Hepatocellular Jaundice

CLINICAL DIAGNOSTIC MANUAL

Hepatocellular jaundice is a type of jaundice resulting from dysfunction of hepatocytes, the main liver cells responsible for bilirubin metabolism. This condition is characterised by the accumulation of bilirubin in the blood due to the liver’s inability to process it properly. Clinically, jaundice manifests as a yellowish discoloration of the skin, sclera, and mucous membranes, and it may indicate acute or chronic liver damage. Accurate diagnosis is essential to determine the underlying cause and guide effective treatment.

Pathology	Clinical Symptoms and Signs	Suspected Diagnosis	Confirmatory Diagnosis
Viral hepatitis (A, B, C, D, E)	Jaundice, fatigue, dark urine, pale stools, hepatomegaly, right upper quadrant pain, fever (in acute hepatitis)	Clinical history, signs of jaundice, elevated liver enzymes	Specific viral serology (IgM for hepatitis A, B, E; PCR for hepatitis B, C, D)
Liver cirrhosis	Chronic jaundice, fatigue, ascites, esophageal varices, hepatic encephalopathy, splenomegaly, telangiectasias, gynecomastia, palmar erythema	History of alcoholism or chronic hepatitis, advanced symptoms of liver dysfunction	Liver biopsy, ultrasound showing cirrhosis, altered liver function tests
Drug or toxin-induced hepatotoxicity	Jaundice, nausea, vomiting, anorexia, hepatomegaly, right upper quadrant pain	History of drug or toxin exposure, signs of acute liver damage	Elevated liver enzymes, medication history, improvement upon drug cessation
Hepatic steatosis (NAFLD and alcoholic)	Fatigue, hepatomegaly, jaundice (less common in early stages), mild abdominal pain, moderately elevated transaminases	History of alcoholism or metabolic risk factors, ultrasound showing fatty liver	Liver biopsy showing steatosis, elevated transaminases
Autoimmune hepatitis	Jaundice, fatigue, arthralgias, myalgias, mild fever, hepatomegaly, telangiectasias	History of autoimmune diseases, elevated transaminases, positive autoantibodies	Liver biopsy with lymphoplasmacytic infiltration, autoantibodies (ANA, SMA, LKM-1)
Hemochromatosis	Jaundice, fatigue, joint pain, hepatomegaly, diabetes, skin hyperpigmentation, cirrhosis in advanced stages	Family history, symptoms of hyperpigmentation and diabetes, elevated iron and ferritin levels	Liver biopsy with iron deposits, HFE gene mutation (C282Y, H63D)
Wilson’s disease	Jaundice, fatigue, neurological symptoms (tremors, dysarthria), hepatomegaly, Kayser-Fleischer rings in the eyes	Neurological and liver symptoms in young individuals, low ceruloplasmin levels	Liver biopsy showing copper deposits, elevated 24-hour urinary copper
Alpha-1 antitrypsin deficiency	Jaundice, dyspnea, chronic cough, hepatomegaly, family history of liver or lung disease	Family history, symptoms of liver and lung dysfunction, low AAT levels	Genetic testing for AAT mutation, liver biopsy showing PAS-positive deposits
Hepatocellular carcinoma	Jaundice, weight loss, abdominal pain, hepatomegaly, palpable liver mass, fatigue, ascites	History of cirrhosis or chronic hepatitis, liver mass on imaging	Liver biopsy, elevated alpha-fetoprotein levels, CT or MRI with typical features
Systemic infections affecting the liver	Jaundice, high fever, chills, abdominal pain, hepatomegaly, signs of sepsis (in severe cases)	Recent infection history, severe systemic symptoms, elevated liver enzymes	Positive blood cultures, serological tests for specific infections, abdominal ultrasound or CT
Primary sclerosing cholangitis	Jaundice, intense pruritus, fatigue, right upper quadrant pain, hepatomegaly, cholestasis symptoms	History of inflammatory bowel disease, elevated ALP and GGT	MR cholangiography showing bile duct strictures, liver biopsy
Gilbert’s syndrome	Mild intermittent jaundice, generally asymptomatic, triggered by stress, fasting, or illness	History of mild jaundice without other symptoms, normal liver enzymes	Clinical diagnosis, DNA testing for UGT1A1 gene mutation