Jaundice Flashcards
What are the differentials of jaundice?
Alcoholic Liver Disease Choledocholithiasis Hepatitis Non-alcoholic Steatohepatits Ascending cholangitis Autoimmune hepatitis Pancreatic Carcinoma Haemochomatosis Haemolytic Anaemia
What are the symptoms of alcoholic liver disease?
5 to 10 years of alcohol abuse (>50 to 60 g/day for men and 20 to 30 g/day for women), abdominal pain, pruritus, generalised malaise, weight loss, fatigue, anorexia, cachexia, pale stool, dark urine, melaena, or haematemesis
What are the signs of alcoholic liver disease?
parotid gland enlargement, Dupuytren’s contracture, generalised wasting, gynaecomastia, altered sensorium, asterixis or altered deep tendon reflexes, track marks (if concomitant drug use), ecchymosis or petechiae, spider angioma, thenar eminence loss, palmar erythema, caput medusa, ascites, hepatosplenomegaly or small liver, pleural effusion, right heart failure, positive rectal examination (blood)
What first line investigations would you do in alcoholic liver disease?
serum liver function tests: aspartate aminotransferase and alanine aminotransferase rarely >200 U/L; raised serum bilirubin; low albumin
prothrombin time (PT)/international normalised ratio (INR): elevated
full blood count: low platelet count; high white blood cell (WBC) count
urea: elevated
CAGE score: >2
abdominal ultrasound: usually hyperechoic, may describe mixed echogenicity in cirrhotic patients
What other investigations would you do in alcoholic liver disease?
upper endoscopy: varices
What are the symptoms of choledocholithiasis?
right upper quadrant (RUQ) pain, aggravated by meals, fever
What are the signs of choledocholithiasis?
RUQ abdominal tenderness, fever
What first line investigations would you consider in choledochlithiasis?
serum liver function tests: high direct bilirubin, gamma-GT, and alkaline phosphatase
prothrombin time/international normalised ratio: usually normal
full blood count: elevated white blood cell count
abdominal ultrasound: intra- and extrahepatic biliary tree dilation with/without stone(s) in the common bile duct
What other investigations would you consider in choledochlithiasis?
serum cholesterol: may be increased
magnetic resonance cholangiopancreatography: stone(s) in the bile duct
endoscopic ultrasound: stone(s) in the bile duct
endoscopic retrograde cholangiopancreatography: stone(s) in the bile duct
What are the symptoms of Hepatitis E?
may be hx of risk factors (e.g., travel to Southeast Asia, northern and central Africa, India, and Central America), exposure to pigs or undercooked pork; more common in middle-aged/older men; anorexia, nausea and vomiting, diarrhoea, abdominal pain, pruritus, myalgia, neurological symptoms (5% of patients); pregnancy is associated with more florid disease; patients with pre-exsiting liver disease have a high risk of decompensation and a 70% mortality
What are the signs of hepatitis E?
may be normal; abdominal tenderness, tender hepatosplenomegaly, lymphadenopathy, jaundice, ascites, signs of encephalopathy (e.g., memory, attention, and concentration deficits, confusion, asterixis, nystagmus, clonus, rigidity, coma)
What first line investigations would you do in hepatitis E?
serum liver function tests: high direct bilirubin, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and gamma-GT
prothrombin time/international normalised ratio: may be increased
abdominal ultrasound: nonspecific
What other investigations would you consider in Hepatitis E?
serum anti-hepatitis E virus IgM antibodies: positive
hepatitis E virus polymerase chain reaction: positive
What are the symptoms of Hepatitis A?
may be hx of risk factors (e.g., travel to endemic part of the world, close contact with known infected person, known food-borne outbreak), anorexia, nausea, vomiting, diarrhoea, abdominal pain, weight loss
What are the signs of Hepatitis A?
abdominal tenderness, tender hepatosplenomegaly, lymphadenopathy, jaundice; fulminant infection: worsening jaundice, ascites, signs of encephalopathy (e.g., memory, attention, and concentration deficits, confusion, asterixis, nystagmus, clonus, rigidity, coma)
What are the first line investigations that you would do in Hepatitis A?
serum liver function tests: high direct bilirubin, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and gamma-GT prothrombin time (PT)/international normalised ratio (INR): may be increased full blood count: low or normal platelet count abdominal ultrasound: nonspecific
What other investigations would you do in Hepatitis A?
serum IgM anti-hepatitis A virus: positive
What are the symptoms of Hepatitis B?
may be hx of risk factor (e.g., travel to endemic part of the world, high-risk sexual hx, intravenous drug use), may have minimal or no symptoms, may have lethargy, nausea, vomiting, abdominal pain; acute presentation (uncommon): worsening jaundice and lethargy, confusion; chronic infection with late complications: pruritus, abdominal swelling, haematemesis, melaena, confusion, lethargy, weight loss, weakness, bruising
What are the signs of Hepatitis B?
acute infection: usually normal, but may have jaundice, tender hepatomegaly, and if severe: signs of encephalopathy (e.g., memory, attention, and concentration deficits, confusion, asterixis, nystagmus, clonus, rigidity, coma); chronic infection: may have jaundice, muscle wasting, gynaecomastia, palmar erythema, spider angiomata, petechiae, ascites, distended abdominal veins, hepatosplenomegaly, signs of encephalopathy
