JAUNDICE (ASSESMENT (History - Duration & any previous jaundice.…
History - Duration & any previous jaundice. Colour of stool & urine. Pain - site, severity, radiation. Itch.
Systemic - anorexia, weight loss, fever, rigors, rash, fatigue, nausea & vomiting.
Lifestyle - alcohol intake, travel abroad, tattoos, body piercings,blood transfusions, sexual partners, IVDA.
PMH - hepatitis, gallstones, thyroid disease, non-alcohol fatty lover, biliary surgery.
Occupation - exposure to viral hepatitis, HIV or hepatoxic chemicals.
Signs of sepsis.
Chronic liver disease - palmar erythema, finger nail clubbing, dupuytrens contracture.
Liver failure - ataxia, altered mental state, bruising, petechiae or purpura.
Lympahdenopathy. Masses such as hepatomegaly, splenomegaly.
Abdominal tenderness RUQ - Murphys sign. Widespread tenderness may imdicate pancreatitis or pertonitis.
Jaundice (also known as icterus) describes the yellow pigmentation of the skin, sclera, and mucous membranes resulting from raised plasma bilirubin.
Normal plasma bilirubin levels range between 5 to 19 micromol/L.
Clinical jaundice may not become apparent until serum bilirubin is greater than 51 micromol/L.
A full blood count — to identify haemolysis or infection.
Urea and electrolytes — to identify associated renal impairment.
Liver function tests (LFTs)
Clotting screen — abnormal clotting can occur in both biliary obstruction
and parenchymal liver disease.
Amylase if pancreatitis is suspected.
Hepatitis A, B, and C if risk factors are present.
Referral to gastroenterologist once blood results available
Immediate assessment if - signs of hepatic encephalopathy, signs of severe hepatic dysfunction: bruising, purpura or petechiae. Haematemesis or melaena. Sepsis. Marked abdo pain, vomiting. Suspected paracetamol overdose.
Urgent referral if suspected CA - 2week appointment.
If acutely unwell, fever, encephalopathy, dehydration, signs of cholangitis, bilirubin^100micromol/L, abnormal clotting, abnormal renal function, frail or co-morbidities.