Jaundice

114 Jaundice



Instruction


Would you like to ask this patient a few questions and perform a relevant examination?



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


• Alcohol consumption


• 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


• Fever, rigors and abdominal pain: suggests cholangitis.



Examination




• Hands (clubbing, palmar erythema, Duputryen’s contracture)


• Sclera (to confirm the icterus)


• Conjuctiva, for pallor


• Neck, lymph nodes


• Upper chest: spider naevi, loss of axillary hair and gynaecomastia


• Abdomen: hepatomegaly, splenomegaly, Murphy’s sign, palpable gallbladder, ascites


• Legs, for pitting oedema


• Tell the examiner that you would like to:


• examine the urine

• do a digital rectal examination.

Remember: The most important question to answer in the evaluation of any jaundiced patient is ‘Will this patient require surgery to relieve biliary obstruction?’


Be prepared to discuss bilirubin metabolism.

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Dec 4, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Jaundice

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