Jaundice
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  • 1. In the name of God
    • JAUNDICE
    • S.M.Homayouni MD.
    • JUN/05/2009
  • 2. History A complete medical history is perhaps the Single most important Part of the evaluation of the patient With unexplained jaundice
  • 3. Key points in history
    • Length of symptoms
    • Presence and character of abdominal pain
    • Fever
    • Changing appetite, weight , bowel habits
    • Pruritus
  • 4. Surgery
    • Previous biliary surgery may suggest:
    • Retained stone
    • Recurrent stone
    • Biliary stricture
    • Enlarging tumor
    • Anesthetic drugs
  • 5. Important considerations
    • Use or exposure to chemical and medication
  • 6. Presence of any accompanying symptoms
    • Arthralgia
    • Myalgia , fatigue , weakness , rash
    • Anorexia , malaise , weight loss
    • Abdominal pain
    • Fever , pruritis
    • Change in urine and stool color
  • 7. Carefully question about :
    • Transfusion
    • Iv Drug
    • Intranasal
    • Tattoo
    • Sexual activity
  • 8. Other important questions:
    • Occupational exposure to hepatotoxins
    • Alcohol consumption
    • Duration of jaundice
    • recent travel history
    • exposure to people with jaundice
  • 9. Physical examination
    • General assessment
    • nutritional status
    • Temporal and proximal muscle wasting
  • 10. Physical examination
    • Excoriation
    • Fever
    • Epigastric or RUQ tenderness
    • Liver size and consistancy
    • Spleenomegaly
    • Ascites
    • Morphy sign
    • Lynphadenopathy
    • Xanthomata , K-F ring
  • 11. Stigmata of chronic liver disease
    • Spider angioma
    • Palmar erythema
    • Gynecomastia
    • Caput medusa
    • Dupuytren ’ s cantracture
    • Parotid gland enlargment
    • Testicular atrophy
    • Virchow node
    • Periumiblical nodule
    • Increased jvp
    • Right pleural effusion
  • 12. First task
    • Hemolysis
    • Hepatobiliary disease
  • 13. Lab tests
    • Basic tests of liver function
    • A complete blood count
  • 14. Further workup
    • The results of the clinical evaluation direct the physician to a logical progression of imaging studies , serological tests , and pathological evaluation .
  • 15. Spider angioma
  • 16. Spider angioma
  • 17. Spider angioma
  • 18. Spider angioma
  • 19. Palmar erythema
  • 20. Palmar erythema
  • 21. Gynecomastia
  • 22. Caput medusa
  • 23. Caput medusa
  • 24. Dupuytren’s cantracture
  • 25. Dupuytren’s cantracture
  • 26. Parotid gland enlargment