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Jaundice in the Emergency Department: Meeting the Challenges of Diagnosis and Treatment

Jaundice in the Emergency Department: Meeting the Challenges of Diagnosis and Treatment

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  Issue Info

Author: Todd Taylor, MD; Matthew Wheatley, MD, FACEP

Peer Reviewers: Arlene S. Chung, MD, MACM; Corinne Horan, DO

Publication Date: April 1, 2018

CME Expiration Date: April 1, 2021

CME Credits: 4 AMA PRA Category 1 CreditsTM, 4 ACEP Category I Credits, 4 AAFP Prescribed Credits, 4 AOA Category 2A or 2B Credits. 

PubMed ID: 29565526

  About This Issue

Jaundice is a manifestation of elevated serum bilirubin, and can have many causes, some of which can be life-threatening. This issue will help the emergency clinician narrow down the differential diagnosis to determine a cause and allow for swift disposition:

  • Is bilirubin elevated because of increased production, impaired uptake, impaired conjugation, obstruction, hepatocellular injury, or inherited disorder?
  • What are the laboratory tests you need to order to uncover the cause?
  • Which imaging study should you order first?
  • Which scans can offer therapeutic as well as imaging options?
  • What are the key indicators of life-threatening causes of jaundice: acetaminophen overdose, ascending cholangitis, pancreatic mass, and hemolysis?
  • What is the critical window of time for treating acetaminophen-induced liver injury?
  • How can you tell when neonatal jaundice is life-threatening?
  • What are the red flags of jaundice in a pregnant patient?
  • How should a liver transplant patient be managed?
  Issue Features
  Table of Contents
  1. Abstract
  2. Case Presentations
  3. Introduction
  4. Critical Appraisal of the Literature
  5. Selected Abbreviations
  6. Etiology and Pathophysiology
    1. Conditions That Cause Indirect Hyperbilirubinemia
      1. Increased Bilirubin Production
      2. Impaired Hepatic Bilirubin Uptake
      3. Impaired/Decreased Conjugation
    2. Conditions That Cause Direct Hyperbilirubinemia
    3. Extrahepatic Biliary Obstruction
    4. Intrahepatic Cholestasis
  7. Differential Diagnosis
  8. Prehospital Care
  9. Emergency Department Evaluation
    1. Initial Stabilization
    2. History
    3. Physical Examination
  10. Diagnostic Studies
    1. Laboratory Testing
      1. Comprehensive Metabolic Panel Testing
        • Liver Function Tests
        • Chemistry Panel
      2. Complete Blood Cell Count
      3. Coagulation Studies
      4. Other Tests
      5. Summary of Laboratory Studies
    2. Imaging Studies
      1. Ultrasound
      2. Computed Tomography
      3. Hepatobiliary Iminodiacetic Acid Scanning
      4. Endoscopic Retrograde Cholangiopancreatography
      5. Magnetic Resonance Cholangiopancreatography
      6. Percutaneous Transhepatic Cholangiography
      7. Which Imaging Modality Is Right for My Patient?
  11. Treatment
    1. Hemolysis
    2. Extrahepatic Obstruction
    3. Hepatocellular Injury
      1. Managing Encephalopathy
      2. Managing Coagulopathy
      3. Antibiotic Administration
      4. Consideration for Transplantation
    4. Acetaminophen-Induced Liver Injury
  12. Special Circumstances
    1. Pediatric Patients
    2. Jaundice in Pregnancy
      1. Hyperemesis Gravidarum
      2. Intrahepatic Cholestasis of Pregnancy
      3. Infectious Causes
      4. Acute Fatty Liver of Pregnancy
    3. Transplant Patients
  13. Controversies and Cutting Edge
  14. Disposition
  15. Summary
  16. Risk Management Pitfalls for Jaundice in the Emergency Department
  17. Case Conclusions
  18. Clinical Pathway for Managing Jaundice in the Emergency Department
  19. Tables and Figures
  20. References

 

  CME Information

Accreditation: EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. This activity has been planned and implemented in accordance with the accreditation requirements and policies of the ACCME.

Credit Designation: EB Medicine designates this enduring material for a maximum of 4 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Faculty Disclosures: It is the policy of EB Medicine to ensure objectivity, balance, independence, transparency, and scientific rigor in all CME-sponsored educational activities. All faculty participating in the planning or implementation of a sponsored activity are expected to disclose to the audience any relevant financial relationships and to assist in resolving any conflict of interest that may arise from the relationship. In compliance with all ACCME Essentials, Standards, and Guidelines, all faculty for this CME activity were asked to complete a full disclosure statement. The information received is as follows: Dr. Taylor, Dr. Wheatley, Dr. Chung, Dr. Horan, Dr. Mishler, Dr. Toscano, and their related parties report no significant financial interest or other relationship with the manufacturer(s) of any commercial product(s) discussed in this educational presentation. Dr. Jagoda made the following disclosures: Consultant, Daiichi Sankyo Inc; Consultant, Pfizer Inc; Consultant, Banyan Biomarkers Inc; Consulting fees, EB Medicine.

Commercial Support: This issue of Emergency Medicine Practice did not receive any commercial support

 

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Last Modified: 04/24/2018
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