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Factors determining the severity of jaundice
Last reviewed: 06.07.2025
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Even with complete biliary obstruction, the severity of jaundice may vary. Following a rapid rise, serum bilirubin levels begin to decline after about 3 weeks, even if obstruction persists. The severity of jaundice depends on both the production of bile pigment and the excretory function of the kidneys. The rate of formation of bilirubin from heme may vary; in addition to bilirubin, other products may be formed that do not undergo diazoreaction. Bilirubin, mainly unconjugated, may also be excreted from the serum of the intestinal mucosa.
With prolonged cholestasis, the skin acquires a greenish tint, probably due to the deposition of biliverdin, which is not involved in the diazo reaction (van den Bergh), and possibly other pigments.
Conjugated bilirubin, which is water-soluble and can penetrate body fluids, causes more severe jaundice than unconjugated bilirubin. The extravascular space of the body is larger than the intravascular space. Therefore, hepatocellular and cholestatic jaundice are usually more intense than hemolytic.
The following types of jaundice are distinguished:
- Suprahepatic (hemolytic).
- Hepatic (parenchymal).
- Subhepatic (mechanical).
In suprahepatic jaundice, the erythropoietic system is primarily affected, with increased breakdown of erythrocytes, hyperproduction of bilirubin, and insufficient uptake by the liver.
In hepatic jaundice, the pathological process is localized in hepatocytes, cholangioli, there is an isolated or combined disorder of the capture, conjugation and excretion of bilirubin from liver cells.
In subhepatic jaundice, the pathological process is localized in the extrahepatic bile ducts, the release of bilirubin through the bile ducts is disrupted with its entry into the blood, and there is also a decrease in the excretion of pigment from hepatocytes.
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