Pathophysiology and causes of jaundice in the critically ill 

Critically-ill patients develop jaundice for a variety of reasons. A good understanding of bilirubin metabolism can help the clinician to diagnose and treat jaundice. Intensive care unit (ICU) physicians commonly encounter elevated serum bilirubin in severely-ill patients, which can be associated with increased morbidity and mortality. A complex interaction of enzymatic pathways leads to safe excretion of bilirubin. This fine homeostasis is often disturbed and leads jaundice, which can be broadly classified into three main categories—prehepatic, hepatic, and post-hepatic. Common examples include sepsis, cardiac failure, drug toxicity, hepatic ischaemia, gall stone disease, etc. Management strategies directed towards the underlying causes aim to improve outcome. The aetiology can be often multifactorial and difficult to treat. This chapter provides a brief overview of bilirubin metabolism and aetiopathogenesis of jaundice. We also provide key recommendations to develop a systematic diagnostic approach, provide guidance on ordering appropriate investigations and on interpreting their results.