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

Points & Pearls Excerpt

• Jaundice has a broad differential. It can result from a multitude of hepatic and hematologic pathologies, including obstructive process, hepatocellular process, or hemolytic/hematopoietic process.
• The history and physical examination are particularly important in narrowing the differential for jaundice.
• Studies have shown that clinical estimates of serum bilirubin have shown poor interrelater reliability. Skin examination alone is insufficient in judging serum bilirubin levels.

• Lalani T, Couto CA, Rosen MP, et al. ACR appropriateness criteria jaundice. J Am Coll Radiol. 2013;10(6):402-409. (Consensus statement) DOI: https://doi.org/10.1016/j.jacr.2013.02.020
• Pasanen PA, Partanen KP, Pikkarainen PH, et al. A comparison of ultrasound, computed tomography and endoscopic retrograde cholangiopancreatography in the differential diagnosis of benign and malignant jaundice and cholestasis. Eur J Surg. 1993;159(1):23-29. (Prospective; 220 patients) https://inis.iaea.org/search/search.aspx?orig_q=RN:25018170
• Kiewiet JJ, Leeuwenburgh MM, Bipat S, et al. A systematic review and meta-analysis of diagnostic performance of imaging in acute cholecystitis. Radiology. 2012;264(3):708-720. (Review) DOI: https://doi.org/10.1148/radiol.12111561
• Williams EJ, Green J, Beckingham I, et al. Guidelines on the management of common bile duct stones (CBDS). Gut. 2008;57(7):1004-1021. (Consensus guideline) DOI: http://dx.doi.org/10.1136/gut.2007.121657
• Smilkstein MJ, Knapp GL, Kulig KW, et al. Efficacy of oral N-acetylcysteine in the treatment of acetaminophen overdose. Analysis of the national multicenter study (1976 to 1985). N Engl J Med. 1988;319(24):1557-1562. (Retrospective; 2540 patients) DOI: http://dx.doi.org/10.1056/NEJM198812153192401
• Wolf SJ, Heard K, Sloan EP, et al. Clinical policy: critical issues in the management of patients presenting to the emer-gency department with acetaminophen overdose. Ann Emerg Med. 2007;50(3):292-313. (Practice guideline) DOI: https://doi.org/10.1016/j.jen.2008.02.004
• Knox TA, Olans LB. Liver disease in pregnancy. N Engl J Med. 1996;335(8):569-576. (Review) DOI: https://doi.org/10.1056/NEJM199608223350807
• Lee WM. Acute liver failure. N Engl J Med. 1993;329(25):1862- 1872. (Review) DOI: https://doi.org/10.1056/NEJM199312163292508