Sunday, January 15, 2006

jaundice

Jaundice is yellowness of skin and eyes caused by an excess of bile pigment. The assessment and management of jaundice is no different in the elderly and young adults. The types of jaundice are classified by whether the predominant pigment is unconjugated or conjugated.
• Unconjugated- The most common cause in the elderly person is the breakdown of hemoglobin from a pulmonary infarct in a person with cardiac failure. If cardiac failure is absent, some impairment of function of the congested liver presumably contributes.
• Conjugated- Usually subdivided into hepatic and post-hepatic. In the hepatic classification, hepatocellular damage may be associated with cardiac failure, hepatitis, macronodular or primary biliary cirrhosis, or associated with other diseases. In the post-hepatic classification there is often extrahepatic cholestasis due to gallstones or carcinoma in the ampullary region. Obstructive jaundice was much more common than hepatocellular jaundice in a study of elderly jaundiced people. Malignant causes of obstruction outnumber gallstone jaundice.
See also CANCER, LIVER; HEPATITIS.
Brocklehurst, J. C. Textbook of Geriatric Medicine and Gerontology. New York: Churchill Livingstone, 1985.

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