II. Definition

  1. "Yellow Skin" related to Hyperbilirubinemia

III. Pathophysiology

IV. Causes

  1. See Hyperbilirubinemia
  2. See Conjugated Hyperbilirubinemia
  3. See Unconjugated Hyperbilirubinemia
  4. Intrahepatic causes (55% of cases)
    1. Viral Hepatitis (especially Hepatitis C)
    2. Alcoholic Liver Disease
    3. Hepatotoxin
  5. Extrahepatic causes (45% of cases)
    1. Gallstone Disorders (e.g. Acute Cholecystitis, Choledocholithiasis)
    2. Hemolysis
    3. Cancer
  6. Pseudojaundice (skin pigmentation that mimics Jaundice)
    1. See Differential Diagnosis below

V. Symptoms

VI. Signs: Jaundice

  1. See Jaundice in Newborns
  2. Jaundice sites of predilection
    1. Face
    2. Trunk
    3. Tongue frenulum (early finding)
    4. Sclera (see Scleral Icterus)
  3. Factors that accentuate Jaundice
    1. Tanned skin
  4. Factors that may hide Jaundice
    1. Artificial light

VII. Signs: General

  1. Abdominal exam
    1. Hepatomegaly
    2. Splenomegaly
    3. Ascites
  2. Signs of Chronic Liver Disease
    1. Ecchymosis
    2. Spider angiomas
    3. Gynecomastia
    4. Palmar erythema
    5. Testicular atrophy
  3. Hepatic Encephalopathy signs
    1. Asterixis (flapping Tremor)
    2. Mental status changes
  4. Findings suggestive of Obstructive Jaundice
    1. Sinus Bradycardia
    2. Dark yellow or brown colored Urine
      1. Direct Hyperbilirubinemia (increased Urobilinogen)
      2. Shaking specimen results in yellow foam
    3. Acolic Stools
      1. Gray-white, malodorous stools

VIII. Labs: Initial

  1. Complete Blood Count
  2. Bilirubin: Diagnosis requires Bilirubin fractionation
    1. See Bilirubin
    2. Jaundice visible when Bilirubin >3-4 mg/dl
    3. See Indirect Bilirubin (Hemolytic Jaundice)
    4. See Direct Bilirubin (Obstructive Jaundice)
  3. Other Liver Function Tests
    1. Aspartate transaminase (AST)
    2. Alanine transaminase (ALT)
    3. Gamma-glutamyl transpeptidase (GGT)
    4. Alkaline Phosphatase
    5. Prothrombin Time or INR
    6. Serum Albumin
    7. Serum Protein
  4. Urinalysis
    1. Bilirubin in urine suggests Conjugated Bilirubin

IX. Differential Diagnosis: Causes of Yellow Skin

  1. See Hyperbilirubinemia
  2. Carotenemia
  3. Quinacrine
  4. Addison Disease
  5. Anorexia Nervosa
  6. Spray-on tanning substances
  7. Occupational exposure to Explosive manufacturing (Dinitrophenol, Tetryl)

X. Evaluation: Based on Bilirubin fractionation (as above)

  1. Unconjugated Hyperbilirubinemia
    1. See Indirect Bilirubin for causes
    2. Evaluate for Hemolysis
      1. Peripheral Smear
      2. Lactate Dehydrogenase
      3. Haptoglobin
      4. Direct Coombs Test
      5. Consider G6PD testing
  2. Conjugated Hyperbilirubinemia
    1. See Direct Bilirubin for causes
    2. Screen for Viral Hepatitis (Hepatitis A, Hepatitis B, and Hepatitis C)
    3. Evaluate for obstruction
      1. Consider abdominal right upper quadrant Ultrasound or Abdominal CT
      2. Consider Abdominal MRCP
    4. Consider Autoimmune Condition screening
      1. Antinuclear Antibody (ANA)
      2. Anti Liver-Kidney microsomal Antibody
      3. Anti-Smooth Muscle Antibody

XI. References

  1. Degowin (1987) Diagnostic Exam, Macmillan, p.480-1
  2. Feldman (1998) Sleisenger and Fordtran's, p. 220-231
  3. Fargo (2017) Am Fam Physician 95(3): 164-8 [PubMed]
  4. Pasha (1996) Med Clin North Am 80:995-1019 [PubMed]
  5. Roche (2003) Am Fam Physician 69:299-304 [PubMed]

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Related Studies

Ontology: Icterus (C0022346)

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

  • Blood diseases
  • Genetic syndromes
  • Liver diseases, such as hepatitis or cirrhosis
  • Blockage of bile ducts
  • Infections
  • Medicines
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, オウダン, オウダンNOS, 黄疸
Swedish Gulsot
Czech žloutenka, ikterus, Ikterus NOS, Ikterus
Finnish Ikterus
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