Pre PACES Podcast #96 Jaundice
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Sep 15, 2024 Dr Rob Miller, a gastroenterology trainee with hepatobiliary expertise, breaks down jaundice assessment. He covers how to approach painful versus painless presentations. Key talks include bilirubin metabolism, focused history and exam signs, differential categories, core blood tests and imaging choices. Procedures like ERCP and EUS and practical management priorities are also explored.
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Jaundice Defined And Why It Matters
- Jaundice is yellow skin/ sclera discoloration caused by raised bilirubin and is clinically visible around bilirubin ~40–50 μmol/L.
- A systematic approach is essential to identify underlying causes and guide management.
Use Pain And Stools To Triage Causes
- Divide causes clinically into painful versus painless jaundice to prioritise differentials quickly.
- Use obstructive symptoms (pale stools, dark urine) to suspect biliary obstruction.
Bilirubin Physiology And Diagnostic Clues
- Unconjugated bilirubin is produced from haem breakdown, is albumin-bound and is conjugated in the liver to become water-soluble.
- Obstruction causes conjugated bilirubin to reflux into plasma, so split bilirubin helps localise pathology.