Jaundice

Jaundice can be either a symptom or a sign or both.  It is confirmed by a high serum bilirubin and is usually clinically evident at levels above 35μmol/l.

In the history (and examination) it is useful to try and distinguish what type of jaundice (pre-hepatic, hepatic, post-hepatic) is present.  This will help to guide the diagnosis.

History

  • Wash hands, introduce self, check name and DOB, establish initial rapport, start with open question etc
  • HPC:
    • Onset and progression
    • Colour:
      • Pale yellow more associated with pre-hepatic jaundice (anaemia and jaundice)
  • Other symptoms/signs:
    • Dark urine (hepatic/post-hepatic jaundice) and/or pale stools (post-hepatic)
    • Pruritis?
    • Abdo pain
      • Painful: Alcoholic; infection; biliary colic; pancreatitis; cholecystitis; metastasis
      • Painless: Haemolysis; Primary Biliary Sclerosis; Pancreatic/biliary malignancy; cirrhosis; haemochromatosis
    • nausea/vomiting
    • haematemesis
    • fatigue/malaise
    • fever
    • loss of apetite/weight loss
    • Rash/arthritis
    • Abdominal swelling
    • Confusion
    • Sleep disturbance
    • Cardiac/resp symptoms
  • PMHx
    • Previous jaundice? Previous gallstones? Malignancy? Recent anaesthesia? Blood transfusion? Autoimmune disorders? etc
  • RHx including illicit drugs
    • Antibiotics, antirheumatics
  • FHx
  • Social Hx
    • Full Alcohol history including FAST/CAGE
    • Sexual history
    • Travel History
    • Tattoos/piercings

Examination

  • General Examination is important
    • Look for signs of liver disease; any tattoos (risk of Hep C); jaundice in the sclera (may be more apparent than skin);
  • see also Abdominal Examination

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