What are the key clinical features that may indicate a serious underlying condition in a patient with jaundice?

Key clinical features indicating a serious underlying condition in a patient presenting with jaundice include:

• Presence of red flag signs and symptoms such as coagulopathy, abnormal clotting profile, or signs of significant illness requiring urgent admission ¹.
• Bilirubin level greater than 100 micromol/L, which necessitates same-day secondary care assessment ¹.
• Abnormal renal function accompanying jaundice ¹.
• History or suspicion of paracetamol overdose ¹.
• Frailty or significant co-morbidities increasing risk of serious illness ¹.
• Age 40 years or older, as jaundice in this group has a higher likelihood of underlying malignancy such as pancreatic cancer, warranting urgent referral via a suspected cancer pathway ¹.
• Cholestatic or obstructive pattern on liver function tests (elevated bilirubin with raised alkaline phosphatase) suggesting biliary obstruction or gallstones, requiring specialist referral ¹.
• Hepatitic pattern on liver function tests (raised bilirubin with raised alanine transaminase) indicating possible liver inflammation, requiring urgent specialist assessment ¹.
• Unexplained jaundice in any patient should prompt immediate referral for further investigation to exclude serious causes including malignancy, liver disease, or inherited conditions such as haemochromatosis or Wilson's disease ¹.

These features highlight the need for urgent investigation and management due to the potential for serious underlying pathology in adults presenting with jaundice ¹.