Mistakes in acute jaundice and how to avoid them

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Mistakes in acute jaundice and how to avoid them

Spyridon Siakavellas, Georgios Papatheodoridis

Summary

AI Generated

Jaundice arises from abnormalities in bilirubin formation, metabolism, or excretion, or from biliary tree obstruction at any anatomical level, and numerous conditions can cause it.

Jaundice can result from abnormalities in bilirubin formation, metabolism, and excretion processes
Obstruction of the biliary tree from intrahepatic origins to the ampulla of Vater can cause jaundice even when bilirubin processing is functioning properly
The material presents the view that a careful diagnostic approach is warranted to identify the underlying cause
The material states that prompt intervention saves lives in many cases, contrasting with conventional wisdom that jaundice by itself never killed anyone

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Fevery J. Bilirubin in clinical practice: a review. Liver Int 2008; 28: 592–605. [Link]

Silverberg NB and Lee-Wong M. Generalized yellow discoloration of the skin. The diagnosis: carotenemia. Cutis 2014; 93: E11–E12. [Link]

Erlinger S, Arias IM and Dhumeaux D. Inherited disorders of bilirubin transport and conjugation: new insights into molecular mechanisms and consequences. Gastroenterology 2014; 146: 1625–1638. [Link]

Marchand A, Galen RS and Van Lente F. The predictive value of serum haptoglobin in hemolytic disease. JAMA 1980; 243: 1909–1911. [Link]

Vitek L, et al. Gilbert syndrome and ischemic heart disease: a protective effect of elevated bilirubin levels. Atherosclerosis 2002; 160: 449–456. [Link]

European Association for the Study of the Liver. EASL Clinical Practical Guidelines on the management of acute (fulminant) liver failure. J Hepatol 2017; 66: 1047–1081. [Link]

Taylor T and Wheatley M. Jaundice in the emergency department: meeting the challenges of diagnosis and treatment. Emerg Med Pract 2018; 20: 1–24. [Link]

Vuppalanchi R, Liangpunsakul S and Chalasani N. Etiology of new-onset jaundice: how often is it caused by idiosyncratic drug-induced liver injury in the United States? Am J Gastroenterol 2007; 102: 558–562. [Link]

European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Autoimmune hepatitis. J Hepatol 2015; 63: 971–1004. [Link]

10.

Chand N and Sanyal AJ. Sepsis-induced cholestasis. Hepatology 2007; 45: 230–241. [Link]

11.

Giallourakis CC, Rosenberg PM and Friedman LS. The liver in heart failure. Clinics Liv Dis 2002; 6: 947–967. [Link]

12.

van Lingen R, et al. Jaundice as a presentation of heart failure. J R Soc Med 2005; 98: 357–359. [Link]

13.

Okwara CJ, et al. Jaundice: A thyroid problem? Dig Dis Sci 2017; 62: 1901–1905. [Link]

14.

Saik RP, et al. Spectrum of cholangitis. Am J Surg 1975; 130: 143–150. [Link]

15.

Miura F, et al. TG13 flowchart for the management of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci 2013; 20: 47–54. [Link]

16.

Thursz MR, et al. Prednisolone or pentoxifylline for alcoholic hepatitis. New Engl J Med 2015; 372: 1619–1628. [Link]

17.

Crabb DW, et al. Standard definitions and common data elements for clinical trials in patients with alcoholic hepatitis: Recommendation From the NIAAA Alcoholic Hepatitis Consortia. Gastroenterology 2016; 150: 785–790. [Link]

18.

Moreau R, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology 2013; 144: 1426–1437, e1–9. [Link]

19.

Desmet VJ, et al. Classification of chronic hepatitis: diagnosis, grading and staging. Hepatology 1994; 19: 1513–1520. [Link]

20.

Kamath PS, et al. A model to predict survival in patients with end-stage liver disease. Hepatology 2001; 33: 464–470. [Link]

Abstract

Jaundice can be caused by abnormalities in any of the steps comprising the formation, metabolism and excretion of bilirubin. In addition, these processes may be functioning properly, but jaundice can be seen because of an obstruction of the biliary tree at any point, from its intrahepatic origins to its end at the ampulla of Vater. For this reason, it is clear that numerous conditions can result in jaundice. When faced with a patient presenting with jaundice a reasonable and careful diagnostic approach is, therefore, warranted to elucidate the underlying cause of this sign. Conventional wisdom may be that “jaundice by itself never killed anyone,” but it is imperative to find the cause as soon as possible, as prompt intervention saves lives in many cases.

Topics

Hepatobiliary

Citation

Siakavellas S and Papatheodoridis G. Mistakes in acute jaundice and how to avoid them. UEG Education 2018; 18: 24–26.

Published

2025

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Abstract

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Digestive Oncology Endoscopy Oesophagus

Published

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Abstract

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Mistakes in Familial Mediterranean Fever and how to avoid them

Manik Gemilyan, Gagik Hakobyan

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Fevery J. Bilirubin in clinical practice: a review. Liver Int 2008; 28: 592–605. [Link]

Silverberg NB and Lee-Wong M. Generalized yellow discoloration of the skin. The diagnosis: carotenemia. Cutis 2014; 93: E11–E12. [Link]

Marchand A, Galen RS and Van Lente F. The predictive value of serum haptoglobin in hemolytic disease. JAMA 1980; 243: 1909–1911. [Link]

Vitek L, et al. Gilbert syndrome and ischemic heart disease: a protective effect of elevated bilirubin levels. Atherosclerosis 2002; 160: 449–456. [Link]

European Association for the Study of the Liver. EASL Clinical Practical Guidelines on the management of acute (fulminant) liver failure. J Hepatol 2017; 66: 1047–1081. [Link]

Taylor T and Wheatley M. Jaundice in the emergency department: meeting the challenges of diagnosis and treatment. Emerg Med Pract 2018; 20: 1–24. [Link]

European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Autoimmune hepatitis. J Hepatol 2015; 63: 971–1004. [Link]

10.

Chand N and Sanyal AJ. Sepsis-induced cholestasis. Hepatology 2007; 45: 230–241. [Link]

11.

Giallourakis CC, Rosenberg PM and Friedman LS. The liver in heart failure. Clinics Liv Dis 2002; 6: 947–967. [Link]

12.

van Lingen R, et al. Jaundice as a presentation of heart failure. J R Soc Med 2005; 98: 357–359. [Link]

13.

Okwara CJ, et al. Jaundice: A thyroid problem? Dig Dis Sci 2017; 62: 1901–1905. [Link]

14.

Saik RP, et al. Spectrum of cholangitis. Am J Surg 1975; 130: 143–150. [Link]

15.

Miura F, et al. TG13 flowchart for the management of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci 2013; 20: 47–54. [Link]

16.

Thursz MR, et al. Prednisolone or pentoxifylline for alcoholic hepatitis. New Engl J Med 2015; 372: 1619–1628. [Link]

17.

18.

Moreau R, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology 2013; 144: 1426–1437, e1–9. [Link]

19.

Desmet VJ, et al. Classification of chronic hepatitis: diagnosis, grading and staging. Hepatology 1994; 19: 1513–1520. [Link]

20.

Kamath PS, et al. A model to predict survival in patients with end-stage liver disease. Hepatology 2001; 33: 464–470. [Link]

Abstract

Familial Mediterranean fever (FMF), also called periodic disease, Armenian disease, etc., is a prototypical autoinflammatory disorder where the underlying mechanism is the dysfunction of innate immunity, resulting in unprovoked episodes of inflammation.¹ Although considered rare worldwide, it is prevalent in people of Mediterranean origin; however, one can expect to encounter patients in all parts of the modern world. FMF is a monogenic disease with autosomal recessive inheritance.² Unlike other monogenic disorders, the diagnosis remains largely clinical, and it is important to understand the limitations of genetic testing. Another distinguishing feature is the well-established effectiveness of lifelong monotherapy with colchicine in preventing attacks and complications.³

Topics

Primary Care

Published

2025

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Mistakes in gastrostomy insertion in children and adolescents and how to avoid them

Christos Tzivinikos, Ilse Broekaert, Jorge Amil Dias, Matjaz Homan

Summary

AI Generated

Summary is not available for this content yet.

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Fevery J. Bilirubin in clinical practice: a review. Liver Int 2008; 28: 592–605. [Link]

Silverberg NB and Lee-Wong M. Generalized yellow discoloration of the skin. The diagnosis: carotenemia. Cutis 2014; 93: E11–E12. [Link]

Marchand A, Galen RS and Van Lente F. The predictive value of serum haptoglobin in hemolytic disease. JAMA 1980; 243: 1909–1911. [Link]

Vitek L, et al. Gilbert syndrome and ischemic heart disease: a protective effect of elevated bilirubin levels. Atherosclerosis 2002; 160: 449–456. [Link]

European Association for the Study of the Liver. EASL Clinical Practical Guidelines on the management of acute (fulminant) liver failure. J Hepatol 2017; 66: 1047–1081. [Link]

Taylor T and Wheatley M. Jaundice in the emergency department: meeting the challenges of diagnosis and treatment. Emerg Med Pract 2018; 20: 1–24. [Link]

European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Autoimmune hepatitis. J Hepatol 2015; 63: 971–1004. [Link]

10.

Chand N and Sanyal AJ. Sepsis-induced cholestasis. Hepatology 2007; 45: 230–241. [Link]

11.

Giallourakis CC, Rosenberg PM and Friedman LS. The liver in heart failure. Clinics Liv Dis 2002; 6: 947–967. [Link]

12.

van Lingen R, et al. Jaundice as a presentation of heart failure. J R Soc Med 2005; 98: 357–359. [Link]

13.

Okwara CJ, et al. Jaundice: A thyroid problem? Dig Dis Sci 2017; 62: 1901–1905. [Link]

14.

Saik RP, et al. Spectrum of cholangitis. Am J Surg 1975; 130: 143–150. [Link]

15.

Miura F, et al. TG13 flowchart for the management of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci 2013; 20: 47–54. [Link]

16.

Thursz MR, et al. Prednisolone or pentoxifylline for alcoholic hepatitis. New Engl J Med 2015; 372: 1619–1628. [Link]

17.

18.

Moreau R, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology 2013; 144: 1426–1437, e1–9. [Link]

19.

Desmet VJ, et al. Classification of chronic hepatitis: diagnosis, grading and staging. Hepatology 1994; 19: 1513–1520. [Link]

20.

Kamath PS, et al. A model to predict survival in patients with end-stage liver disease. Hepatology 2001; 33: 464–470. [Link]

Abstract

Adequate nutrition is essential for the homeostasis of fluids and nutrients, growth and thriving, especially in children. While the underlying principle of percutaneous endoscopic gastrostomy (PEG) placement is the same for both adults and children—providing a means of enteral feeding through the stomach—the indications, considerations and techniques differ owing to anatomical differences, age-dependent physiological concerns, and the age- and disease-specific needs of the child.

If feeding via nasogastric tube (NGT) or naso-jejunal tube (NJT) is necessary for a prolonged time, placement of a PEG or percutaneous endoscopic gastro-jejunal (PEG-J) tube should be considered. A PEG tube also allows the delivery of medications and venting of the stomach when needed. Nutrition via PEG facilitates the transition to out-of-hospital care and improves the quality of life (QoL) for children and families while improving the outcome of children with chronic diseases.

There are recent clinical guidelines providing guidance for PEG tube placement in children, but little advice on, e.g., choosing the right device for the right patient, details on postoperative management, removal of the PEG tube and other specific cases. The following article provides a combination of evidence-based data and the authors’ clinical experience.

Topics

Paediatrics Small Intestine & Nutrition Stomach & H. Pylori

Citation

Broekaert I.J, Dias J.A, Homan M and Tzivinikos C. Mistakes in gastrostomy insertion in children and adolescents and how to avoid them. UEG Education 2024; 24: 34-38.

Published

2024

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Egle Dieninyte - Misiune

UEG Mistakes In Articles

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

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Mistakes in biomarkers for IBD and how to avoid them

James C. Lee, Chris Palmer-Jones

Summary

AI Generated

Summary is not available for this content yet.

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Was this helpful?

Thanks for your feedback.

References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Fevery J. Bilirubin in clinical practice: a review. Liver Int 2008; 28: 592–605. [Link]

Silverberg NB and Lee-Wong M. Generalized yellow discoloration of the skin. The diagnosis: carotenemia. Cutis 2014; 93: E11–E12. [Link]

Marchand A, Galen RS and Van Lente F. The predictive value of serum haptoglobin in hemolytic disease. JAMA 1980; 243: 1909–1911. [Link]

Vitek L, et al. Gilbert syndrome and ischemic heart disease: a protective effect of elevated bilirubin levels. Atherosclerosis 2002; 160: 449–456. [Link]

European Association for the Study of the Liver. EASL Clinical Practical Guidelines on the management of acute (fulminant) liver failure. J Hepatol 2017; 66: 1047–1081. [Link]

Taylor T and Wheatley M. Jaundice in the emergency department: meeting the challenges of diagnosis and treatment. Emerg Med Pract 2018; 20: 1–24. [Link]

European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Autoimmune hepatitis. J Hepatol 2015; 63: 971–1004. [Link]

10.

Chand N and Sanyal AJ. Sepsis-induced cholestasis. Hepatology 2007; 45: 230–241. [Link]

11.

Giallourakis CC, Rosenberg PM and Friedman LS. The liver in heart failure. Clinics Liv Dis 2002; 6: 947–967. [Link]

12.

van Lingen R, et al. Jaundice as a presentation of heart failure. J R Soc Med 2005; 98: 357–359. [Link]

13.

Okwara CJ, et al. Jaundice: A thyroid problem? Dig Dis Sci 2017; 62: 1901–1905. [Link]

14.

Saik RP, et al. Spectrum of cholangitis. Am J Surg 1975; 130: 143–150. [Link]

15.

Miura F, et al. TG13 flowchart for the management of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci 2013; 20: 47–54. [Link]

16.

Thursz MR, et al. Prednisolone or pentoxifylline for alcoholic hepatitis. New Engl J Med 2015; 372: 1619–1628. [Link]

17.

18.

Moreau R, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology 2013; 144: 1426–1437, e1–9. [Link]

19.

Desmet VJ, et al. Classification of chronic hepatitis: diagnosis, grading and staging. Hepatology 1994; 19: 1513–1520. [Link]

20.

Kamath PS, et al. A model to predict survival in patients with end-stage liver disease. Hepatology 2001; 33: 464–470. [Link]

Abstract

The complexity of managing inflammatory bowel disease (IBD) stems from the heterogeneity of Crohn’s disease and ulcerative colitis. This leads to differences in disease course, complications, and treatment responses among patients. Current treatment strategies rely on a trial-and-error approach, but there's a need for personalized therapy. Efforts have been made to develop reliable prognostic and predictive biomarkers to overcome disease heterogeneity. This article discusses common mistakes in biomarker development, interpretation, and application in IBD, emphasizing evidence-based insights and lessons learned from other fields.

Topics

IBD

Citation

: Palmer-Jones C. and Lee J. C. Mistakes in biomarkers for IBD and how to avoid them. UEG Education 2023; 23: 8-11.

Published

2023

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Oesophageal cancer with Massimiliano di Pietro (Part 2)

Pradeep Mundre

From Vienna to Berlin: What inspired us last year at UEG Week

Pradeep Mundre

Mistakes in Familial Mediterranean Fever and how to avoid them

Gagik Hakobyan

Mistakes in gastrostomy insertion in children and adolescents and how to avoid them

Christos Tzivinikos

Mistakes in biomarkers for IBD and how to avoid them

James C. Lee

Pancreatic cystic neoplasms with Marco del Chiaro

Egle Dieninyte - Misiune

UEG Podcast Episode

UEG Podcast

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Not sure what you can access? Learn more about account types.

Pancreatic cystic neoplasms with Marco del Chiaro

Marco Del Chiaro, Egle Dieninyte - Misiune

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

Abstract

Topics

Pancreas

Published

2025

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Mistakes in Familial Mediterranean Fever and how to avoid them

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Christos Tzivinikos

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Pancreatic cystic neoplasms with Marco del Chiaro

Egle Dieninyte - Misiune