Jaundice 2 Flashcards
What would RUQ discomfort, nausea, vomiting and jaundice suggest?
hepatitis of any cause (virus, autoimmune, drugs, alcohol)
What would fever or diarrhoea and jaundice suggest?
liver infection (viral hep, abscess)
What would steatorrhoea, dark urine, pruritis with jaundice suggest?
obstruction to biliary flow
What would weight loss, fever, night sweats and jaundice suggest?
malignancy of liver, bile duct or pancreas
What would bronzed skin and signs of DM with jaundice suggest?
haematochrosis
What would exposure to outdoor water/sewage with jaundice suggest?
leptospirosis
What conditions should you check in PMHx with jaundice?
- Gallstones
- Liver disease
- Haemophilia
- Recent blood transfusion or surgery
- UC
- DM
- Emphysema
- Psychosis
What would PMHx of gallstones make more likely with jaundice?
- obstructive jaundice due to gallstones
2. ascending cholangitis blocking the CBD
What would a PMHx of liver disease make more likely with jaundice?
- alcoholic liver disease
- NAFLD
- Hep B + C
- haemochromatosis
- Wilson’s disease
- alpha-1 antitrypsin deficiency
- PBC
- PSC
Why do you ask about haemophilia in PMHx with jaundice?
could have received blood transfusion in 80s with hep C
Why do you ask about recent blood transfusion or surgery with jaundice?
blood group incompatability (rare)
Why do you ask about UC in jaundice?
makes PSC more likely
Why do you ask about DM in jaundice?
seen in haematochromatisis
Why do you ask about emphysema with jaundice?
suggests alpha-1antitrypsin therapy
Why do you ask about psychosis with jaundice?
may suggest Wilson’s disease
What mechanisms can medications cause haemolysis by?
- Intravascular haemolysis
- Autoimmune, extravacular haemolysis
- Cholestasis
What medications can cause intravascular haemolysis?
- sulphonamides
2. aspirin in G6PDH-deficient patients
What medication causes autoimmune, extravascular haemolysis?
methydopa
What medication can cause haemolysis by hepatitis?
paracetamol overdose
What medications can cause haemolysis by cholestasis?
co-amoxiclav
What familial conditions can cause jaundice that you need to ask about in FHx?
- Gilbert’s disease
- Haemochromatosis
- Wilson’s disease
- Sickle cell disease
- Thalassaemia
- Hereditary spherocytsosis
- G6PDH deficiency (X linked)
What social history should you ask about?
- Excessive alcohol consumption? 35 units/week (female) 50 units/week (male) dangerous
- IV drug use
- Unprotected sex or multiple partners
- Foreign travel
- Tattoos
Why do you ask about foreign travel in SHx with jaundice?
- Malaria
- Hep A
- Hep E
Why do you ask about tattoos in jaundice?
viral hep
What basic observations do you check for with jaundice?
- Signs of dehydration
2. Fever
What are signs of dehydration?
- tachycardia
- narrow pulse pressure
- hypotension (late sign)
What do you need to look for on inspection with jaundice?
- Confirm patient is icteric (yellow eyes) and jaundiced (yellow skin)
- Cachectic
- Scratch marks
- Needle marks
- Spider naevia, palmar erythema, clubbing, bruising, gynaecomastia
- Bronzed tan
- Kayser-Fleischer rings in iris
What would a cachectic patient with jaundice suggest?
malignancy
What would a jaundice patient with scratch mark suggest?
pruritis
What would a jaundice patient with needle marks suggest?
IV drug use
What would a jaundice patient with spider naevia, palmar erythema, clubbing, bruising, gynaecomastia suggest?
chronic liver disease
What would a jaundice patient with bronzed tan suggest?
haemochromatosis
What would a jaundice patient with kayser-Fleischer rings in iris suggest?
Wilsons
What do you check in palpitation with jaundice?
- Hepatomegasly, splenomegaly or epigastric mass?
- RUQ tenderness?
- Ascites?
- Palpable lymphadenopathy
What would hepatomegaly, splenomegaly, or epigastric mass with jaundice suggest?
- malignancy
- extravascular haemolysis
- acute hepatitis
What would RUQ tenderness with jaundice suggest?
- acute hepatitis
2. gallbladder disease
What would ascites with jaundice suggest?
chronic liver disease
What would palpable lympahdenopathy with jaundice suggest?
malignancy
If a jaundiced patient has anaemia on FBC what would you do?
a blood film
If a jaundiced patient has a raised serum unconjugated bilirubin what would you do?
do blood film
If a jaundiced patient has raised liver enzymes (ALT and AST) what would you do next?
- do viral serology, ASMA, ANA (viral and autoimmune hep)
2. do AMA (for PBC) and alcohol history (alcohol hep)
If a jaundiced patient has raised biliary enzymes (ALP and GGP) what would you do next?
- do AMA (for PBC) and alcohol history (alcohol hep)
2. do US of biliary tree (for dilation or obvious masses)
If a jaundiced patient has positive urinary bilirubin what would you do next?
do US of biliary tree (for dilation or obvious masses)
If a jaundiced patient has positive serum amylase what would you do next?
US of biliary tree (for dilation or obvious masses)