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