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Bedside Approach to Jaundice
Bedside Approach to Jaundice
Bedside Approach to Jaundice
Bedside Approach to Jaundice
Bedside Approach to Jaundice
Bedside Approach to Jaundice
Bedside Approach to Jaundice
Bedside Approach to Jaundice
Bedside Approach to Jaundice
Bedside Approach to Jaundice
Bedside Approach to Jaundice
Bedside Approach to Jaundice
Bedside Approach to Jaundice
Bedside Approach to Jaundice
Bedside Approach to Jaundice
Bedside Approach to Jaundice
Bedside Approach to Jaundice
Bedside Approach to Jaundice
Bedside Approach to Jaundice
Bedside Approach to Jaundice
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Bedside Approach to Jaundice

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Jaundice

Jaundice

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  • 1. Dr Manish Chandra Prabhakar MGIMS Sewagram 1
  • 2.   Classifying jaundice as hemolytic , hepatocellular or obstructive Determine the etiology 2
  • 3.        Sclera yellow – bilirubin > 3g/dl Urine is tea or cola coloured – conjugated bilirubin Colour – lemon yellow – hemolytic jaundice orange yellow – hepatocellular jaundice green yellow – obstructive jaundice Stool 3
  • 4.     Carotenoderma – healthy with sclera spared Quinacrine – 4- 37% of the cases Muddy sclera Florescent light 4
  • 5.      Developing in matter of hours and deepening rapidly – viral or drug induced hepatitis Long standing – Mild – hemolytic – family history Deep – obstructive Chronic liver disease – alcoholics 5
  • 6.      Malaria Leptospirosis – occupational history Viral hepatitis Cholangitis Dengue hemorrhagic fever 6
  • 7.    Sudden onset right upper quadrant colicy pain with chills – choledocholithiasis and ascending cholangitis Epigastic and back ache – pancreatic cancer Biliary obstruction but no pain with deterioration in health and decreasing weight – malignant obstruction 7
  • 8.    Persistent – obstructive jaundice Transient – Viral hepatitis Unilateral jaundice 8
  • 9.    Drug history – Predictable – dose related - acetaminophen Unpredictable – isoniazide 9
  • 10.      Travel / exposure to contaminant food – Hep A / hepatotoxin Blood transfusion – HCV, HIV, HBV High risk behaviour – sharing needles , drug abuse , unsafe sex Alcohol Family history – Hemolytic anemias, Wilson’s disease 10
  • 11.      Chronic liver cell failure – distension of abdomen , anasarca , hemorrhoids, hemetemesis , Arthralgia , myalgia , rash – viral hepatitis History of hepatobiliary surgery Breathlessness – heart failure Vit D and Vit A deficiency 11
  • 12.         Pulse – Tachycardia – fever , heart failure Bradycardia – obstructive jaundice Tachypnea – heart failure , fever Pallor – hemolysis , malignancy , cirrhosis Pallor with knuckle pigmentation – megaloblastic anemia Lymphadenopathy – Virchow’s and Sister Mary Joseph’s nodes. Clubbing may be seen in chronic cholestasis. 12
  • 13.       Mental status – hepatic encephalopathy hepatocellular jaundice Flapping tremors Fetor hepaticus Skin – Brusing – clotting factor defects Petechiae / purpura –Thrombocytopenia of cirrhosis 13
  • 14.    Other integumentary manifestation of cirrhosis – spider nevi, palmar erythema, leuconychia, alopecia Scratch marks, hyper pigmentation, xanthomas on eyelids, extensor surface and palmar creases - Chronic cholestasis Pigmentation of shin and ulcers – sickle cell disease 14
  • 15.      Multiple venous thrombosis – carcinoma of body of pancreas Ankle edema – cirrhosis or IVC obstruction due to hepatic malignancy Stigmata of chronic liver disease Raised JVP – heart failure  spider nevi KF ring – Wilson’s disease  palmar erythema  gynecomastia  caput medusae  dupuytren's contractures,  parotid gland enlargement,  testicular atrophy 15
  • 16.    o o     Caput medusae Ascitis – cirrhosis / malignancy Palpation of Liver – non palpable - not always a good sign Palpable – Large nodular liver – malignancy Smooth – extra hepatic cholestasis Uniformly enlarged – fatty liver Tender – right heart failure, viral or alcoholic hepatitis , amyloidosis 16
  • 17.    Murphy’s sign – cholecystitis Palpation of gall bladder – Courvoisier’s law Spleenomegaly – hemolytic jaundice , portal hypertension 17
  • 18.         Hemolytic jaundice – Positive family history Acholuric urine Stool normal coloured Lemon yellow icteruc Anemia Hemolytic faces Spleenomegaly 18
  • 19.       Prodromal symptoms – myalgia, fever, rash Urine and stool colour may not be normal Pruritus may be present Orange yellow icterus Bleeding manifestation may be present Tender hepatomegaly 19
  • 20.         Urine is dark Clay coloured greasy stools Pruritus Green yellow icterus Sinus bradycardia may be present Xanthelesma Murphy’s sign Vit A and D deficiency 20

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