Medical Jaundice
Examination
Viva
Differential
Rx: Cause
Hx
Ix
Pre-hepatic
Anaemia: tired, SOB, palpitations, ankle swelling
FH: HS
CTD: arthritis
Hepatic
EtOH intake
Foreign travel: Hep A
Blood transfusions, IVDU, sex: Hep B and C
Sore throat: EBV
Drug Hx: OCP, Abx, neuroleptics, OTCs
Post-hepatic
Dark urine, pale stools
Itching
Stones: RUQ pain or biliary colic
Malignancy
Change in bowel habit: esp. steatorrhoea
Back pain
Wt. ↓ and ↓ appetite
Urine Dip
Bloods
Imaging
Liver biopsy: check clotting first
Pre-hepatic
Hepatic
Post Hepatic
No BR (acholuric)
↑ urobilinogen
Hb
Haemosiderin
↑cBR
↑ urobilinogen
↑↑cBR
No urobiligen
FBC and film ± DAT: haemolysis
U+E: hepatorenal syndrome
LFTs
Clotting: ↑INR in CLD and Vit K deficiency
Liver screen
Conjugated vs. unconjugated BR
Hepatocellular dysfunction LFTs
Cholestatic LFTs
Abdo US + PV duplex
MRCP, CT, MRI
Pre-hepatic
Splenectomy
Hepatic
Post-Hepatic
Viral: supportive or anti-virals
Drugs: avoid
EtOH: abstinence + support
PBC / PSC: ursodeoxycholic acid
Stones / Ca: relieve obstruction
DDX
CLD: EtOH, viral, NAFLD
Splenomegaly
Haemolysis
CLD ( → portal HTN)
Viral hepatitis: e.g. EBV
Hepatomegaly
No CLD or organomegaly
Hepatitis
CLD
Biliary obstruction
Haemolysis
Drugs: fluclox, OCP
Gilberts
Commonest Causes
Other Causes
Haemolysis
CLD
Gallstones
Pre-hepatic
Unconjugated
Hepatic
Un- / Conjugated
Post-hepatic
Conjugated
Haemolysis
- AIHA
- HS
- SCD
CLD
Hepatitis
Drugs
- EtOH
- Viral
- Paracetamol
- Statins
- Anti-TB
Gallstones
Ca Head Panc
LNs @ porta hepatis
- Ca
- TB
Pre-hepatic
Hepatic
Post-hepatic
Haemolysis
- PNH
- MAHA
- Malaria
- G6PD
Congenital
AI
Ca: 1O, 2O
Vasc
↓ BR excretion
Drugs
PBC
PSC
Cholangio Ca
- OCP
- Augmentin, fluclox
Significant Negatives
Completion
Abdomen
Peripheral Examination
Cause
Pancreatic Ca: cachexia, Virchow’s node
Haemolysis: pallor
CLD
Excoriations and pruritus
Splenomegaly
Hepatomegaly
Palpable gallbladder: Ca head of pancreas
Urine dip: look for BR, urobilinogen and Hb
Acute liver failure / decompensation
CLD
Organomegaly