12. History
PC:
• Jaundice (Yellowish discoloration of
sclera+mucus membrane+Skin)
• Exclude other causes for yellow discolouration
*Carotenaemia (Only skin, mainly palm and sole
are orange color) in eating carrot,mango,papaya
and hypothyroidism
*Antimalarial drugs
*Vit-B12 deficiency
13. History
HPC & Systemic Rvw
• Jaundice
1. Sudden onset- Gall stones OR Viral hepatitis
2. Gradual onset- Cirrhosis, Pancreatic CA OR
Porta hepatis metastases
3. Progressive- Malignant obstruction
4. Fluctuaing- Stones in the CBD, CA of the
duodenal papilla OR repeated hemolytic
episodes.
14. History
• Pain:
1. Painless- Viral hepatitis (Dragging subcostal ache
due to hepatic enlargement)
2. Pailess+Fluctuating- intermittent obstruction by
gallstone OR necrosing ampullary CA
3. Painless+Progressive- Malignant obstruction of
CBD
4. Painful- Gallstones OR Pancreatic CA
Biliary colic- right subcosatl pain radiating beneath
the costal margin to shoulder blade
Moderate boring pain passing through to backChronic pancreatitis OR pancreatic tumor
15. History
• Fever:
1. Fever with chills- Extra hepatic cholestasis with
cholangitis due to bile duct stone,Liver abscess
and leptospirosis
2. Fever without chills- Viral hepatitis, Drug
induced hepatitis
• Pruritus:
Results from the irritation of cutaneous nerves by
retained bile salt
Cholestatic jaundice
16. History
• Weight lossProgressive weight loss- Malignancy
Also in chronic hepatocellular damage.
• Anorexia and fatigue
Early signs of hepatitis
(This is due to production of cachexin and TNF)
17. History
• Colour of the urine and stool
Pre hepatic
Hepatic
Post hepatic
Urine colour
Normal
Dark
Dark
Stool colour
Normal
Normal
Pale
18. History
Contact history:
1. Contact with jaundice patients from work
mates, family- hygienic habits such as toilets,
drinking water, taking meals from out side
(HepA & HepB)
2. Contact Hx of muddy water in leptospirosis
19. History
Obstetric Hx:
• Ask about LRMP and calculate POA
• Benign intra hepatic cholestasis is common in
pregnancy period
20. History
PMHx
• Viral hepatitis
• History of transfusion of blood OR blood
products (HepB & HepC)
• Recent parenteral injection (HepB & HepC)
• Amoebic dysentery
• Jaundice following febrile illness- some
congenital haemolytic anaemia may be
triggered by febrile illness eg- G6PD deficiency
21. History
• Recurrent left hypochondrial pain due to
splenomegaly eg- Hereditary spherocytosis
• Recurrent foot ulcer eg- some form of chronic
haemolytic anaemia such as sickle cell disease
• Hx of breast cancer and bowelcancer
• SLE and other connective tissue disorders (Hx
suggestive of joint pain, skin rash)
22. History
PSHx
• Previous difficult biliary surgery suggest –
traumatic stricture OR a residual stones in the
CBD
• Post operative jaundice
1. Resorption of haematomas,haemoperitonium,
haemolysis of transfused erythrocyte
2. Impaired hepatocellular function- halogenated
anaesthetics, sepsis
24. History
Family Hx:
• FHx of jaundice+anaemia+splenectomyHereditary spherocytosis
• FHx of jaundice+anaemia- congenital
hyperbilirubinaemias
• Consanguinity of parents- Inherited congenital
haemolytic anaemia eg- G6PD deficiency
• Neuropsychiatry llness+jaundice- Wilson’s
disease
25. History
Social Hx:
• Hx of Alcohol consumption in Units for yearsChronic alcohol liver disease Hepatocellular CA
jaundice
Cirrhosis and pancreatic CA
• Toddy consumption- Amoebic liver abscess
• Sexual promiscuity and unprotected sexual behaviorHepB transmission
• Occupational HxSheep farmers OR allied workers- Hydatid infestation
Working at chemical enviorment eg-CCl4
26. Examination
General:
• Depth of jaundice:
Lemmon yellow- haemolytic jaundice
Orange- hepatocellular cause
Deep mahogany hue- Prolonged obstructive
jaundice
33. Examination
• Site of tenderness:
Tenderness over the gall bladder indicate biliary
inflammation
34. Examination
• Gall bladder
A palpable gall bladder in the presence of the
jaundice means that janundice is unlikely to be
due to a stone (Courvoisier’s sign). CA of head of
the pancreas must be suspected
35. Examination
• Liver:
1. Palpable large nodule of large proportionmetastatic malignancy
2. Small nodules- cirrhosis
3. Slightly enlarged smooth live chronic
cholestasis
4. Tender liver- viral hepatitis and liver abscess