II. Definitions
- Jaundice
- "Yellow Skin" related to Hyperbilirubinemia
III. Pathophysiology
IV. Causes
- See Hyperbilirubinemia
- See Conjugated Hyperbilirubinemia
- See Unconjugated Hyperbilirubinemia
- Intrahepatic causes (55% of cases)
- Extrahepatic causes (45% of cases)
- Gallstone Disorders (e.g. Acute Cholecystitis, Choledocholithiasis)
- Hemolysis
- Cancer
- Pseudojaundice (skin pigmentation that mimics Jaundice)
- See Differential Diagnosis below
V. Symptoms
- Pruritus
- Yellow Skin
- Weight loss
-
Abdominal Pain
- Painless Jaundice (and direct Hyperbilirubinemia) is an ominous presentation often associated with obstructive malignancy
VI. Signs: Jaundice
- See Jaundice in Newborns
- Jaundice sites of predilection
- Face
- Trunk
- Tongue frenulum (early finding)
- Sclera (see Scleral Icterus)
- Factors that accentuate Jaundice
- Tanned skin
- Factors that may hide Jaundice
- Artificial light
VII. Signs: General
- Abdominal exam
- Signs of Chronic Liver Disease
- Ecchymosis
- Spider Angiomas
- Gynecomastia
- Palmar erythema
- Testicular atrophy
-
Hepatic Encephalopathy signs
- Asterixis (flapping Tremor)
- Mental status changes
- Findings suggestive of Obstructive Jaundice
- Sinus Bradycardia
- Dark yellow or brown colored Urine
- Direct Hyperbilirubinemia (increased Urobilinogen)
- Shaking specimen results in yellow foam
- Acolic Stools
- Gray-white, malodorous stools
VIII. Labs: Initial
- Complete Blood Count
-
Bilirubin: Diagnosis requires Bilirubin fractionation
- See Bilirubin
- Jaundice visible when Bilirubin >3-4 mg/dl
- See Indirect Bilirubin (Hemolytic Jaundice)
- See Direct Bilirubin (Obstructive Jaundice)
- Other Liver Function Tests
- Aspartate transaminase (AST)
- Alanine transaminase (ALT)
- Gamma-glutamyl transpeptidase (GGT)
- Alkaline Phosphatase
- Prothrombin Time or INR
- Serum Albumin
- Serum Protein
-
Urinalysis
- Bilirubin in urine suggests Conjugated Bilirubin
IX. Differential Diagnosis: Causes of Yellow Skin
- See Hyperbilirubinemia
- Carotenemia
- Quinacrine
- Addison Disease
- Anorexia Nervosa
- Spray-on tanning substances
- Occupational exposure to Explosive manufacturing (Dinitrophenol, Tetryl)
X. Evaluation: Based on Bilirubin fractionation (as above)
-
Unconjugated Hyperbilirubinemia
- See Indirect Bilirubin for causes
- Mild Unconjugated Hyperbilirubinemia is common and often caused by Gilbert Syndrome (benign)
- Evaluate for Hemolysis (do not miss!)
- Peripheral Smear
- Lactate Dehydrogenase
- Haptoglobin
- Direct Coombs Test
- Consider G6PD testing
-
Conjugated Hyperbilirubinemia
- See Direct Bilirubin for causes
- Screen for Viral Hepatitis (Hepatitis A, Hepatitis B, and Hepatitis C)
- Evaluate for obstruction
- Consider abdominal right upper quadrant Ultrasound or Abdominal CT
- Consider Abdominal MRCP
- Consider Autoimmune Condition screening
- Antinuclear Antibody (ANA)
- Anti Liver-Kidney microsomal Antibody
- Anti-Smooth Muscle Antibody
XI. References
- Degowin (1987) Diagnostic Exam, Macmillan, p.480-1
- Feldman (1998) Sleisenger and Fordtran's, p. 220-231
- Fargo (2017) Am Fam Physician 95(3): 164-8 [PubMed]
- Nelson (2025) Am Fam Physician 111(1): 25-30 [PubMed]
- Pasha (1996) Med Clin North Am 80:995-1019 [PubMed]
- Roche (2003) Am Fam Physician 69:299-304 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| Definition (CHV) | skin yellowing due to excessive bilirubin in body |
| Definition (CHV) | skin yellowing due to excessive bilirubin in body |
| Definition (CHV) | skin yellowing due to excessive bilirubin in body |
| Definition (MEDLINEPLUS) |
Jaundice causes your skin and the whites of your eyes to turn yellow. Too much bilirubin causes jaundice. Bilirubin is a yellow chemical in hemoglobin, the substance that carries oxygen in your red blood cells. As red blood cells break down, your body builds new cells to replace them. The old ones are processed by the liver. If the liver cannot handle the blood cells as they break down, bilirubin builds up in the body and your skin may look yellow. Many healthy babies have some jaundice during the first week of life. It usually goes away. However, jaundice can happen at any age and may be a sign of a problem. Jaundice can happen for many reasons, such as |
| Definition (NCI) | Yellow pigmentation of the skin, mucous membranes, and the eyes due to hyperbilirubinemia. Causes include liver disease, biliary tract obstruction, and hemolysis. |
| Definition (NCI_NCI-GLOSS) | A condition in which the skin and the whites of the eyes become yellow, urine darkens, and the color of stool becomes lighter than normal. Jaundice occurs when the liver is not working properly or when a bile duct is blocked. |
| Definition (CSP) | clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. |
| Definition (MSH) | A clinical manifestation of HYPERBILIRUBINEMIA, characterized by the yellowish staining of the SKIN; MUCOUS MEMBRANE; and SCLERA. Clinical jaundice usually is a sign of LIVER dysfunction. |
| Concepts | Pathologic Function (T046) |
| MSH | D007565 |
| ICD10 | R17 |
| SnomedCT | 274245007, 206897003, 158250005, 161866005, 158249005, 263780001, 139122003, 18165001 |
| LNC | LA7450-5, LA17203-3 |
| English | Icterus, Jaundice, ICTERUS, [D]Icterus NOS, [D]Jaundice, [D]Icterus (context-dependent category), [D]Icterus NOS (context-dependent category), Unspecified jaundice, Icterus [D], jaundice (diagnosis), jaundice, Jaundice NOS, Jaundice [Disease/Finding], icteric, Jaundice - symptom, Icterus [D] (situation), [D]Icterus, [D]Icterus (situation), Jaundice (disorder), [D]Icterus NOS (situation), JAUNDICE, Icteric, Jaundiced, Jaundice (finding), icterus, Icterus, NOS, Jaundice, NOS, Icterus [D] (context-dependent category), Icterus NOS |
| French | ICTERE, JAUNISSE, Ictère SAI, Jaunisse, Ictère |
| Portuguese | ICTERICIA, Icterícia NE, Icterícia |
| Spanish | ICTERICIA, Ictericia NEOM, Icterus, [D]ictericia, SAI (categoría dependiente del contexto), ictericia [D] (categoría dependiente del contexto), ICTERUS, ictericia [D] (situación), [D]ictericia, SAI (situación), ictericia [D], [D]ictericia, SAI, [D]ictericia, ictericia (hallazgo), ictericia, Ictericia |
| German | IKTERUS, Gelbsucht NNB, GELBSUCHT, Gelbsucht, nicht naeher bezeichnet, Gelbsucht, Ikterus |
| Dutch | geelzucht NAO, icterus, Niet gespecificeerde geelzucht, geelzucht, Geelzucht, Cholemie, Icterus |
| Italian | Ittero NAS, Ittero |
| Japanese | 黄疸ＮＯＳ, ｵｳﾀﾞﾝ, ｵｳﾀﾞﾝNOS, 黄疸 |
| Swedish | Gulsot |
| Czech | žloutenka, ikterus, Ikterus NOS, Ikterus |
| Finnish | Ikterus |
| Russian | ZHELTUKHA, ЖЕЛТУХА |
| Korean | 상세불명의 황달 |
| Polish | Żółtaczka |
| Hungarian | Sárgaság k.m.n., Sárgaság, Icterus |
| Norwegian | Ikterus, Gulsott, Icterus |
Ontology: Yellow complexion (C0558148)
| Concepts | Finding (T033) |
| SnomedCT | 225549006 |
| Dutch | gele huid, huidverkleuring geel, huidkleuring geel |
| French | Coloration jaune de la peau, Coloration cutanée jaune |
| German | gelbe Hautfarbe, Hautfarbe gelb |
| Italian | Cute gialla, Colorito della cute giallo |
| Portuguese | Pele amarela, Coloração amarela da pele |
| Spanish | Piel amarilla, Piel amarillenta, Coloración amarilla de la piel, piel amarilla (hallazgo), piel amarilla |
| Japanese | 黄色皮膚, 皮膚黄染, ｷｲﾛﾋﾌ, ﾋﾌｵｳｾﾝ, ｵｳｼｮｸﾋﾌ |
| English | Yellow complexion, skin yellowing, yellow complexion, skin yellow, yellow skin, Yellow skin, Yellow skin (finding), Skin coloring yellow, Skin colouring yellow |
| Czech | Žluté zbarvení kůže, Žlutá kůže |
| Hungarian | Sárga bőr, Bőr elszíneződése, sárga, sárga bőrelszíneződés |
