Jaundice is icterus or yellowing of the skin, caused by increased levels of bilirubin in the system. The causes of jaundice may be pre-hepatic, hepatic (intrahepatic) or post-hepatic (extrahepatic).
Pre-hepatic jaundice is caused by anything which causes an increased rate of haemolysis (breakdown of red blood cells). In tropical countries, malaria can cause jaundice in this manner. Defects in bilirubin metabolism also present as jaundice.
Hepatic causes include acute hepatitis, drug toxicity and alcoholic liver disease. Less common causes include primary biliary cirrhosis, cholestasis of pregnancy and metastatic carcinoma.
Post-hepatic jaundice is caused by an interruption to the drainage of bile. The most common causes are gallstones in the common bile duct and pancreatic cancer in the head of the pancreas. Other causes include strictures of the common bile duct, ductal carcinoma, pancreatitis and pancreatic pseudocysts. A rare cause of obstructive jaundice is Mirizzi's syndrome.
The presence of pale stools suggests an obstructive or post-hepatic cause as normal faeces get their colour from bile pigments.
Webster 1913's definition of jaundice is correct for obstructive jaundice but leaves out the other causes of jaundice.
Another way of classifying the causes of jaundice are as follows: haemolytic, intrahepatic and extrahepatic.
There's also jaundice in the newborn. This happens quite often and is not a cause for concern unless it appears before the first 24 hours or does not spontaneously resolve.
A not well understood cause of jaundice is breastfeeding, which is a diagnosis of exclusion (i.e. exclude any dangerous causes of jaundice first), is harmless and resolves on cessation of breastfeeding. Worried mothers can trial their baby on formula feeds for a few days to see if the jaundice ebbs while continuing to express milk so nursing can resume later.