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In the name of God <ul><li>JAUNDICE </li></ul><ul><li>S.M.Homayouni MD. </li></ul><ul><li>JUN/05/2009 </li></ul>
History  A complete medical history  is perhaps the  Single most important  Part of the evaluation of the patient  With un...
Key points in history <ul><li>Length of symptoms </li></ul><ul><li>Presence and character of abdominal pain </li></ul><ul>...
Surgery  <ul><li>Previous biliary surgery may suggest: </li></ul><ul><li>Retained stone </li></ul><ul><li>Recurrent stone ...
Important considerations  <ul><li>Use or exposure to chemical and medication  </li></ul>
Presence of any accompanying symptoms  <ul><li>Arthralgia  </li></ul><ul><li>Myalgia , fatigue , weakness , rash  </li></u...
Carefully question about :  <ul><li>Transfusion  </li></ul><ul><li>Iv Drug  </li></ul><ul><li>Intranasal  </li></ul><ul><l...
Other important questions:  <ul><li>Occupational exposure to hepatotoxins  </li></ul><ul><li>Alcohol consumption </li></ul...
Physical examination  <ul><li>General assessment  </li></ul><ul><li>nutritional  status  </li></ul><ul><li>Temporal and pr...
Physical examination  <ul><li>Excoriation </li></ul><ul><li>Fever </li></ul><ul><li>Epigastric  or RUQ tenderness </li></u...
Stigmata of chronic liver disease  <ul><li>Spider angioma  </li></ul><ul><li>Palmar erythema  </li></ul><ul><li>Gynecomast...
First task <ul><li>Hemolysis </li></ul><ul><li>Hepatobiliary disease </li></ul>
Lab tests <ul><li>Basic tests of liver function </li></ul><ul><li>A complete blood count </li></ul>
Further workup <ul><li>The results of the clinical evaluation direct the physician to a logical progression of imaging stu...
Spider angioma
Spider angioma
Spider angioma
Spider angioma
Palmar erythema
Palmar erythema
Gynecomastia
Caput medusa
Caput medusa
Dupuytren’s  cantracture
Dupuytren’s  cantracture
Parotid gland enlargment
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Jaundice

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Transcript of "Jaundice"

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