Painless jaundice in adults should prompt consideration of which benign condition?

• A. Acute hepatitis
• B. Choledocholithiasis
• C. Pancreatic cancer
• D. Gilbert syndrome

Answer: (D)

Painless jaundice in adults often points to a mild, unconjugated elevation of bilirubin rather than an obstruction or inflammatory liver disease. Gilbert syndrome is a common, benign cause of this pattern. It stems from a mild deficiency of the liver enzyme that conjugates bilirubin (UDP-glucuronosyltransferase), so bilirubin remains in the unconjugated form and can rise intermittently, especially during stress, illness, or fasting. The jaundice is typically mild, episodes come and go, and liver enzymes are normal because there is no real liver injury or biliary obstruction. Urine usually isn’t dark and stools remain normal, reflecting the unconjugated nature of the bilirubin.

In contrast, acute hepatitis would usually bring systemic symptoms and elevated liver enzymes; biliary obstruction or choledocholithiasis would cause conjugated hyperbilirubinemia with dark urine and pale stools, and pancreatic cancer, while it can cause painless jaundice, is not benign and is often accompanied by weight loss and other signs. Gilbert syndrome best fits painless, intermittent jaundice without alarming features.