What are the three types of jaundice?

Jaundice is classified as pre-hepatic (too much bilirubin produced, usually haemolysis), hepatic (the liver cannot take up, conjugate or excrete bilirubin) and post-hepatic or obstructive (bile cannot drain). Pre-hepatic jaundice is unconjugated with normal urine; post-hepatic jaundice is conjugated with dark urine, pale stools and itch.

How do you tell obstructive jaundice from hepatitis at the bedside?

Ask about urine and stool colour and look at the enzyme pattern. Obstruction gives dark urine, pale stools, itch and a dominant rise in alkaline phosphatase and GGT. Hepatitis gives dark urine with normal stools and a dominant rise in ALT, often above 1000 U/L.

Which imaging test comes first in jaundice?

Abdominal ultrasound, whenever cholestasis or mechanical obstruction is suspected. It answers the key question — are the bile ducts dilated? — and often shows gallstones.

Types of jaundice: pre-hepatic, hepatic and post-hepatic

Creator: Dr. Mohammed Maree
Published: 2026-09-28
License: https://creativecommons.org/licenses/by-nc/4.0/

Written and clinically reviewed by Dr. Mohammed Maree, consultant minimally invasive and bariatric surgeon, Al-Makassed Hospital, Jerusalem, and Assistant Professor of Surgery, Al-Quds University. Last updated 6 October 2026.

The short answer

Jaundice is sorted by asking where the block is. Pre-hepatic jaundice is too much bilirubin being made, so it is unconjugated and the urine stays normal. Hepatic jaundice is a liver that cannot handle it, giving a mixed picture with dark urine. Post-hepatic jaundice is bile that cannot drain, so the bilirubin is conjugated, the urine is dark, the stools are pale and the patient itches.

One question — where is the block? — with three answers. Everything else on this site follows from which of these three rows a patient is in.

How to tell them apart

Three bedside findings separate the three groups before any imaging is done.

	Pre-hepatic	Hepatic	Post-hepatic
Bilirubin type	Unconjugated	Mixed	Conjugated
Urine	Normal colour	Dark	Dark
Stool	Normal or dark	Normal	Pale
Itch	No	Sometimes	Often, and may precede the jaundice
Enzymes	Normal	ALT ↑↑↑	ALP and GGT ↑↑↑

A urine dipstick costs almost nothing and splits unconjugated from conjugated jaundice in minutes. Unconjugated bilirubin is bound to albumin and cannot be filtered, so it never appears in the urine. The full reasoning is here.

Causes, by level

Pre-hepatic

Anything that breaks red cells faster than the liver can conjugate the bilirubin: G6PD deficiency and favism, hereditary spherocytosis, sickle cell disease, thalassaemia, autoimmune haemolysis, malaria, a mechanical heart valve, or a large resolving haematoma. Gilbert syndrome belongs here too, though the mechanism is reduced conjugation rather than haemolysis.

Hepatic

Hepatocellular injury — viral hepatitis A to E, alcohol, paracetamol and other drugs, autoimmune hepatitis, ischaemic "shock liver", Wilson disease, decompensated cirrhosis, sepsis. Or intrahepatic cholestasis, where secretion fails without a mechanical block: co-amoxiclav, flucloxacillin, oral contraceptives, anabolic steroids, primary biliary cholangitis, primary sclerosing cholangitis, pregnancy and long-term TPN.

Post-hepatic

Use the surgical sieve — is the obstruction in the lumen, in the wall, or outside the wall?

In the lumen: common bile duct stones (much the commonest), parasites, blood clot.
In the wall: cholangiocarcinoma, ampullary tumour, benign stricture after bile duct injury, primary sclerosing cholangitis, choledochal cyst.
Outside the wall: pancreatic head cancer, chronic pancreatitis or pseudocyst, Mirizzi syndrome, nodes at the porta hepatis.

Why the distinction matters

Intrahepatic cholestasis from drugs or PBC produces the same blood picture as a stone in the bile duct. Only imaging separates them, and the finding that does it is duct dilatation. That is why ultrasound is the first-line imaging test whenever cholestasis or mechanical obstruction is suspected.

Red flags

Fever or rigors with jaundice and right upper quadrant pain — cholangitis, which needs blood cultures, antibiotics, fluids and biliary drainage.
Confusion or bleeding with new jaundice — acute liver failure.
Painless, progressive jaundice with weight loss — suspect malignancy.
Jaundice in pregnancy, or any paracetamol overdose.

Practise on a patient

Two of the nine simulated patients turn on exactly this reasoning. You choose the questions; the patient answers only what you ask.

Case 4 · clerk this patientRight upper quadrant painAisha Malik, 42, teacher
Biliary colic, cholecystitis and cholangitis — separated by two questions, one of which is about the colour of her urine.Case 2 · clerk this patientVomiting bloodBrian Costello, 58, publican
The alcohol and drug history that also decides whether this liver is the problem.

The R-factor calculator works out whether a set of liver tests is hepatocellular, mixed or cholestatic from the ALT and ALP.

MechanismWhy pale stools and dark urine?The single finding that tells you bile is not reaching the gut.PhysiologyBilirubin metabolismFrom red cell to stool and urine, and the four points it fails.InterpretationReading liver function testsThree patterns and the R-factor.OSCETaking a jaundice historySix questions with the exact words to say.

The three types of jaundice