Icterus

The yellow discoloration of the skin, sclerae, and other tissues due to deposition of bile pigments resulting from elevated serum bilirubin (normal range: 1.7–20.5 µmol/L or 0.1–1.2 mg/dL), reflecting impaired bilirubin production, metabolism, conjugation, or excretion.

Causes

• Prehepatic (hemolytic) causes

  • Hemolytic anemia

  • Sickle cell disease

  • Malaria

  • Thalassemia

  • Autoimmune hemolytic anemia

  • Transfusion reactions

  • Glucose-6-phosphate dehydrogenase (G6PD) deficiency

  • Neonatal hyperbilirubinemia

• Hepatic causes

  • Viral hepatitis

  • Cirrhosis

  • Alcohol-related liver disease

  • Inherited disorders: Gilbert syndrome, Crigler-Najjar syndrome

  • Drug-induced liver injury

  • Metabolic dysfunction-associated steatotic liver disease (MASLD)

  • Autoimmune hepatitis

  • Hemochromatosis

  • Wilson disease

  • Sepsis

  • Total parenteral nutrition–associated cholestasis

  • Pregnancy-related cholestatic liver disease

• Posthepatic (obstructive) causes

  • Gallstones (choledocholithiasis)

  • Cholangiocarcinoma

  • Pancreatic cancer

  • Pancreatitis

  • Benign biliary strictures

  • Primary sclerosing cholangitis

  • External compression of the bile ducts by tumors or enlarged lymph nodes