Roche Sean P, Kobos Rebecca
Department of Family and Community Medicine, Albany Medical College, Albany, New York 12208, USA.
Am Fam Physician. 2004 Jan 15;69(2):299-304.
Jaundice in an adult patient can be caused by a wide variety of benign or life-threatening disorders. Organizing the differential diagnosis by prehepatic, intrahepatic, and posthepatic causes may help make the work-up more manageable. Prehepatic causes of jaundice include hemolysis and hematoma resorption, which lead to elevated levels of unconjugated (indirect) bilirubin. Intrahepatic disorders can lead to unconjugated or conjugated hyperbilirubinemia. The conjugated (direct) bilirubin level is often elevated by alcohol, infectious hepatitis, drug reactions, and autoimmune disorders. Posthepatic disorders also can cause conjugated hyperbilirubinemia. Gallstone formation is the most common and benign posthepatic process that causes jaundice; however, the differential diagnosis also includes serious conditions such as biliary tract infection, pancreatitis, and malignancies. The laboratory work-up should begin with a urine test for bilirubin, which indicates that conjugated hyperbilirubinemia is present. If the complete blood count and initial tests for liver function and infectious hepatitis are unrevealing, the work-up typically proceeds to abdominal imaging by ultrasonography or computed tomographic scanning. In a few instances, more invasive procedures such as cholangiography or liver biopsy may be needed to arrive at a diagnosis.
成年患者的黄疸可能由多种良性或危及生命的疾病引起。按肝前性、肝内性和肝后性病因进行鉴别诊断，可能有助于使检查工作更易于管理。黄疸的肝前性病因包括溶血和血肿吸收，这会导致非结合（间接）胆红素水平升高。肝内疾病可导致非结合或结合性高胆红素血症。酒精、传染性肝炎、药物反应和自身免疫性疾病常使结合（直接）胆红素水平升高。肝后性疾病也可导致结合性高胆红素血症。胆结石形成是导致黄疸的最常见的良性肝后性过程；然而，鉴别诊断还包括严重疾病，如胆道感染、胰腺炎和恶性肿瘤。实验室检查应首先进行胆红素尿检，这表明存在结合性高胆红素血症。如果全血细胞计数以及肝功能和传染性肝炎的初步检查没有发现问题，检查通常会进行腹部超声或计算机断层扫描成像检查。在少数情况下，可能需要进行更具侵入性的检查，如胆管造影或肝活检，以做出诊断。
