Jaundice

Question 1

Time course

Answer 1

When did you first notice the yellow colour?
Has it been getting worse?
Does the jaundice come and go?

Question 2

Context

Answer 2

Have there been changes to your medication?
Have there been any changes to your diet?
Has anybody else you know gotten the same symptoms?Do you remember if you had vaccinations for Hepatitis?

I am going to need to ask you a few more personal questions to find out what might be causing this. These are questions which we ask everyone who comes in with similar problems and is absolutely confidential.

Do you drink alcohol? (go onto alcohol) 
Have you had any tattoos or piercing? 
Have you travelled overseas recently?
Have you ever injected yourself with drugs? 
Have you had unprotected sex recently? 
Have you even had unprotected sex?

Question 3

Associated features

Answer 3

Have you noticed anything else with the jaundice?
Have you notices in changes with your bowel habits?
Have you noticed any changes with the stool?
Have you noticed any changes with your urine?
Have you experienced an itch at all?
Have you experienced any pain?
Have you had any swelling?
Have you had a fever at all?

Question 4

Differential diagnosis

Answer 4

Hepatitis A + E – recent ravel, nausea, other contacts, vaccination history (A)

Hepatitis B + C – risky sex, IV drug use, piercings and tattoos, vaccination history (B)

Gallstones – Transient Severe Abdominal Pain, intermittent jaundice, high cholesterol, change in diet, recent attempts to lose weight, obesity, dark urine, pale stools

Chronic Liver Disease – Alcohol History, Hepatitis in the past, ascites, peripheral oedema, dark urine, pale stools (but may be normal)

Drug reactions and medication - medication (eg rifampicin- antibiotic), dark urine

Haemolysis –
 Malaria – travel, fever, fatigue, chills, headache, nausea and vomiting, possible dark urine
 Other Infection - fever, fatigue, chills, headache, nausea and vomiting, possible dark urine
 Genetic (eg Sickle Cell) – fatigue, family history of sickle cell anaemia, normal urine and stool