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Medical Jaundice (Examination (Abdomen (Excoriations and pruritus,…

- - - - Splenectomy
    - - Viral: supportive or anti-virals
      - Drugs: avoid
      - EtOH: abstinence + support
    - - PBC / PSC: ursodeoxycholic acid
      - Stones / Ca: relieve obstruction
  - - - Anaemia: tired, SOB, palpitations, ankle swelling
      - FH: HS
      - CTD: arthritis
    - - EtOH intake
      - Foreign travel: Hep A
      - Blood transfusions, IVDU, sex: Hep B and C
      - Sore throat: EBV
      - Drug Hx: OCP, Abx, neuroleptics, OTCs
    - - Dark urine, pale stools
      - Itching
      - Stones: RUQ pain or biliary colic
      - Malignancy
        
        Change in bowel habit: esp. steatorrhoea
        
        Back pain
        
        Wt. ↓ and ↓ appetite
  - - - Pre-hepatic
        
        No BR (acholuric)
        ↑ urobilinogen
        Hb
        Haemosiderin
      - Hepatic
        
        ↑cBR
        ↑ urobilinogen
      - Post Hepatic
        
        ↑↑cBR
        No urobiligen
    - - FBC and film ± DAT: haemolysis
      - U+E: hepatorenal syndrome
      - LFTs
        
        Conjugated vs. unconjugated BR
        
        Hepatocellular dysfunction LFTs
        
        Cholestatic LFTs
      - Clotting: ↑INR in CLD and Vit K deficiency
      - Liver screen
    - - Abdo US + PV duplex
      - MRCP, CT, MRI
- - - - Haemolysis
      - CLD ( → portal HTN)
      - Viral hepatitis: e.g. EBV
    - - Hepatitis
      - CLD
    - - Biliary obstruction
      - Haemolysis
      - Drugs: fluclox, OCP
      - Gilberts
  - - - Haemolysis
        
        AIHA
        
        HS
        
        SCD
    - - CLD
      - Hepatitis
        
        EtOH
        
        Viral
      - Drugs
        
        Paracetamol
        
        Statins
        
        Anti-TB
    - - Gallstones
      - Ca Head Panc
      - LNs @ porta hepatis
        
        Ca
        
        TB
  - - - Haemolysis
        
        PNH
        
        MAHA
        
        Malaria
        
        G6PD
    - - Congenital
      - AI
      - Ca: 1O, 2O
      - Vasc
      - ↓ BR excretion
    - - Drugs
        
        OCP
        
        Augmentin, fluclox
      - PBC
      - PSC
      - Cholangio Ca