66YO with jaundice for 6 weeks (Others (Pseudojaundice: excessive…
66YO with jaundice for 6 weeks
Weight loss/pruritis => noninfectious jaundice
Primary biliary cirrhosis. Other sx: fatigue (excessive daytime somnolence); jaundice; RUQ discomfort; hyperpigmentation; excoriationsl xanthelasmas
Cholangiocarcinoma. Other sx: abdominal pain.
Increased/easy bruisability => coagulopathy due to impaired clotting factor synthesis from cirrhosis.
Pancreatic/biliary tract (posthepatic jaundice) cancers. Other sx: weight loss; lymphadenopathy; for gall bladder cancer: hepatomegaly, mass in right upper quadrant (Courvoisier's sign); for pancreatic cancer: epigastric pain
Gallstones/choledocholithiasis if pt is well and cholangitis if pt is febrile. Other sx: sudden and rapidly intensifying pain is in upper right portion of abdomen/center of abdomen just below breastbone; back pain between shoulder blades; pain in right shoulder; nausea/vomiting
Choledocholithiasis. Other sx: biliary colic; non-febrile/not sick; jaundice may be intermittent, fluctuating or progressive; nausea/vomiting
Cholangitis. Other sx: Charcot's triad (fever, RUQ pain, jaundice); Raynaud's pentad = hypotension and confusion/altered mentation too
Budd-Chiari syndrome. Classic triad: abdo pain (RUQ), ascites, hepatomegaly from hepatic vein occlusion.
Fever => infective
Acute hepatitis: viral; toxin/alcohol; medication. Other sx: right hypochondrial pain. Could be due to alcohol (Dupuytren's contracture and parotidomegaly). Could be due to paracetamol o/d or TCM.
Sepsis. Other sx: confusion/altered mentation
Normal/dark stools with normal urine and no pruritis => pre-hepatic: bilirubin overproduction, exceed hepatic ability to conjugate OR reduced hepatic uptake and processing
Inherited RBC hemolysis, e.g. G6PD deficiency; spherocytosis; thalassemia; sickle cell anemia
Acquired RBC hemolysis, e.g. autoimmune; MAHA; mechanical hemolysis; malaria
Impaired hepatic uptake, e.g. drugs; CHF or portosystemic shunts. Other sx: leg swelling; edema; right heart failure: elevated JVP; pulsatile liver; RUQ pain
Normal stool with tea-coloured urine and pruritis => hepatic
Pale stool with dark urine and pruritis => post-hepatic
Periampullary cancer. Other sx: pancreatic pain; cachexia; lymphadenopathy
Hemoglobinuria from acute hemolysis
Bilirubinuria (due to any cause of conjugated hyperbilirubinemia)
Gross hematuria from coagulopathy
Pseudojaundice: excessive ingestion of foods rich in beta-carotene, e.g. squash, melons, carrots. No scleral icterus, bilirubin elevation.
Drug use, e.g. acetaminophen; penicillins
Travel hx: ascaris lumbricodes; liver flukes.
Family hx of jaundice => inherited disorders of bilirubin metabolism.