Jaundice & Decompensated Liver Disease
Interpret liver-test patterns and recognise complications that require urgent investigation and treatment.
Quick revision ↓ Medical Dictionary
01Classify the pattern
Jaundice can result from excess bilirubin production, hepatocellular dysfunction or impaired bile drainage. Consider bilirubin fractions alongside ALT, AST, alkaline phosphatase and clinical findings. A cholestatic pattern suggests a different investigation pathway from predominant hepatocellular injury, but mixed patterns occur. Dark urine and pale stools support conjugated hyperbilirubinaemia and impaired bile flow; neither identifies the cause without further assessment.
02Assess function and cause
Aminotransferases indicate injury rather than directly measuring functional reserve. Albumin and clotting measures offer information about synthesis but have other influences. Review alcohol, prescribed and non-prescribed medicines, viral exposures, metabolic risk and autoimmune features. Ultrasound often helps evaluate biliary obstruction and chronic-liver appearances. Acute jaundice with coagulopathy or altered consciousness needs urgent specialist assessment rather than an outpatient repeat alone.
03Recognise decompensation
Ascites, variceal bleeding, encephalopathy and worsening jaundice indicate clinically important deterioration in chronic liver disease. Search for infection, gastrointestinal bleeding, dehydration, constipation and medication effects. Fluid overload may coexist with reduced effective circulating volume, complicating treatment. Avoid assuming every confused patient with cirrhosis has only hepatic encephalopathy; glucose disturbance, intracranial disease, intoxication and sepsis remain possible.
04Ascites and infection
New or worsening ascites and illness in cirrhosis often require diagnostic paracentesis through the supervised pathway. Spontaneous bacterial peritonitis may occur without impressive abdominal pain or fever. Ascitic neutrophil count and microbiology guide management, and a count of at least 250 cells per microlitre supports treatment for SBP in the appropriate setting. Assess renal function and haemodynamics because complications can progress quickly.
05Long-term and emergency care
Management addresses the cause, nutrition, complications and referral for specialist or transplant assessment when indicated. Patients need medication review, vaccination and surveillance tailored to their condition. Suspected acute liver failure, major bleeding or cholangitis requires urgent care. Fever, jaundice and right-upper-quadrant pain suggest biliary infection; instability makes source control and timely antibiotics particularly urgent rather than waiting for the classic triad to be complete.
High-Yield Revision
- Liver enzymes show injury patterns, not complete functional reserve.
- Confusion in cirrhosis needs a broad precipitant search.
- SBP can have subtle symptoms.
Common Pitfalls
- Do not delay evaluation of jaundice with coagulopathy or encephalopathy.
- Do not assume absence of fever excludes infection in cirrhosis.
References & Further Reading
Read the relevant guideline sections alongside these original clinical teaching cases. Local pathways, available services and individual patient factors determine care.
Reference review: 27 September 2026. Consult current local protocols for prescribing, procedures and escalation.