114 Jaundice
Salient features
History
Take a history by asking the patient about the following:
• His or her age: hepatitis is more common in the young and carcinoma in the elderly
• Sore throat and rash: infectious mononucleosis
• Occupation: Weil’s disease in sewerage and farm workers
• Contact with jaundice: hepatitis A
• Drug history: oral contraceptives, phenothiazines
• Blood transfusions, injections, arthritis, urticaria: hepatitis B
• Pruritus: cholestasis caused by hepatitis A, primary biliary cirrhosis
• Colour of the urine: dark, tea- or cola-coloured urine is caused by renal excretion of conjugated bilirubin
• Colour of the stools: pale stools in obstructive jaundice
• Abdominal pain: cholecystitis, gallstones, cholangitis, carcinoma of the pancreas
• Past history: recurrent jaundice, as in Dubin–Johnson syndrome
Examination
• Hands (clubbing, palmar erythema, Duputryen’s contracture)
• Sclera (to confirm the icterus)
• Upper chest: spider naevi, loss of axillary hair and gynaecomastia
• Abdomen: hepatomegaly, splenomegaly, Murphy’s sign, palpable gallbladder, ascites
• Tell the examiner that you would like to:
Remember: The most important question to answer in the evaluation of any jaundiced patient is ‘Will this patient require surgery to relieve biliary obstruction?’

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