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Symptoms and Signs – Differential Diagnosis of Jaundice
Jaundice is a condition characterised by a yellow colouring of the skin, mucous membranes, or sclera of the eyes. It specifically indicates the presence of high quantities of conjugated or unconjugated bilirubin in the bloodstream. Fair-skinned patients exhibit the most prominent manifestations on their face, trunk, and sclera, while dark-skinned patients experience them on their hard palate, sclera, and conjunctiva.
The manifestation of jaundice is more evident under natural sunlight. Indeed, it can be imperceptible under artificial or low-quality illumination. Frequently, it is accompanied by itching (due to the adverse effects of bile pigment on sensory neurons), dark urine, and feces of clay hue.
Jaundice can arise from three different pathophysiologic mechanisms. Refer to Jaundice: The Impaired Metabolism of Bilirubin. It could serve as the sole indicator of specific diseases, such as pancreatic cancer.
Historical Background and Physical Assessment
Accurately recording a patient's jaundice history is crucial for identifying its underlying etiology. Ask the patient to indicate the initial onset of jaundice. Is he additionally experiencing pruritus, feces of clay tone, or urine of dark color? Indicate any previous occurrences or a familial predisposition to jaundice. Does he have nonspecific manifestations, such as weariness, fever, or chills; gastrointestinal manifestations, such anorexia, stomach pain, nausea, weight loss, or vomiting; or cardiovascular manifestations, such as dyspnea or rapid heartbeats? Discuss alcohol consumption and any medical history of cancer, liver illness, or gallbladder problems. Has the patient experienced recent weight loss? Obtain a drug history as well. Request information regarding any prior occurrences of hepatitis, gallstones, or liver or pancreatic disorders.
Undertake the physical examination in a well-lit room. Ensure that the orange-yellow color is in fact jaundice and not caused by hypercarotenemia, which is more noticeable on the palms and soles and does not impact the sclera. Evaluate the patient's skin for its texture, dryness, hyperpigmentation, and presence of xanthomas. Look for spider angiomas or petechiae, clubbed fingers, and gynecomastia. To diagnose heart failure in the patient, use auscultation to detect arrhythmias, murmurs, gallops, crackles, and irregular bowel sounds. Conduct palpation of the lymph nodes.
edema and abdominal soreness, pain, and embolism. Conduct palpation and percussing of the liver and spleen to assess for enlargement, and do ascites testing using the shifting dullness and fluid wave procedures. Acquire initial measurements of the patient's cognitive condition: Delicate alterations in the sensorium can serve as an initial indication of declining liver function.
Jaundice: Impaired Bilirubin Metabolism
It manifests in three distinct forms: prehepatic, hepatic, and posthepatic jaundice. All three conditions result in elevated bilirubin levels in the bloodstream caused by compromised metabolism.
In cases of prehepatic jaundice, specific medical diseases and disorders, such as transfusion responses and sickle cell anemia, lead to significant hemolysis. Rapid lysis of red blood cells surpasses the liver's ability to conjugate bilirubin, resulting in the release of significant quantities of unconjugated bilirubin into the bloodstream. This leads to heightened intestinal conversion of bilirubin into water-soluble urobilinogen, which can be eliminated by urine and feces. The insolubility of unconjugated bilirubin in water prevents its direct excretion in urine.
The condition known as hepatic jaundice arises when the liver is unable to modify or eliminate bilirubin, resulting in elevated concentrations of both conjugated and unconjugated bilirubin in the bloodstream. This phenomenon manifests in conditions such as hepatitis, cirrhosis, metastatic cancer, and during the extended use of medications that are processed by the liver.
The condition known as posthepatic jaundice arises in individuals with a biliary or pancreatic disease when the normal rate of bilirubin formation is obstructed by inflammation, scar tissue, a tumor, or gallstones, therefore impeding the passage of bile into the gut. This results in the accrual of conjugated bilirubin in the bloodstream. Renal excretion of water-soluble, conjugated bilirubin occurs.
Medical Causes Carcinoma
Pancreatic cancer of the ampulla of Vater first presents with variable jaundice, slight stomach discomfort, a recurring fever, and chills. First indication of the condition may be occult bleeding. Additional symptoms reported are weight loss, itching, and back discomfort.
Hepatic cancer, whether it is primary liver cancer or carcinoma that has spread to the liver, can lead to jaundice by blocking the bile duct. Even advanced malignancy yields vague indications and symptoms, including pain and sensitivity in the right upper quadrant, nausea, loss of weight, and a mild temperature. Upon examination, one may observe irregular, nodular, hard hepatomegaly, ascites, peripheral edema, a bruit noted over the liver, and a mass in the right upper quadrant.
Progression of jaundice, perhaps accompanied by pruritus, may be the sole indication of pancreatic cancer. Common initial observations include nonspecific symptoms such as weight loss and discomfort in the back or abdomen. The other indications and manifestations encompass anorexia, nausea and vomiting, pyrexia, steatorrhea, exhaustion, debility, diarrhea, itching, and cutaneous lesions (often on the legs).
Cholangitis
Charcot’s triad is caused by blockage and infection in the common bile duct, resulting in jaundice, right upper quadrant pain, and a high temperature accompanied by chills.
Cholecystitis
25% of patients with cholecystitis develop nonobstructive jaundice. Biliary colic usually reaches its highest point suddenly and lasts for 2 to 4 hours. The discomfort thereafter focuses in the right upper quadrant and remains continuous. Jaundice is caused by local inflammation or the migration of kidney stones to the common bile duct. Additional symptoms include nausea, vomiting (often hinting the existence of a stone), fever, excessive sweating, chills, sensitivity upon touch, a positive Murphy's sign, and maybe abdominal distension and rigidity.
Cholelithiasis
Cholelithiasis invariably results in jaundice and biliary colic. The condition is defined by intense and persistent pain in the upper right quadrant or epigastrium of the right side, which extends to the right scapula or shoulder and worsens over a period of several hours. Presenting indications and manifestations include emesis, tachycardia, and agitation. An obstruction of the common bile duct results in pyrexia, chills, jaundice, feces with a clay-colored appearance, and stomach pain. Following the ingestion of a high-fat meal, the patient may encounter a sensation of nonspecific epigastric fullness and dyspepsia.
Cirrhosis
Mild to severe jaundice accompanied by pruritus in conditions of Laënnec's cirrhosis sometimes indicates hepatocellular necrosis or increasing hepatic insufficiency. Common initial symptoms include ascites, weakness, leg edema, nausea and vomiting, diarrhea or constipation, loss of appetite, weight loss, and pain in the right upper quadrant. Profound hematemesis and other propensities for bleeding may also manifest. Additional abnormalities include hepatomegaly and parotid gland enlargement, digits with clubbing, Dupuytren's contracture, cognitive impairment, asterixis, fetor hepaticus, spider angiomas, and palmar erythema. Males may have gynecomastia, sparse hair in the chest and axilla, and testicular atrophy; females may encounter anomalies in their menstrual cycles.
Fluctuating jaundice in primary biliary cirrhosis may manifest years after the initial occurrence of other symptoms, including nausea that worsens at sleep (often the first indicator), weakness, exhaustion, weight loss, and diffuse abdominal pain. Prolonged itching can result in skin excoriation. Complicating symptoms include excessive pigmentation; signs of impaired absorption, such as nighttime diarrhea, steatorrhea, purpura, and osteomalacia; hematemesis caused by varices in the esophagus; ascites; swelling; xanthelasmas; xanthomas on the palms, soles, and elbows; and enlarged liver.
Dubin-Johnson syndrome
Fluctuating jaundice that worsens with stress is the primary symptom of Dubin-Johnson syndrome, a rare, chronic hereditary disorder that often manifests as late as age 40. Possible findings include modest hepatic enlargement and discomfort, pain in the upper abdomen, feelings of nausea, and episodes of vomiting.
Heart failure
Hepatic dysfunction leading to jaundice is observed in patients with profound right-sided heart failure. Additional consequences encompass jugular vein dilatation, cyanosis, remittent swelling of the legs and sacrum, consistent weight increase, cognitive impairment, enlarged liver, nausea and vomiting, stomach pain, and loss of appetite caused by visceral edema. Manifestations of ascites occur late. Also present may be oliguria, significant weakness, and anxiety. In the event that left-sided heart failure occurs initially, additional symptoms may encompass weariness, difficulty breathing, constriction of breathing, repeated episodes of shortness of breath, rapid breathing, irregular heartbeats, and increased heart rate.
Hepatic abscess
Recurrent abscesses can lead to jaundice, although the main symptoms are a chronic fever accompanied by chills and perspiration. Additional observations include persistent, intense pain in the upper right quadrant or midepigastrium, which may be directed to the shoulder; feelings of nausea and vomiting; loss of appetite; enlargement of the liver; an increased size of the right hemidiaphragm; and fluid accumulation in the abdomen.
Hepatitis
Dark urine and clay-colored stools usually develop before jaundice in the late stages of acute viral hepatitis. The initial systemic manifestations are somewhat diverse and encompass tiredness, nausea, vomiting, malaise, arthralgia, myalgia, headache, anorexia, photophobia, pharyngitis, cough, diarrhea or constipation, and a low-grade fever accompanied with enlargement of the liver and lymph nodes. During the icteric phase, which passes within 2 to 3 weeks unless there are problems, systemic symptoms decrease, but there may be an enlarged, palpable liver, weight loss, anorexia, and discomfort and tenderness in the right upper quadrant.
Pancreatitis (acute). Acute edema of the pancreatic head and subsequent blockage Although jaundice can be caused by the common bile duct, the main symptom of acute pancreatitis is typically intense epigastric pain that often spreads to the trunk. Assuming a supine position with the knees flexed toward the chest or assuming an upright seated orientation provides relief. Initial manifestations include episodes of nausea, chronic vomiting, abdominal distension, and the presence of Turner's or Cullen's sign. Additional observations include pyrexia, increased heart rate, abdominal stiffness and sensitivity, reduced colonic noises, and crackling sounds.
Severe pancreatitis produces extreme restlessness; mottled skin; cold, diaphoretic extremities; paresthesia; and tetany — the last two being symptoms of hypocalcemia. Fulminant pancreatitis results in extensive hemorrhage.
Sickle cell anemia
In the patient with sickle cell anemia, hemolysis results in the development of jaundice. Additional observations encompass hindered growth and development, heightened vulnerability to infection, potentially fatal thrombotic consequences, and, frequently, the presence of leg ulcers, necrotic joints, pyrexia, and chills. Additional symptoms may include arthralgia and angina. The manifestations of severe hemolysis include hematuria and pallor, persistent weariness, weakness, dyspnea (or dyspnea during exertion), and tachycardia. Alternatively, the patient may exhibit splenomegaly. A sickle cell crisis is characterized by intense bone, abdominal, thoracic, and muscle pain, a low-grade fever, and heightened weakness, jaundice, and dyspnea.
Secondary Factors
Drugs
Many medications might induce liver damage and consequent jaundice. Sulfonamides, mercaptopurine, erythromycin estolate, niacin, troleandomycin, androgenic steroids, 3-hydroxy-3-methylglutaryl reductase inhibitors, phenothiazines, ethanol, methyldopa, rifampin, and Dilantin are among the examples of medications.
Therapeutic interventions. Acute jaundice following upper abdominal surgery can be caused by hepatocellular injury resulting from organ manipulation, edema, and blocked bile flow; by the injection of halothane; or by protracted surgery leading to shock, blood loss, or blood transfusion.
A surgical shunt commonly employed to mitigate portal hypertension, such as a portacaval shunt, can potentially result in the development of jaundice.
Points of Special Consideration
In order to reduce itching, do regular bathing of the patient; use an antipruritic cream, such as calamine; and give diphenhydramine or hydroxyzine. Readied the patient for diagnostic examinations aimed at assessing biliary and hepatic function. Additional laboratory tests include urobilinogen levels in urine and feces, serum bilirubin, liver enzyme, and cholesterol levels; prothrombin time; and a complete blood count. Additional diagnostic procedures available are ultrasonography, cholangiography, liver biopsy, and exploratory laparotomy.
Therapeutic Counseling for Patients
The patient should be instructed on suitable dietary modifications and strategies to alleviate pruritus should be explored.
Guidelines for Pediatric Populations
Neonatal populations often experience physiological jaundice, which typically manifests 3 to 5 days postpartum. Neonatal obstructive jaundice often arises as a consequence of congenital biliary atresia. Choledochal cysts, which are congenital cystic dilations of the common bile duct, can also lead to jaundice in children, especially those of Japanese ancestry.
An exhaustive list of additional causes of jaundice encompasses Crigler-Najjar syndrome, Gilbert's disease, Rotor's syndrome, thalassemia major, hereditary spherocytosis, erythroblastosis fetalis, Hodgkin's disease, infectious mononucleosis, Wilson's disease, amyloidosis, and Reye's syndrome.
Jaundice is a condition characterised by a yellow colouring of the skin, mucous membranes, or sclera of the eyes. It specifically indicates the presence of high quantities of conjugated or unconjugated bilirubin in the bloodstream. Fair-skinned patients exhibit the most prominent manifestations on their face, trunk, and sclera, while dark-skinned patients experience them on their hard palate, sclera, and conjunctiva.
The manifestation of jaundice is more evident under natural sunlight. Indeed, it can be imperceptible under artificial or low-quality illumination. Frequently, it is accompanied by itching (due to the adverse effects of bile pigment on sensory neurons), dark urine, and feces of clay hue.
Jaundice can arise from three different pathophysiologic mechanisms. Refer to Jaundice: The Impaired Metabolism of Bilirubin. It could serve as the sole indicator of specific diseases, such as pancreatic cancer.
Historical Background and Physical Assessment
Accurately recording a patient's jaundice history is crucial for identifying its underlying etiology. Ask the patient to indicate the initial onset of jaundice. Is he additionally experiencing pruritus, feces of clay tone, or urine of dark color? Indicate any previous occurrences or a familial predisposition to jaundice. Does he have nonspecific manifestations, such as weariness, fever, or chills; gastrointestinal manifestations, such anorexia, stomach pain, nausea, weight loss, or vomiting; or cardiovascular manifestations, such as dyspnea or rapid heartbeats? Discuss alcohol consumption and any medical history of cancer, liver illness, or gallbladder problems. Has the patient experienced recent weight loss? Obtain a drug history as well. Request information regarding any prior occurrences of hepatitis, gallstones, or liver or pancreatic disorders.
Undertake the physical examination in a well-lit room. Ensure that the orange-yellow color is in fact jaundice and not caused by hypercarotenemia, which is more noticeable on the palms and soles and does not impact the sclera. Evaluate the patient's skin for its texture, dryness, hyperpigmentation, and presence of xanthomas. Look for spider angiomas or petechiae, clubbed fingers, and gynecomastia. To diagnose heart failure in the patient, use auscultation to detect arrhythmias, murmurs, gallops, crackles, and irregular bowel sounds. Conduct palpation of the lymph nodes.
edema and abdominal soreness, pain, and embolism. Conduct palpation and percussing of the liver and spleen to assess for enlargement, and do ascites testing using the shifting dullness and fluid wave procedures. Acquire initial measurements of the patient's cognitive condition: Delicate alterations in the sensorium can serve as an initial indication of declining liver function.
Jaundice: Impaired Bilirubin Metabolism
It manifests in three distinct forms: prehepatic, hepatic, and posthepatic jaundice. All three conditions result in elevated bilirubin levels in the bloodstream caused by compromised metabolism.
In cases of prehepatic jaundice, specific medical diseases and disorders, such as transfusion responses and sickle cell anemia, lead to significant hemolysis. Rapid lysis of red blood cells surpasses the liver's ability to conjugate bilirubin, resulting in the release of significant quantities of unconjugated bilirubin into the bloodstream. This leads to heightened intestinal conversion of bilirubin into water-soluble urobilinogen, which can be eliminated by urine and feces. The insolubility of unconjugated bilirubin in water prevents its direct excretion in urine.
The condition known as hepatic jaundice arises when the liver is unable to modify or eliminate bilirubin, resulting in elevated concentrations of both conjugated and unconjugated bilirubin in the bloodstream. This phenomenon manifests in conditions such as hepatitis, cirrhosis, metastatic cancer, and during the extended use of medications that are processed by the liver.
The condition known as posthepatic jaundice arises in individuals with a biliary or pancreatic disease when the normal rate of bilirubin formation is obstructed by inflammation, scar tissue, a tumor, or gallstones, therefore impeding the passage of bile into the gut. This results in the accrual of conjugated bilirubin in the bloodstream. Renal excretion of water-soluble, conjugated bilirubin occurs.
Medical Causes Carcinoma
Pancreatic cancer of the ampulla of Vater first presents with variable jaundice, slight stomach discomfort, a recurring fever, and chills. First indication of the condition may be occult bleeding. Additional symptoms reported are weight loss, itching, and back discomfort.
Hepatic cancer, whether it is primary liver cancer or carcinoma that has spread to the liver, can lead to jaundice by blocking the bile duct. Even advanced malignancy yields vague indications and symptoms, including pain and sensitivity in the right upper quadrant, nausea, loss of weight, and a mild temperature. Upon examination, one may observe irregular, nodular, hard hepatomegaly, ascites, peripheral edema, a bruit noted over the liver, and a mass in the right upper quadrant.
Progression of jaundice, perhaps accompanied by pruritus, may be the sole indication of pancreatic cancer. Common initial observations include nonspecific symptoms such as weight loss and discomfort in the back or abdomen. The other indications and manifestations encompass anorexia, nausea and vomiting, pyrexia, steatorrhea, exhaustion, debility, diarrhea, itching, and cutaneous lesions (often on the legs).
Cholangitis
Charcot’s triad is caused by blockage and infection in the common bile duct, resulting in jaundice, right upper quadrant pain, and a high temperature accompanied by chills.
Cholecystitis
25% of patients with cholecystitis develop nonobstructive jaundice. Biliary colic usually reaches its highest point suddenly and lasts for 2 to 4 hours. The discomfort thereafter focuses in the right upper quadrant and remains continuous. Jaundice is caused by local inflammation or the migration of kidney stones to the common bile duct. Additional symptoms include nausea, vomiting (often hinting the existence of a stone), fever, excessive sweating, chills, sensitivity upon touch, a positive Murphy's sign, and maybe abdominal distension and rigidity.
Cholelithiasis
Cholelithiasis invariably results in jaundice and biliary colic. The condition is defined by intense and persistent pain in the upper right quadrant or epigastrium of the right side, which extends to the right scapula or shoulder and worsens over a period of several hours. Presenting indications and manifestations include emesis, tachycardia, and agitation. An obstruction of the common bile duct results in pyrexia, chills, jaundice, feces with a clay-colored appearance, and stomach pain. Following the ingestion of a high-fat meal, the patient may encounter a sensation of nonspecific epigastric fullness and dyspepsia.
Cirrhosis
Mild to severe jaundice accompanied by pruritus in conditions of Laënnec's cirrhosis sometimes indicates hepatocellular necrosis or increasing hepatic insufficiency. Common initial symptoms include ascites, weakness, leg edema, nausea and vomiting, diarrhea or constipation, loss of appetite, weight loss, and pain in the right upper quadrant. Profound hematemesis and other propensities for bleeding may also manifest. Additional abnormalities include hepatomegaly and parotid gland enlargement, digits with clubbing, Dupuytren's contracture, cognitive impairment, asterixis, fetor hepaticus, spider angiomas, and palmar erythema. Males may have gynecomastia, sparse hair in the chest and axilla, and testicular atrophy; females may encounter anomalies in their menstrual cycles.
Fluctuating jaundice in primary biliary cirrhosis may manifest years after the initial occurrence of other symptoms, including nausea that worsens at sleep (often the first indicator), weakness, exhaustion, weight loss, and diffuse abdominal pain. Prolonged itching can result in skin excoriation. Complicating symptoms include excessive pigmentation; signs of impaired absorption, such as nighttime diarrhea, steatorrhea, purpura, and osteomalacia; hematemesis caused by varices in the esophagus; ascites; swelling; xanthelasmas; xanthomas on the palms, soles, and elbows; and enlarged liver.
Dubin-Johnson syndrome
Fluctuating jaundice that worsens with stress is the primary symptom of Dubin-Johnson syndrome, a rare, chronic hereditary disorder that often manifests as late as age 40. Possible findings include modest hepatic enlargement and discomfort, pain in the upper abdomen, feelings of nausea, and episodes of vomiting.
Heart failure
Hepatic dysfunction leading to jaundice is observed in patients with profound right-sided heart failure. Additional consequences encompass jugular vein dilatation, cyanosis, remittent swelling of the legs and sacrum, consistent weight increase, cognitive impairment, enlarged liver, nausea and vomiting, stomach pain, and loss of appetite caused by visceral edema. Manifestations of ascites occur late. Also present may be oliguria, significant weakness, and anxiety. In the event that left-sided heart failure occurs initially, additional symptoms may encompass weariness, difficulty breathing, constriction of breathing, repeated episodes of shortness of breath, rapid breathing, irregular heartbeats, and increased heart rate.
Hepatic abscess
Recurrent abscesses can lead to jaundice, although the main symptoms are a chronic fever accompanied by chills and perspiration. Additional observations include persistent, intense pain in the upper right quadrant or midepigastrium, which may be directed to the shoulder; feelings of nausea and vomiting; loss of appetite; enlargement of the liver; an increased size of the right hemidiaphragm; and fluid accumulation in the abdomen.
Hepatitis
Dark urine and clay-colored stools usually develop before jaundice in the late stages of acute viral hepatitis. The initial systemic manifestations are somewhat diverse and encompass tiredness, nausea, vomiting, malaise, arthralgia, myalgia, headache, anorexia, photophobia, pharyngitis, cough, diarrhea or constipation, and a low-grade fever accompanied with enlargement of the liver and lymph nodes. During the icteric phase, which passes within 2 to 3 weeks unless there are problems, systemic symptoms decrease, but there may be an enlarged, palpable liver, weight loss, anorexia, and discomfort and tenderness in the right upper quadrant.
Pancreatitis (acute). Acute edema of the pancreatic head and subsequent blockage Although jaundice can be caused by the common bile duct, the main symptom of acute pancreatitis is typically intense epigastric pain that often spreads to the trunk. Assuming a supine position with the knees flexed toward the chest or assuming an upright seated orientation provides relief. Initial manifestations include episodes of nausea, chronic vomiting, abdominal distension, and the presence of Turner's or Cullen's sign. Additional observations include pyrexia, increased heart rate, abdominal stiffness and sensitivity, reduced colonic noises, and crackling sounds.
Severe pancreatitis produces extreme restlessness; mottled skin; cold, diaphoretic extremities; paresthesia; and tetany — the last two being symptoms of hypocalcemia. Fulminant pancreatitis results in extensive hemorrhage.
Sickle cell anemia
In the patient with sickle cell anemia, hemolysis results in the development of jaundice. Additional observations encompass hindered growth and development, heightened vulnerability to infection, potentially fatal thrombotic consequences, and, frequently, the presence of leg ulcers, necrotic joints, pyrexia, and chills. Additional symptoms may include arthralgia and angina. The manifestations of severe hemolysis include hematuria and pallor, persistent weariness, weakness, dyspnea (or dyspnea during exertion), and tachycardia. Alternatively, the patient may exhibit splenomegaly. A sickle cell crisis is characterized by intense bone, abdominal, thoracic, and muscle pain, a low-grade fever, and heightened weakness, jaundice, and dyspnea.
Secondary Factors
Drugs
Many medications might induce liver damage and consequent jaundice. Sulfonamides, mercaptopurine, erythromycin estolate, niacin, troleandomycin, androgenic steroids, 3-hydroxy-3-methylglutaryl reductase inhibitors, phenothiazines, ethanol, methyldopa, rifampin, and Dilantin are among the examples of medications.
Therapeutic interventions. Acute jaundice following upper abdominal surgery can be caused by hepatocellular injury resulting from organ manipulation, edema, and blocked bile flow; by the injection of halothane; or by protracted surgery leading to shock, blood loss, or blood transfusion.
A surgical shunt commonly employed to mitigate portal hypertension, such as a portacaval shunt, can potentially result in the development of jaundice.
Points of Special Consideration
In order to reduce itching, do regular bathing of the patient; use an antipruritic cream, such as calamine; and give diphenhydramine or hydroxyzine. Readied the patient for diagnostic examinations aimed at assessing biliary and hepatic function. Additional laboratory tests include urobilinogen levels in urine and feces, serum bilirubin, liver enzyme, and cholesterol levels; prothrombin time; and a complete blood count. Additional diagnostic procedures available are ultrasonography, cholangiography, liver biopsy, and exploratory laparotomy.
Therapeutic Counseling for Patients
The patient should be instructed on suitable dietary modifications and strategies to alleviate pruritus should be explored.
Guidelines for Pediatric Populations
Neonatal populations often experience physiological jaundice, which typically manifests 3 to 5 days postpartum. Neonatal obstructive jaundice often arises as a consequence of congenital biliary atresia. Choledochal cysts, which are congenital cystic dilations of the common bile duct, can also lead to jaundice in children, especially those of Japanese ancestry.
An exhaustive list of additional causes of jaundice encompasses Crigler-Najjar syndrome, Gilbert's disease, Rotor's syndrome, thalassemia major, hereditary spherocytosis, erythroblastosis fetalis, Hodgkin's disease, infectious mononucleosis, Wilson's disease, amyloidosis, and Reye's syndrome.
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