Modern practice of internal medicine with emergency conditions. Management of patients with jaundice : guidelines for students and interns

Abstract

Jaundice is not a diagnosis per se but rather a physical manifestation of elevated serum bilirubin. It is not a common chief complaint. Instead, the jaundiced patient often presents with a related symptom, (e.g., abdominal pain, pruritis, vomiting, or substance ingestion). Hyperbilirubinemia is only dangerous in and of itself in neonates, where it can cross the blood brain barrier and deposit in the brain tissue, causing encephalopathy (kernicterus). In adults, jaundice serves as a marker for potentially serious hematologic or hepatobiliary dysfunction such as massive hemolysis, fulminant hepatic failure, or ascending cholangitis. Indeed, these are the cases where the emer-gency physician must intervene aggressively in order to maximize good out-comes.