McKnight J T, Jones J E
University of Alabama School of Medicine, Tuscaloosa.
Am Fam Physician. 1992 Mar;45(3):1139-48.
Jaundice is a disorder of bilirubin metabolism and has many causes. History and physical examination help establish the diagnosis in 70 to 80 percent of patients. Elevation of alkaline phosphatase and gamma-glutamyl transpeptidase suggests cholestasis, either intrahepatic (e.g., medication reactions) or extrahepatic (e.g., choledocholithiasis), whereas markedly elevated serum aminotransferases are indicative of hepatocellular damage from infection, toxins or ischemia. Ultrasound examination is a useful initial procedure when extrahepatic obstruction is suspected. Endoscopic retrograde cholangiopancreatography and computed tomography may be better used to diagnose obstruction at the level of the pancreas or distal common bile duct. The treatment is based on the etiology of jaundice and includes removal of offending medications or toxins, therapy for underlying liver disease or surgery for extrahepatic obstruction.
黄疸是一种胆红素代谢紊乱疾病，病因众多。病史和体格检查有助于70%至80%的患者确诊。碱性磷酸酶和γ-谷氨酰转肽酶升高提示胆汁淤积，可能是肝内性的（如药物反应）或肝外性的（如胆总管结石），而血清转氨酶显著升高则表明感染、毒素或缺血导致肝细胞损伤。当怀疑有肝外梗阻时，超声检查是一种有用的初步检查方法。内镜逆行胰胆管造影和计算机断层扫描可能更有助于诊断胰腺或胆总管远端的梗阻。治疗基于黄疸的病因，包括停用引起问题的药物或毒素、治疗潜在的肝脏疾病或对肝外梗阻进行手术。
