Tattoos

Sexual activity (Hep B, C are considered sexually transmitted disease)

Recent travel history (ask about any food and drinks taken, especially more difficult if
examining room has fluorescent lighting. Best to do it under natural lighting.

If examiner suspects scleral icterus, a second place to examine is underneath tongue

Skin examination for icterus

As serum bilirubin levels rise, skin will eventually become yellow in light skinned
patients and even green if process is long standing

Green color is produced by oxidation of bilirubin to biliverdin

Darkening of urine

Patients often describe urine as tea or cola-colored

Sensitive indicator of increased bilirubin

Due to renal excretion of conjugated bilirubin fraction

Bilirubinuria indicates