Jaundice history & symptoms: Difference between revisions

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==Overview==
==Overview==
Common symptoms of jaundice that the patient will notice, is yellowing of the skin, nausea, and vomiting. Specific symptoms will depend on the underlying factor that caused jaundice to occur.
Common symptoms associated with jaundice are yellowing of the skin, [[nausea]], and [[vomiting]]. Specific symptoms will depend on the underlying cause of jaundice. Patients may present with [[fever]], [[anorexia]], [[dark urine]], [[fatigue]], [[pruritis]], [[right upper quadrant pain]]. A detailed history of [[alcohol]] use, [[Blood transfusion|blood transfusions]], history of [[Hepatitis|viral hepatitis]] and family history of [[Hepato-biliary diseases|liver disease]] is recommended for all the [[Patient|patients]].


==History and Symptoms==
==History and Symptoms==
Jaundice typically appears in a 'top to bottom' progression (starting with the face, progressing toward the feet), and resolves in a 'bottom to top' manner.  
* Jaundice typically progress in "top to bottom" manner, from face to feet.  
 
The caregiver should ask questions regarding
* Alcohol/hepatotoxic medication use


'''Various Symptoms'''
* Specific history should be focused on alcohol or [[hepatotoxic]] medication use.    
* '''Alcohol Hepatitis'''<ref name="pmid29336434">{{cite journal |vauthors=Singal AK, Bataller R, Ahn J, Kamath PS, Shah VH |title=ACG Clinical Guideline: Alcoholic Liver Disease |journal=Am. J. Gastroenterol. |volume= |issue= |pages= |year=2018 |pmid=29336434 |doi=10.1038/ajg.2017.469 |url=}}</ref>
*:* [[Ddx:Fever|Fever]]
* '''Viral Hepatitis'''<ref name="pmid41915022">{{cite journal |vauthors=Krugman S, Giles JP |title=Viral hepatitis. New light on an old disease |journal=JAMA |volume=212 |issue=6 |pages=1019–29 |year=1970 |pmid=4191502 |doi= |url=}}</ref>
*:* [[Anorexia]]
*:* Dark urine
*:* [[Ddx:Fatigue|Fatigue]]
*:* [[Light-colored stools]]  ([[acholic stools]])
*:* [[Ddx:Nausea and Vomiting|Nausea]]
*:* [[Ddx:Pruritis|Pruritis]]
*:* [[Abdominal pain|Right upper quadrant (RUQ) pain]]
*:* [[Nausea and Vomiting]]


* '''Cirrhosis'''
==='''History'''===
the symptoms of liver cirrhosis are very non-specific:
Patients with jaundice may have a positive history of:
====Social history====
*History of [[alcohol]] use:
**Amount
**Duration
*History of illicit [[:Category:Drugs|drug]] use
*History of unprotected sexual intercourse
====Past Medical history====
*History of [[Infection|infections]]:<ref name="pmid21877109">{{cite journal |vauthors=Flores YN, Lang CM, Salmerón J, Bastani R |title=Risk factors for liver disease and associated knowledge and practices among Mexican adults in the US and Mexico |journal=J Community Health |volume=37 |issue=2 |pages=403–11 |year=2012 |pmid=21877109 |doi=10.1007/s10900-011-9457-4 |url=}}</ref>
**[[Hepatitis B]]
**Hepatitis [[Hepatitis C|C]]
*History of [[Autoimmunity|autoimmune disorders]]:
**[[Autoimmune hepatitis]]
**[[Crohn's disease]]
*History of [[Blood transfusion|blood transfusions]]
====Family history====
*[[Family history]] of liver disease:
**[[Wilson's disease]]
**[[Hemochromatosis]]
====Medication history====
*History of use of any [[Hepatotoxicity|hepatotoxic]] drugs
==='''Common Symptoms'''===
Common symptoms of jaundice depends on the underlying factor that causes jaundice and include:
* '''[[Viral Hepatitis]]'''<ref name="pmid41915022">{{cite journal |vauthors=Krugman S, Giles JP |title=Viral hepatitis. New light on an old disease |journal=JAMA |volume=212 |issue=6 |pages=1019–29 |year=1970 |pmid=4191502 |doi= |url=}}</ref><ref name="pmid29336434">{{cite journal |vauthors=Singal AK, Bataller R, Ahn J, Kamath PS, Shah VH |title=ACG Clinical Guideline: Alcoholic Liver Disease |journal=Am. J. Gastroenterol. |volume= |issue= |pages= |year=2018 |pmid=29336434 |doi=10.1038/ajg.2017.469 |url=}}</ref>
** [[Anorexia]]
** [[Dark urine]]
** [[Ddx:Fatigue|Fatigue]]
** Light-colored stools  ([[acholic stools]])
** [[Ddx:Pruritis|Pruritis]]
** [[Abdominal pain|Right upper quadrant (RUQ) pain]]
** [[Nausea and vomiting]]


Right upper quadrant abdominal pain  
* '''[[Cirrhosis]]'''<ref name="pmid9683971">{{cite journal |vauthors=Williams EJ, Iredale JP |title=Liver cirrhosis |journal=Postgrad Med J |volume=74 |issue=870 |pages=193–202 |year=1998 |pmid=9683971 |pmc=2360862 |doi= |url=}}</ref><ref name="pmid18328931">{{cite journal |vauthors=Schuppan D, Afdhal NH |title=Liver cirrhosis |journal=Lancet |volume=371 |issue=9615 |pages=838–51 |year=2008 |pmid=18328931 |pmc=2271178 |doi=10.1016/S0140-6736(08)60383-9 |url=}}</ref>
Fever  
** [[Right upper quadrant abdominal pain resident survival guide|Right upper quadrant abdominal pain]]
Anorexia  
** [[Fever]]
Fatigue and weakness  
** [[Anorexia]]
Nausea and vomiting  
** [[Fatigue]] and [[weakness]]
Weight loss  
** [[Nausea and vomiting]]
Abdominal pain and bloating  
** [[Weight loss]]
Menstrual irregularities
** [[Abdominal pain]] and bloating
Symptoms of hypogonadism:  
** [[Menstrual disorder|Menstrual irregularities]]
Impotence
** Symptoms of [[hypogonadism]]:
Infertility
*** [[Erectile dysfunction|Impotence]]
Testicular atrophy
*** [[Infertility]]
Loss of libido
*** [[Testicular atrophy]]
Easy bruisability
*** Loss of [[libido]]
Decompensated cirrhosis may present with[4]  
** [[Easy bruising]]
Jaundice
** Symptoms due to [[hepatic encephalopathy]]:
Increase in abdominal girth due to ascites
*** [[Altered mental status]]
Pruritus
*** [[Confusion]]
Signs of upper gastrointestinal bleeding:
*** [[Sleep disturbances]]
Hematemesis
*** [[Muscle cramps]] due to reduction in effective circulating plasma volume
Hematochezia
*** Lower extremity [[edema]]
Melena
** '''[[Primary biliary cirrhosis]]'''<ref name="pmid12853201">{{cite journal |vauthors=Talwalkar JA, Lindor KD |title=Primary biliary cirrhosis |journal=Lancet |volume=362 |issue=9377 |pages=53–61 |date=July 2003 |pmid=12853201 |doi=10.1016/S0140-6736(03)13808-1 |url= |author=}}</ref>
Symptoms due to hepatic encephalopathy:  
*** [[Fatigue]] out of proportion to the severity of the [[disease]]
Altered mental status
*** [[Pruritis]]:
Confusion
**** May be intermittent
Sleep disturbances
**** Worse at night
Muscle cramps due to reduction in effective circulating plasma volume  
**** May present in the last trimester of [[pregnancy]] and may be mis-diagnosed as [[Cholestatic jaundice of pregnancy|cholestasis of pregnancy]]
Lower extremity edema
* '''[[Pancreatic cancer]]'''<ref name="pmid15960930">{{cite journal |vauthors=Porta M, Fabregat X, Malats N, Guarner L, Carrato A, de Miguel A, Ruiz L, Jariod M, Costafreda S, Coll S, Alguacil J, Corominas JM, Solà R, Salas A, Real FX |title=Exocrine pancreatic cancer: symptoms at presentation and their relation to tumour site and stage |journal=Clin Transl Oncol |volume=7 |issue=5 |pages=189–97 |year=2005 |pmid=15960930 |doi= |url=}}</ref>
Symptoms may vary depending on the underlying cause of cirrhosis:
** [[Weight loss|Weight Loss]] (significant)
Primary biliary cirrhosis presents with the following symptoms:
** [[Epigastric|Midepigastric]] [[pain]] which may also radiate either to the lower back region and mid-back region
Fatigue out of proportion to the severity of the disease  
** [[Nausea and vomiting]]
Pruritis  
** [[Malaise]]
May be intermittent  
** [[Fatigue]]
Increases in the evening
** [[Anorexia|Loss of appetite]]
May present in the last trimester of pregnancy and may be mis-diagnosed as cholestasis of pregnancy  
** [[Anorexia]]
Primary sclerosing cholangitis may present with the following in addition to the above symptoms of cirrhosis:
** [[Dyspepsia]]
Fatigue  
** [[Ascites]]
Pruritis  
** [[Dark urine]]
Steatorrhea  
** [[Acholic stools|Light-colored or greasy stools]]
Abdominal pain, mainly in the right upper quadrant (RUQ)  
* '''[[Cholestasis]]'''<ref name="pmid22541702">{{cite journal |vauthors=Bunchorntavakul C, Reddy KR |title=Pruritus in chronic cholestatic liver disease |journal=Clin Liver Dis |volume=16 |issue=2 |pages=331–46 |year=2012 |pmid=22541702 |doi=10.1016/j.cld.2012.03.010 |url=}}</ref>
Yellowish discoloration of the skin and mucous membranes (jaundice)
** Clay-colored or white stools
Fever  
** [[Dark urine]]
Weight loss
** Inability to [[digest]] certain foods
** [[Itching]]
** [[Nausea]] or [[vomiting]]
** [[Right upper quadrant abdominal pain resident survival guide|Right upper quadrant abdominal pain]]
* '''[[Cholangiocarcinoma]]''' <ref name="pmid21460876">{{cite journal |vauthors=Patel T |title=Cholangiocarcinoma--controversies and challenges |journal=Nat Rev Gastroenterol Hepatol |volume=8 |issue=4 |pages=189–200 |year=2011 |pmid=21460876 |pmc=3888819 |doi=10.1038/nrgastro.2011.20 |url=}}</ref>
** [[Pruritis]]
** [[Abdominal pain]]
** [[Fever]]
** [[Fatigue]]
==='''Less Common Symptoms'''===
Less common symptoms of jaundice include
*'''[[Primary sclerosing cholangitis]]'''<ref name="pmid27653566">{{cite journal |vauthors=Lazaridis KN, LaRusso NF |title=Primary Sclerosing Cholangitis |journal=N. Engl. J. Med. |volume=375 |issue=12 |pages=1161–70 |date=September 2016 |pmid=27653566 |pmc=5553912 |doi=10.1056/NEJMra1506330 |url= |author=}}</ref>
** [[Fatigue]]
** [[Pruritis]]
** [[Steatorrhea]]
** [[Abdominal pain]], mainly in the [[right upper quadrant]] ([[RUQ]])
** [[Fever]]
** [[Weight loss]]


* '''Primary biliary cirrhosis'''
* '''Decompensated [[cirrhosis]]'''<ref name="pmid25230084">{{cite journal |vauthors=Bloom S, Kemp W, Lubel J |title=Portal hypertension: pathophysiology, diagnosis and management |journal=Intern Med J |volume=45 |issue=1 |pages=16–26 |year=2015 |pmid=25230084 |doi=10.1111/imj.12590 |url=}}</ref>
* '''Choledocholithiasis'''
** Increase in abdominal girth due to [[ascites]]
* '''Cholangiocarcinoma'''
** [[Itch|Pruritus]]
* '''Primary sclerosing cholangitis'''
** Signs of [[upper gastrointestinal bleeding]]:
* '''Acute pancreatitis'''
*** [[Hematemesis]]
* '''Chronic pancreatitis'''
*** [[Hematochezia]]
*** [[Melena]]


==References==
==References==
{{reflist|2}}
{{reflist|2}}
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Latest revision as of 22:27, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farnaz Khalighinejad, MD [2]

Overview

Common symptoms associated with jaundice are yellowing of the skin, nausea, and vomiting. Specific symptoms will depend on the underlying cause of jaundice. Patients may present with fever, anorexia, dark urine, fatigue, pruritis, right upper quadrant pain. A detailed history of alcohol use, blood transfusions, history of viral hepatitis and family history of liver disease is recommended for all the patients.

History and Symptoms

  • Jaundice typically progress in "top to bottom" manner, from face to feet.
  • Specific history should be focused on alcohol or hepatotoxic medication use.

History

Patients with jaundice may have a positive history of:

Social history

  • History of alcohol use:
    • Amount
    • Duration
  • History of illicit drug use
  • History of unprotected sexual intercourse

Past Medical history

Family history

Medication history

Common Symptoms

Common symptoms of jaundice depends on the underlying factor that causes jaundice and include:

Less Common Symptoms

Less common symptoms of jaundice include

References

  1. ↑ Flores YN, Lang CM, Salmerón J, Bastani R (2012). "Risk factors for liver disease and associated knowledge and practices among Mexican adults in the US and Mexico". J Community Health. 37 (2): 403–11. doi:10.1007/s10900-011-9457-4. PMID 21877109.
  2. ↑ Krugman S, Giles JP (1970). "Viral hepatitis. New light on an old disease". JAMA. 212 (6): 1019–29. PMID 4191502.
  3. ↑ Singal AK, Bataller R, Ahn J, Kamath PS, Shah VH (2018). "ACG Clinical Guideline: Alcoholic Liver Disease". Am. J. Gastroenterol. doi:10.1038/ajg.2017.469. PMID 29336434.
  4. ↑ Williams EJ, Iredale JP (1998). "Liver cirrhosis". Postgrad Med J. 74 (870): 193–202. PMC 2360862. PMID 9683971.
  5. ↑ Schuppan D, Afdhal NH (2008). "Liver cirrhosis". Lancet. 371 (9615): 838–51. doi:10.1016/S0140-6736(08)60383-9. PMC 2271178. PMID 18328931.
  6. ↑ Talwalkar JA, Lindor KD (July 2003). "Primary biliary cirrhosis". Lancet. 362 (9377): 53–61. doi:10.1016/S0140-6736(03)13808-1. PMID 12853201.
  7. ↑ Porta M, Fabregat X, Malats N, Guarner L, Carrato A, de Miguel A, Ruiz L, Jariod M, Costafreda S, Coll S, Alguacil J, Corominas JM, Solà R, Salas A, Real FX (2005). "Exocrine pancreatic cancer: symptoms at presentation and their relation to tumour site and stage". Clin Transl Oncol. 7 (5): 189–97. PMID 15960930.
  8. ↑ Bunchorntavakul C, Reddy KR (2012). "Pruritus in chronic cholestatic liver disease". Clin Liver Dis. 16 (2): 331–46. doi:10.1016/j.cld.2012.03.010. PMID 22541702.
  9. ↑ Patel T (2011). "Cholangiocarcinoma--controversies and challenges". Nat Rev Gastroenterol Hepatol. 8 (4): 189–200. doi:10.1038/nrgastro.2011.20. PMC 3888819. PMID 21460876.
  10. ↑ Lazaridis KN, LaRusso NF (September 2016). "Primary Sclerosing Cholangitis". N. Engl. J. Med. 375 (12): 1161–70. doi:10.1056/NEJMra1506330. PMC 5553912. PMID 27653566.
  11. ↑ Bloom S, Kemp W, Lubel J (2015). "Portal hypertension: pathophysiology, diagnosis and management". Intern Med J. 45 (1): 16–26. doi:10.1111/imj.12590. PMID 25230084.

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