**Figure 1.**

*Approach to Jaundice.*

Physical exam showed typical signs of cirrhosis. Labs showed an ALP of 200, ALT 2810, AST 2670 U/L, normal gamma-glutamyl transferase (GGT), bilirubin of 3.3 mg/dL (2 direct, 1.3 indirect), and normal iron and copper levels. Patient was positive for hepatitis C, attributed to his previous blood transfusion. Alpha fetoprotein (AFP) levels were elevated and patient was scheduled for a liver ultrasound (US) and biopsy to rule out hepatocellular carcinoma (HCC).

### **2.3 Case-3**

A 39-year-old Caucasian female with a body mass index (BMI) of 36 and a history of hamishoto's thyroiditis, presented to the ED with worsening itching and jaundice. Patient's thyroid function tests were within normal range. Cholesterol was 310 mg/dL, ALP 318, ALT 24, AST 21, and GGT 1120 U/L. Liver US showed no signs of bile duct dilation. Anti-mitochondrial antibody (AMA) titers were elevated. Patient was diagnosed with primary biliary cholangitis (PBC) and was started on ursodiol.

Now what do we take from these three different cases, all of whom presented or were seen to have jaundice? To understand the different presentations of jaundice, let us classify it.

The causes of jaundice can be classified in different ways such as pre-hepatic (hemolytic), hepatic (hepatocellular), and post-hepatic (obstructive) (see **Table 1**). Now, we can differentiate between them in many laboratory and clinical findings (see **Tables 2** and **3**) and know how to approach it (see **Figure 1**).

Understanding the classification, differentiating lab results and approach towards jaundice is important. **Figure 1** can help you as a guide in term of what to do and what to expect. It is helpful to keep it in mind as we go through the chapter.
