for download go to http://medicalpresentation.blogspot.in/2012/09/jaundice.html

2.  YELLOWISH DISCOLOURATION OF TISSUE
RESULTING FROM THE DEPOSITION OF
BILIRUBIN
 DEGREE OF SERUM BILIRUBIN ELEVATION CAN
BE ESTIMATED BY PHYSICAL EXAMINATION

3. CAUSES
 ISOLATED HYPERBILIRUBINEMIA
 HEPATOCELLULAR CONDITIONS
 CHOLESTATIC CONDITIONS

4. CAUSES OF ISOLATED HYPER
BILIRUBINEMIA
 INDIRECT
*HEMOLYTIC DISORDERS
1.INHERITED-SPHEROCYTOSIS,ELLIPTOCYTOSIS
SICKLE CELL ANEMIA
2.ACQUIRED-MICROANGIOPATHIC HEMOLYTIC
ANEMIA,PNH
*DRUGS-PIFAMPICIN,PROBENECID,RIBAVIRIN

5. *INHERITED CONDITION-CRIGGLER NAJJAR
GILBERTS SYND
DIRECT
*INHERITED-DUBIN JOHNSONS SYND
ROTORS SYND

6. HEPATOCELLULAR
 VIRAL HEPATITIS
 EBSTEIN BAR VIRUS
 ALCOHOL
 DRUG TOXICITY-ACETAMINOPHEN,ISONIAZID
 ENV.TOXINS-VINYL CHLORIDE,WILD
MUSHROOM(AMANITA PHALLOIDES)
 WILSONS DISEASE

7. CHOLESTATIC CONDITIONS
 INTRAHEPATIC
A.VIRAL HEPATITIS
B.ALC HEPATITIS
C.PRIMARY BILIARY CIRRHOSIS
D.PARANEOPLASTIC SYNDROME
E.GVH
F.INFILTATIVE DISEASE-TB,LYMPHOMA,AMYLOID

8.  EXTRAHEPATIC
A.MALIGNANT-CHOLANGIOCARCINOMA
PANCREATIC CANCER
GALLBLADDER CANCER
B.BENIGN -C/C PANCREATITIS
CHOLEDOCHOLITHIASIS
AIDS CHOLANGIOPATHY

9. HISTORY
 EXPOSURE TO ANY CHEMICAL OR MEDICATION
 PARENTERAL EXPOSURES INCLUDING
TRANSFUSION
 RECENT TRAVEL HISTORY
 EXPOSURE TO PATIENTS
 EXPOSURE TO HEPATOTOXINS

10.  ALCOHOL CONSUMPTION
 HISTORY SHOULD INCLUDE
 DURATION OF JAUNDICE
 ASSOCIATED SYMPTOMS
 ARTHRALGIA,MYALGIA
 RASH,ANOREXIA

11.  WEIGHT LOSS
 ABDOMINAL PAIN
 FEVER,PRURITUS
 CHANGES IN URINE&STOOL

12. PHYSICAL EXAMINATION
 COLLAGENOUS TISSUE HAS GREATER AFFINITY
FOR BILIRUBIN
 SCLERA,PALMAR APONEUROSIS,NAIL
BEDS,UNDER ASPECT OF TONGUE
 PT SHOULD BE EXAMINED IN BRIGHT DAY LIGHT

13.  ITS PRESENCE IS AN INDICATION FOR FURTHER
CLINICAL EXAMINATION

14. PHYSICAL EXAMINATION
 ASSESSMENT OF PATIENTS NUTRITIONAL STATUS
 TEMORAL&PROXIMAL MUSCLE WASTING
SUGGEST – PANCREATIC CANCER OR CIRRHOSIS
 STIGMATA OF CHRONIC LIVER DISEASES
 SPIDER NEVI-VASCULAR DILATATIONS

15.  PALMAR ERYTHEMA-PALMS ARE ERYTHEMATOUS
& WARM DUE TO VASODILATATION
 IMPOTENCE
 GYNAECOMASTIA
 DUPYTRENS CONTRACTURE
 CAPUT MEDUSAE
 TESTICULAR ATROPHY

16.  ENLARGED LEFT SUPRACLAVICULAR NODE-
VIRCHOWS NODE
 PERIUMBILICAL NODULE-SISTER MARY JOSEPHS
NODULE
 BOTH SUGGEST ABDOMINAL MALIGNANCY
 CLUBBING OF FINGERS-COMMON IN CIRRHOSIS

17. ABDOMINAL EXAMINATION
 SHOULD FOCUS ON SIZE AND CONSISTENCY OF
LIVER
 WHETHER SPLEEN IS PALPABLE
 ASCITES PRESENT OR NOT

18.  ENLARGEDLEFT LOBE OF LIVER FELT BELOW THE
XIPHOID WITH AN ENLARGED SPLEEN – SUGGEST
CIRRHOSIS
 ENLARGED TENDER LIVER-VIRAL OR ALCOHOLIC
HEPATITIS
 GROSSLY ENLARGED NODULAR LIVER-
MALIGNANCY

19.  SEVERE RT UPPER QUADRANT TENDERNESS
WITH RESPIRATORY ARREST ON INSPIRATION-
CHOLECYSTITIS
 ASCITES+JAUNDICE-CIRRHOSIS OR MALIGNANCY
WITH PERITONEAL SPREAD

20. THANK YOU…………..