Diagnosis and evaluation of hyperbilirubinemia

Jaundice, the physical finding associated with hyperbilirubinemia, results when the liver is unable to properly metabolize or excrete bilirubin. The purpose of this review is to examine some of the most common causes of jaundice in adults, provide insight into the diagnostic evaluation of jaundice, and review information on the outcomes of patients with jaundice.

An elevated level of bilirubin almost always indicates the presence of an underlying disease state. The best approach to evaluating a patient with jaundice is to start with a careful history and physical examination, followed by imaging assessment of the biliary tree and liver. There are algorithm models that incorporate bilirubin levels in their predictor models for outcomes in patients with chronic liver disease (i.e., the model for end-stage liver disease). However, there are few studies that have examined the outcomes of patients with jaundice.

Evaluation of patients with jaundice starts with a careful history and physical examination, followed by directed imaging of the biliary tree and liver. Although jaundice is generally believed to be a serious medical condition, there is little literature that addresses outcomes in patients with jaundice.