J A U N D I C E...

J A U N D I C E...
(A Patient's Presentation)

A thorough history and examination are essential to determine any likely cause of the jaundice.
Any prodromal flu-like illness may suggest viral hepatitis.
Pain: sudden onset of jaundice with pain in an otherwise healthy individual suggests gallstones. Slow onset of painless jaundice with central abdominal ache, loss of appetite and weight loss suggests carcinoma.
The colour of urine and stools: In viral hepatitis and obstructive jaundice, pale stool and darkening urine precede the jaundice.
Pruritus occurs before the patient becomes overtly jaundiced. The cause is unknown.
Weight loss may suggest an underlying malignancy.
Travel to any country where hepatitis A or any other infective cause is endemic.
Alcohol consumption.
Drug abuse.
Blood transfusions.
Contact with other jaundiced patients?
Medication history (both prescribed and non-prescription drugs).
Drugs associated with jaundice and contra-indicated in jaundice include:
amitriptyline, chlorpromazine, erythromycin, halothane, imipramine, indometacin, isoniazid, methyldopa, monoamine oxidase inhibitors (MAOIs), oral contraceptive pill, rifampicin, salicylates, sulfonamides, thiouracil.
Past medical history:
A past history of hepatitis raises the possibility of chronic active hepatitis.
A history of previous biliary surgery raises the possibility of a stone in the common bile duct.
Malignancy particularly with breast or bowel carcinoma may present with jaundice.
Occupational history may be important, eg in sewerage workers or people exposed to hepatotoxic chemicals.
Family history of jaundice
Obstetric cholestasis is a cause of mild jaundice .....