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jaundice
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Classifying jaundice as hemolytic , hepatocellular or obstructive Determine the etiology
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Onset
Developing in matter of hours and deepening rapidly viral or drug induced hepatitis Long standing Mild hemolytic family history Deep obstructive Chronic liver disease alcoholics
Pain in abdomen
Sudden onset right upper quadrant colicy pain with chills choledocholithiasis and ascending cholangitis Epigastic and back ache pancreatic cancer Biliary obstruction but no pain with deterioration in health and decreasing weight malignant obstruction
Pruritus
Persistent obstructive jaundice Transient Viral hepatitis
Unilateral jaundice
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Drug history Predictable dose related - acetaminophen Unpredictable isoniazide
Clues to etiology
Travel / exposure to contaminant food Hep A / hepatotoxin Blood transfusion HCV, HIV, HBV High risk behaviour sharing needles , drug abuse , unsafe sex Alcohol Family history Hemolytic anemias, Wilsons disease
Associated features
Chronic liver cell failure distension of abdomen , anasarca , hemorrhoids, hemetemesis , Arthralgia , myalgia , rash viral hepatitis History of hepatobiliary surgery
Mental status hepatic encephalopathy hepatocellular jaundice Flapping tremors Fetor hepaticus Skin Brusing clotting factor defects Petechiae / purpura Thrombocytopenia of cirrhosis
Other integumentary manifestation of cirrhosis spider nevi, palmar erythema, leuconychia, alopecia Scratch marks, hyper pigmentation, xanthomas on eyelids, extensor surface and palmar creases - Chronic cholestasis Pigmentation of shin and ulcers sickle cell disease
Multiple venous thrombosis carcinoma of body of pancreas Ankle edema cirrhosis or IVC obstruction due to hepatic malignancy Stigmata of chronic liver disease spider nevi palmar erythema Raised JVP heart failure gynecomastia caput medusae KF ring Wilsons disease
Abdomen in jaundice
Caput medusae Ascitis cirrhosis / malignancy Palpation of Liver o non palpable - not always a good sign o Palpable Large nodular liver malignancy Smooth extra hepatic cholestasis Uniformly enlarged fatty liver Tender right heart failure, viral or alcoholic hepatitis , amyloidosis
Murphys sign cholecystitis Palpation of gall bladder Courvoisiers law Spleenomegaly hemolytic jaundice , portal hypertension
To summarise
Hemolytic jaundice Positive family history Acholuric urine Stool normal coloured Lemon yellow icteruc Anemia Hemolytic faces Spleenomegaly
Hepatocellular jaundice
Prodromal symptoms myalgia, fever, rash Urine and stool colour may not be normal Pruritus may be present Orange yellow icterus Bleeding manifestation may be present Tender hepatomegaly
Obstructive jaundice
Urine is dark Clay coloured greasy stools Pruritus Green yellow icterus Sinus bradycardia may be present Xanthelesma Murphys sign Vit A and D deficiency