Book chapter
Chapter 13 - Jaundice/cholestasis
Hepatology, pp.371-397
Elsevier Inc
2025
DOI: 10.1016/B978-0-443-26710-9.00013-4
Abstract
This chapter addresses the comprehensive evaluation and management of jaundice and cholestasis, emphasizing the importance of a thorough investigation into the underlying etiology when a patient presents with elevated serum bilirubin or jaundice. For acute or subacute jaundice, prompt assessment for signs of acute liver failure (ALF) is crucial, focusing on treating the underlying cause and monitoring ALF severity using criteria like King's college or the Model for End-Stage Liver Disease (MELD) score. Poor prognosis warrants immediate referral to a liver transplantation facility.
Directed treatments, such as endoscopic retrograde cholangiography or corticosteroid therapy, are recommended based on specific etiological diagnoses. Genetic testing is advocated for pediatric patients with chronic hyperbilirubinemia, with referrals to geneticists for congenital cholestasis disorders. Chronic cholestasis patients require monitoring for fat-soluble vitamin deficiencies and nutritional assessments.
The chapter explores a step-up strategy for refractory cholestatic pruritus, discussing interventions like bile acids, cholestyramine, rifampicin, SSRIs, and naltrexone. Plasmapheresis is considered in selected cases. The complexity of cholestatic diseases, ranging from acute liver failure to chronic, mild jaundice with pruritus, underscores the need for multidisciplinary expertise. The chapter concludes by highlighting research opportunities for therapeutic targets in bile transport management within the cholestasis spectrum.”
Details
- Title: Subtitle
- Chapter 13 - Jaundice/cholestasis
- Creators
- Ali Wakil - Brooklyn Hospital CenterGopala Koneru - University of IowaNyan L. Latt - Virtua Health
- Resource Type
- Book chapter
- Publication Details
- Hepatology, pp.371-397
- Publisher
- Elsevier Inc
- DOI
- 10.1016/B978-0-443-26710-9.00013-4
- Language
- English
- Date published
- 2025
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984811209202771
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