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Jaundice: clinical sign describing yellow pigmentation of the skin, sclera…
Jaundice: clinical sign describing yellow pigmentation of the skin, sclera, and mucous membranes due to raised plasma bilirubin.
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Assessment
Systemic- anorexia, weight loss, fevers, rigors, rash, fatigue, nausea and vomiting
Lifestyle- alcohol intake, travel hx, tattoos,body piercing, blood transfusion, sexual partners, IVDA
History- Onset, duration, previous hx jaundice, colour of stools and urine.Pain, site, severity, radiation, itch
PMHx- hepatitis, gallstones, thyroid disease, non alcohol fatty liver, biliary surgery
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Occupation - exposure to viral hepatitis, HIV or hepatoxic chemicals
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Examination
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Chronic Liver disease- palmar erythema, finger nail clubbing, dupuytrens contracture
Liver failure- ataxia, altered mental state, bruising, petechiae or purpura
Lymphadenopathy, masses such as hepatomegaly
Abdominal tenderness RUQ- murphys sign. Widespread tenderness may indicate pancreatitis or peritonitis
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Management
If person well
Clotting screen — abnormal clotting can occur in both biliary obstruction and parenchymal liver disease.
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Hepatitis A, B, and C if risk factors are present.
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Urine dipstick — if positive for bilirubin this indicates increased levels of conjugated bilirubin in the serum
Admission
If acutely unwell- fever, encephalopathy, dehydration, signs of cholangitis, bilirubin over 100micromol/l. Abnormal clotting, renal function, frail or comorbidities. Suspected paracetamol overdose.
Red Flags
Jaundice &weight loss- Refer people aged 40 and over using a suspected cancer pathway (for an appointment within 2 weeks) to exclude pancreatic cancer.
Immediate assessment if signs of hepatic encephalopathy, severe hepatic dysfunction, bruising, purpura or petechiae. Haematemesis or melaena. Marked Abdominal pain. Signs of sepsis.Suspected paracetamol overdose.
LFT results
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Cholestatic picture
ALP raised more than ALT
intra-hepatic cholestasis, cholangitis, or extra-hepatic obstruction.
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Categories
Intra-hepatic causes include viral hepatitis, alcohol misuse, autoimmune disorders, Dubin-Johnson syndrome and Rotor’s syndrome, drugs, and malignancy of the biliary system.
Post-hepatic causes include gallstones, surgical strictures, extra-hepatic malignancy, pancreatitis, and parasitic infections.
Pre-hepatic causes include haemolytic anaemias, drugs, malaria, Gilbert’s syndrome, and Crigler-Najjar syndrome.