding unnecessary neonatal scrotal exploration. Baby B presented on the 11th day of life with scrotal swelling and discoloration. He was a full-term male baby weighing 3485 g, born of normal vaginal delivery with a short duration of labour due to rapid second stage. He developed jaundice on the second day of life. His unconjugated bilirubin was 383 µmol/L. His jaundice was unresponsive to phototherapy, and his gamma-glutamyl transferase levels were 806 IU/L. Hepatitis and Coomb's serology was negative. He was noted to have a right scrotal mass and scrotal discoloration on the right side. The whole testis felt to be enlarged and firm with an odd shape. There were no abdominal masses palpable. The differentials considered were perinatal torsion and testicular tumour. He was otherwise well, tolerating feeds without vomiting. Work-up for jaundice revealed reticulocytosis and falling haemoglobin (167–155 g/L) and haematocrit (0.486–0.448 L/L) over 3 days. This prompted us to look for an intra-abdominal bleed as cause of jaundice and scrotal swelling. He had a scrotal and abdominal ultrasound that revealed a scrotal haematoma and an avascular right adrenal mass suggestive of adrenal haemorrhage (Fig. 1). The testis was normal. Laboratory tests for urinary catecholamines were within normal limits. Ultrasound showing 4-cm adrenal mass with central necrosis. The patient was managed conservatively with a plan to monitor the mass with regular ultrasounds. Follow-up ultrasound showed decrease in the size of the adrenal haemorrhage with liquefaction. In 12 weeks time, the mass was only 1 cm in size (from the initial size of 4 cm) (Fig. 2). Follow-up ultrasound showing decrease in size from the initial scan. Neonatal adrenal haemorrhage occurs in about 0.2% of neonates.1 It is associated with hypoxia, birth trauma, but is also known to be spontaneous. Adrenal haemorrhages are more common in males and on the right side. Clinical features depend on the amount of bleeding. The common presentation is anaemia, jaundice, abdominal distension and abdominal mass. It can be an incidental finding in asymptomatic babies.1 Twenty-two cases of scrotal haematoma as an association with adrenal haemorrhage have been reported in the literature. Nine (41%) have had surgical scrotal exploration to exclude torsion as it may be difficult to feel the testis separate from the scrotal haematoma or haemorrhage could have tracked down a patent processus around the testis. The reason for delayed presentation in our case could be time taken to track down the retroperitoneum. The rest of the cases had non-surgical management after further evaluation.2 One of the cases reported in the literature developed disseminated intravascular coagulation after having an unnecessary scrotal exploration. It was detected to have adrenal haemorrhage by a post-operative abdominal ultrasound scan.3 It is emphasised that an awareness of the condition and a scrotal/abdominal ultrasound helps make the diagnosis and prevent an unnecessary operation. This association should be kept in mind in the clinical scenario of neonatal anaemia, jaundice and acute discoloured scrotum (scrotal haematoma). On rare occasions, computed tomography may be needed to confirm the diagnosis.4

A rare cause of jaundice in a newborn not predicted by maternal blood typing (Discussion and Diagnosis)

A rare cause of jaundice in a newborn not predicted by maternal blood typing (Discussion and Diagnosis)

A rare cause of jaundice in a newborn not predicted by maternal blood typing (Case Presentation)

A rare cause of jaundice in a newborn not predicted by maternal blood typing (Case Presentation)

(154) Prevalence of hepatitis infection in haemodialysis patients

Jaundice is a clinical sign that reflects accumulation of bilirubin in blood. It can result from increased bilirubin production, inability of the liver to conjugate bilirubin or failure to excrete bilirubin into the biliary tree. Appropriate investigation of jaundice starts with a history of associated symptoms, and risk factors for liver disease. Clinical examination should look for stigmata of chronic liver disease and signs of specific liver diseases. Initial blood tests should assess liver injury and synthetic function. A combination of urinalysis and the pattern of abnormal liver function tests can indicate whether the jaundice is likely to be hepatitic or cholestatic, and guide further investigations. This review will describe bilirubin metabolism, the causes of jaundice, and the appropriate investigation of jaundice.

Successful Treatment of Fosinopril-Induced Severe Cholestatic Jaundice with Plasma Exchange

To describe a case of fosinopril-induced severe cholestatic jaundice successfully treated with plasma exchange. A 78-year-old Taiwanese male presented with yellowish skin and generalized itching one month after starting fosinopril 10 mg once a day. Other drugs taken by the patient were excluded as the probable cause of jaundice. Diagnostic modalities, including abdominal ultrasound, computed tomography, and endoscopic retrograde cholangiopancreatography, revealed no evidence of biliary tract obstruction or intraabdominal tumor. According to the Council for International Organizations of Medical Science (CIOMS) scale, fosinopril was a highly probable cause of the patient's jaundice. Liver biopsy showed cholestasis without bile duct damage. Based on results of the CIOMS scale assessment and pathological characteristics of the liver, the diagnosis was highly probable that fosinopril had induced cholestatic jaundice in our patient. During hospitalization, the patient developed severe jaundice and liver failure, despite conservative treatment and withdrawal of fosinopril. He underwent a 5-day course of plasma exchange therapy, and the serum bilirubin level declined rapidly after treatment. His liver function returned to normal 2 months after treatment. Angiotensin-converting enzyme (ACE) inhibitor-induced hepatotoxicity is rare and only a few cases, with most involving captopril, have been reported in the English-language literature. Hepatotoxicity caused by fosinopril is extremely rare. Most ACE inhibitor-induced hepatotoxicity is mild and transient, but it can be fatal. Although orthotopic liver transplantation (OLT) is the standard method for treating drug-induced liver failure, plasma exchange therapy is an alternative therapeutic method or a bridge to OLT for treating liver failure. Plasma exchange therapy may play a valuable role in the treatment of fosinopril-induced cholestatic jaundice and liver failure. This intervention can be considered for temporary liver support until recovery or OLT.

Cholestatic Diseases of Pregnancy

Cholestatic diseases of pregnancy (CDP) are also referred to as intrahepatic cholestasis of pregnancy, recurrent cholestatic jaundice of pregnancy, icterus gravidarum and cholestatic hepatosis. It is a form of intrahepatic cholestasis characterized by pruritus and mild jaundice that usually occurs in the third trimester of pregnancy, though occurrence in earlier gestations is encountered occasionally. It is the second most common cause of jaundice occurring in pregnancy, ranking next to viral hepatitis1. IFEMED Journal Vol. 14 (1) 2008: pp. 23-25

A 9-Year Retained T-Tube Fragment Encased within a Stone as a Rare Cause of Jaundice

Biliary diseases such as cholangitis may cause jaundice and liver damage. Here, we report on an unusual cause of jaundice in an 84-year-old man 9 years after cholecystectomy. Ultrasound analysis revealed unclear extrahepatic cholestasis and subsequent ERCP showed a large biliary stone surrounding a T-tube fragment that had remained in the common bile duct for more than 9 years after surgery. The tip of the drainage and the stone could be successfully removed using Dormia baskets. This case suggests that plastic material accidentally left in the common bile duct favours the development of large biliary casts when present over long periods of time.

Endoscopic ultrasound for cholangiocarcinoma re-evaluation after Wallstent® placement

(MRI) cholangiography and endoscopic retrograde cholangiography (ERC), endoscopic ultrasound (EUS) readily visualizes common bile duct (CBD) and allows the diagnosis of bile duct masses or strictures (1). Once a Wallstent® has been placed, re-evaluation of the bile duct and stent patency may be difficult. We present the case of a patient with a Klastkin tumor to show the utility of EUS in this setting. A 55 year old male, smoker, with medical history of ischemic heart disease and atrial fibrillation, was first admitted to our hospital because of jaundice. The diagnosis of Klastkin tumor IIIA-IV was established based on contrast-enhanced computed tomography (CECT) and ERC. The tumor was considered to be not resectable due to relevant portal infiltration. An uncovered biliary Wallstent® was placed endoscopically for palliation of jaundice and a palliative chemotherapy with oxaliplatin and gemcitabine was administered. Eighteen months later the patient was admitted again because of jaundice relapse and the suspicion of biliary Wallstent® obstruction due to tumor growth. The exact cause of jaundice could not be demonstrated by CECT, and the obstruction of the Wallstent® could only be suspected. MRI cholangiography provided no further information because of stent-related artifacts, whereas ERC was only able to show complete stop at the very distal portion of the stent. On the contrary, lineal EUS (PENTAX FG-3830UT) precisely revealed the growth of the tumor inside the Wallstent® lumen as the cause of biliary obstruction (Fig. 1). The infiltration of the portal vein could also be confirmed during the procedure (Fig. 2). Finally, a palliative EUS-guided transgastric biliary drainage was placed during the same procedure. Several imaging techniques are used in clinical practice for bile duct evaluation, among them MRI cholangiography, CT scan, ERC and EUS (2). In this context, EUS has proved to be a useful diagnostic tool in patients with obstructive jaundice, as it does not only allow a clear visualization of the neoplasia, but also an accurate local tumor staging (3-5). In a recent study comparing ERC, MRI cholangiography, CT and EUS for evaluation of biliary strictures, Rosch et al. (6) demonstrated the highest diagnostic accuracy for MRI associated with EUS. This supports the previous statement of an international panel of experts regarding the major role of EUS for the diagnosis and staging of biliary tumors in clinical practice (7). Endoscopic ultrasound for cholangiocarcinoma re-evaluation after Wallstent® placement

Jaundice: clinical practice in 88,000 liveborn infants.

We reviewed jaundiced infants born between 1971 and 1989. Jaundice was diagnosed in infants whose serum bilirubin level was found to be 154 umol/l or greater. Of 88,137 livebirths, 10,944 (12.4%) were jaundiced. The most common aetiological factor was prematurity (20.3%), followed by ABO erythroblastosis (5.5%), sepsis (1.8%), Rh erythroblastosis (1.8%), bruising (1.3%), multifactorial (1.0%) and glucose-6-phosphate dehydrogenase deficiency (0.5%). In the remainder (67.8%) no cause was found or inadequate investigations were performed to determine a cause. During the period under review there was a significant increase (r = 0.91) in the proportion of newborn infants with jaundice of prematurity, in those not investigated (r = 0.92) and a decrease in the proportion with bruising (r = -0.90) as the cause. Phototherapy was used on 4,126 (37.7%) infants and exchange transfusion performed on 248 (2.3%). Causes of jaundice in infants requiring exchange transfusion were Rh erythroblastosis (108, 43.6%), ABO erythroblastosis (58, 23.4%), jaundice of prematurity (44, 17.7%) and a variety of causes in the remaining 38 (15.3%). Death occurred in 164 (1.5%) infants. In only 7 (4.3%), however, was the death possibly related to hyperbilirubinaemia or its treatment (Rh erythroblastosis (4), necrotizing enterocolitis following exchange transfusion (2) and pulmonary haemorrhage following exchange transfusion (1)). Phototherapy proved safe with no deaths attributable to its use.

Une choléstase causée par un rhabdomyosarcome botryoïde du cholédoque chez un nourrisson de 22 mois

Botrioid rhabdomyosarcoma of the extrahepatic bile ducts is a rare cause of jaundice in children. It has a very poor prognosis and is rarely diagnosed preoperatively. We report a choledochal botrioid rhabdomyosarcoma in a 22-month-old boy who developed an obstructive jaundice. Radiographic explorations suggested cystic lymphangioma. The gallbladder, the cystic duct, the common bile duct and the pancreatic head were resected. The diagnosis was made on pathological examination; adjuvant chemotherapy followed. The patient was disease free 20 months following treatment.

Preventing kernicterus: a wake-up call

Preventing kernicterus: a wake-up call

Myeloid sarcoma of liver: an unusual cause of jaundice. Report of three cases and review of literature

Myeloid sarcoma of liver: an unusual cause of jaundice. Report of three cases and review of literature