CLINICAL APPROACH

IN

A CASE OF JAUNDICE

- DR. M.DEVI VINAYA.

- 2nd year post graduate
- Dept of GENERAL MEDICINE.
Site Predilection
 APPROACH

• BILIRUBIN

HISTORY FRACTION OF BILIRUBIN

OTHER LIVER FUNCTION TESTS

EXAMINATION
IMAGING STUDIES
COMMON CAUSES

drugs infections Gall

stones
Alcoholic Pancreatic
hepatitis disorders
Viral Hemolytic
hepatitis anemias
Clinical clues
in
history taking
VIRAL HEPATITIS
• Prodrome
• Iv drug abuse

• Transfusion

• Contact history

• Occupation
CHRONIC LIVER DISEASE
• recurrent jaundice

• Abdominal distension

• pedal edema

• Black tarry stools

Alcoholic hepatitis

• duration and amount of alcohol

• Withdrawal symptoms

• CAGE questionnaire

• Other alcohol related illness

 • allopathy/ native
medication

• Dose dependant /
independent

• Pruritis, rash, joint

pain
Drug induced liver injury
Infections
• fever

• Pain abdomen right

• Oliguria +/-
Gall stones
• pruritis

• Colicky pain

• Fever

• Urine & stools

Pancreatic disorders
• pain abdomen

• Steatorrhea
 Exertional dyspnea

Blood transfusions & hematinics

Hemolytic Recurrent jaundice

anaemias
Family history

Artificial heart valves

Miscellaneous……
• history of biliary tract surgery

• history of liver transplantation

• Pregnancy

• Weight loss
CLUES
IN
EXAMINATIO
N
• Anemia  hemolysis, cirrhosis, malignancy

• Pedal edema  cirrhosis , severe anemia

• Lymphadenopathy  lymphoma,TB, abdominal malignancy

• Higher mental function

Signs in
jaundice
LIVER
• Tender. - infections, CHF

• Nodular. - cirrhosis, malignancy

• Shrunker - cirrhosis, fulminant hepatic failure

• Hepatomegaly - malignancy, CHF, infiltrative disorders.

 APPROACH

BILIRUBIN

HISTORY FRACTION OF BILIRUBIN

OTHER LIVER FUNCTION TESTS

EXAMINATION
IMAGING STUDIES
Thankyou