The following symptoms and complaints may occur together with jaundice (jaundice):
Pathognomonic (characteristic of a disease).
- Yellowing of the skin and mucous membranes – most likely seen in the sclerae (sclera of the eye); yellowing also affects the internal organs and body fluids
Icterus is visible as:
- Scleral icterus: bilirubin concentration of 2 mg/dl.
- Skin icterus: > 3 to 4 mg/dl
Yellowing and a bilirubin concentration between 1 and 2 mg/dl is called subicterus.Associated symptom.
- Darkening of the urine – due to excretion of bile acids by the kidneys – as well as a decolorization of the stool (= acholic stool: white to gray-white stool, poorly formed / choppy or choppy stool) – due to lack of bile excretion into the intestine due to a disturbance of bile formation or outflow (cholestasis).
Warning signs (red flags)
- Painless progressive (advancing) jaundice→ think of: Pancreatic carcinoma (cancer of the pancreas).
- In the simultaneous occurrence of restlessness, impaired concentration, drowsiness and foetor hepaticus (specific breath odor: smelling of raw liver) think of fulminant liver failure.
- Icterus and fever, possibly also with colic → think of: Cholangitis (bile duct inflammation).
- Icterus and colic → think of: Choledocholithiasis (bile duct stones).
- Icterus and pruritus (itching) → think of: primary biliary cholangitis (PBC, synonyms: non-purulent destructive cholangitis; formerly primary biliary cirrhosis) – relatively rare autoimmune disease of the liver (affects women in about 90% of cases); starts primarily biliary, i.e. at the intra- and extrahepatic bile ducts, which are destroyed by inflammation (= chronic non-purulent destructive cholangitis). In the longer course, the inflammation spreads to the entire liver tissue and eventually leads to scarring and even cirrhosis; detection of antimitochondrial antibodies (AMA); PBC is often associated with autoimmune diseases (autoimmune thyroiditis, polymyositis, systemic lupus erythematosus (SLE), progressive systemic sclerosis, rheumatoid arthritis); associated with ulcerative colitis in 80% of cases; long-term risk of cholangiocellular carcinoma is 7-15%.
- An enlarged, nodular, and hard liver is often the cause of metastases (daughter tumors).
