Pre-Hepatic / Hepatic / Post-Hepatic Classification
| Type | Mechanism | Causes | Urine/Stool |
|---|---|---|---|
| Pre-hepatic | Excess bilirubin production (haemolysis) | Haemolytic anaemia, G6PD deficiency, sickle cell | Dark urine; normal stools |
| Hepatic | Liver cell dysfunction | Hepatitis, cirrhosis, autoimmune hepatitis, Gilbert's syndrome, medications | Variable |
| Post-hepatic (obstructive) | Bile duct blockage | Gallstones, pancreatic cancer, cholangiocarcinoma, PSC | Very dark urine; pale (clay-coloured) stools; itch |
Painless Obstructive Jaundice = UrgentPainless progressive jaundice in a middle-aged or older patient with pale stools, dark urine, and weight loss — pancreatic cancer presentation. Same-day urgent referral for CT and biopsy.
Key Investigations
- LFTs: bilirubin, ALT, AST, ALP, GGT — pattern distinguishes hepatocellular from cholestatic
- Ultrasound abdomen — first-line imaging for biliary dilation and gallstones
- CT abdomen/MRCP — for pancreatic pathology and biliary anatomy
- Hepatitis serology (A, B, C) — for viral hepatitis
- Blood film + haemolytic screen — for pre-hepatic jaundice
Gilbert's Syndrome — The Benign CauseGilbert's syndrome causes intermittently elevated unconjugated bilirubin, particularly during fasting, illness, or alcohol. It's present in ~5–10% of the population. Completely benign. Diagnose by pattern (other LFTs normal; clears with eating); confirm with genetic testing if needed.
What does pale stool and dark urine with jaundice mean?
This is obstructive (post-hepatic) jaundice — bile cannot flow into the gut (causing pale stools) and spills into blood/urine (dark urine). This requires urgent imaging to find and treat the blockage.
Is jaundice in newborns normal?
Neonatal jaundice is common (60% of term babies) and usually physiological — caused by immature liver handling high bilirubin from fetal red cell breakdown. Most resolve in 1–2 weeks. High levels need phototherapy or exchange transfusion.
Can alcohol cause jaundice?
Yes — alcoholic hepatitis and cirrhosis both cause jaundice. Severe acute alcoholic hepatitis (Maddrey score ≥32) is life-threatening and may require steroids. Abstinence is the most important intervention.
What is MRCP?
Magnetic resonance cholangiopancreatography — a non-invasive MRI-based technique that visualises the bile ducts and pancreatic duct without radiation or contrast injection. The gold standard for evaluating biliary obstruction cause before ERCP.
Medical Disclaimer: This page is for general education only and does not replace professional medical advice. Always consult a qualified healthcare provider.