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Z Year3 Clinical Presentations > Jaundice 2 > Flashcards

Jaundice 2 Flashcards

1
Q

What would RUQ discomfort, nausea, vomiting and jaundice suggest?

A

hepatitis of any cause (virus, autoimmune, drugs, alcohol)

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2
Q

What would fever or diarrhoea and jaundice suggest?

A

liver infection (viral hep, abscess)

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3
Q

What would steatorrhoea, dark urine, pruritis with jaundice suggest?

A

obstruction to biliary flow

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4
Q

What would weight loss, fever, night sweats and jaundice suggest?

A

malignancy of liver, bile duct or pancreas

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5
Q

What would bronzed skin and signs of DM with jaundice suggest?

A

haematochrosis

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6
Q

What would exposure to outdoor water/sewage with jaundice suggest?

A

leptospirosis

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7
Q

What conditions should you check in PMHx with jaundice?

A
  1. Gallstones
  2. Liver disease
  3. Haemophilia
  4. Recent blood transfusion or surgery
  5. UC
  6. DM
  7. Emphysema
  8. Psychosis
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8
Q

What would PMHx of gallstones make more likely with jaundice?

A
  1. obstructive jaundice due to gallstones

2. ascending cholangitis blocking the CBD

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9
Q

What would a PMHx of liver disease make more likely with jaundice?

A
  1. alcoholic liver disease
  2. NAFLD
  3. Hep B + C
  4. haemochromatosis
  5. Wilson’s disease
  6. alpha-1 antitrypsin deficiency
  7. PBC
  8. PSC
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10
Q

Why do you ask about haemophilia in PMHx with jaundice?

A

could have received blood transfusion in 80s with hep C

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11
Q

Why do you ask about recent blood transfusion or surgery with jaundice?

A

blood group incompatability (rare)

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12
Q

Why do you ask about UC in jaundice?

A

makes PSC more likely

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13
Q

Why do you ask about DM in jaundice?

A

seen in haematochromatisis

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14
Q

Why do you ask about emphysema with jaundice?

A

suggests alpha-1antitrypsin therapy

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15
Q

Why do you ask about psychosis with jaundice?

A

may suggest Wilson’s disease

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16
Q

What mechanisms can medications cause haemolysis by?

A
  1. Intravascular haemolysis
  2. Autoimmune, extravacular haemolysis
  3. Cholestasis
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17
Q

What medications can cause intravascular haemolysis?

A
  1. sulphonamides

2. aspirin in G6PDH-deficient patients

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18
Q

What medication causes autoimmune, extravascular haemolysis?

A

methydopa

19
Q

What medication can cause haemolysis by hepatitis?

A

paracetamol overdose

20
Q

What medications can cause haemolysis by cholestasis?

A

co-amoxiclav

21
Q

What familial conditions can cause jaundice that you need to ask about in FHx?

A
  1. Gilbert’s disease
  2. Haemochromatosis
  3. Wilson’s disease
  4. Sickle cell disease
  5. Thalassaemia
  6. Hereditary spherocytsosis
  7. G6PDH deficiency (X linked)
22
Q

What social history should you ask about?

A
  1. Excessive alcohol consumption? 35 units/week (female) 50 units/week (male) dangerous
  2. IV drug use
  3. Unprotected sex or multiple partners
  4. Foreign travel
  5. Tattoos
23
Q

Why do you ask about foreign travel in SHx with jaundice?

A
  • Malaria
  • Hep A
  • Hep E
24
Q

Why do you ask about tattoos in jaundice?

A

viral hep

25
Q

What basic observations do you check for with jaundice?

A
  1. Signs of dehydration

2. Fever

26
Q

What are signs of dehydration?

A
  1. tachycardia
  2. narrow pulse pressure
  3. hypotension (late sign)
27
Q

What do you need to look for on inspection with jaundice?

A
  1. Confirm patient is icteric (yellow eyes) and jaundiced (yellow skin)
  2. Cachectic
  3. Scratch marks
  4. Needle marks
  5. Spider naevia, palmar erythema, clubbing, bruising, gynaecomastia
  6. Bronzed tan
  7. Kayser-Fleischer rings in iris
28
Q

What would a cachectic patient with jaundice suggest?

A

malignancy

29
Q

What would a jaundice patient with scratch mark suggest?

A

pruritis

30
Q

What would a jaundice patient with needle marks suggest?

A

IV drug use

31
Q

What would a jaundice patient with spider naevia, palmar erythema, clubbing, bruising, gynaecomastia suggest?

A

chronic liver disease

32
Q

What would a jaundice patient with bronzed tan suggest?

A

haemochromatosis

33
Q

What would a jaundice patient with kayser-Fleischer rings in iris suggest?

A

Wilsons

34
Q

What do you check in palpitation with jaundice?

A
  1. Hepatomegasly, splenomegaly or epigastric mass?
  2. RUQ tenderness?
  3. Ascites?
  4. Palpable lymphadenopathy
35
Q

What would hepatomegaly, splenomegaly, or epigastric mass with jaundice suggest?

A
  1. malignancy
  2. extravascular haemolysis
  3. acute hepatitis
36
Q

What would RUQ tenderness with jaundice suggest?

A
  1. acute hepatitis

2. gallbladder disease

37
Q

What would ascites with jaundice suggest?

A

chronic liver disease

38
Q

What would palpable lympahdenopathy with jaundice suggest?

A

malignancy

39
Q

If a jaundiced patient has anaemia on FBC what would you do?

A

a blood film

40
Q

If a jaundiced patient has a raised serum unconjugated bilirubin what would you do?

A

do blood film

41
Q

If a jaundiced patient has raised liver enzymes (ALT and AST) what would you do next?

A
  1. do viral serology, ASMA, ANA (viral and autoimmune hep)

2. do AMA (for PBC) and alcohol history (alcohol hep)

42
Q

If a jaundiced patient has raised biliary enzymes (ALP and GGP) what would you do next?

A
  1. do AMA (for PBC) and alcohol history (alcohol hep)

2. do US of biliary tree (for dilation or obvious masses)

43
Q

If a jaundiced patient has positive urinary bilirubin what would you do next?

A

do US of biliary tree (for dilation or obvious masses)

44
Q

If a jaundiced patient has positive serum amylase what would you do next?

A

US of biliary tree (for dilation or obvious masses)

Z Year3 Clinical Presentations (37 decks)

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