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{{Jaundice}}
{{Jaundice}}
 
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==Overview==
==Overview==
Jaundice is a yellowish discoloration of the skin and sclerae that is an important symptom of elevated serum [[bilirubin]]. Physical examination of patients with jaundice is based on underlying disease, include [[cervical]] [[lymphadenopathy]], [[hepatomegaly]], [[splenomegaly]], and [[peripheral edema]].


==Physical Examination==
==Physical Examination==
* Complete physical exam including evidence of:
Jaundice is seen with a number of disorders. Physical examination of patients with jaundice is based on underlying [[disease]].
*:* [[Ddx:Hepatomegaly|Hepatomegaly]]
 
*:* [[Ddx:Splenomegaly|Splenomegaly]]
===Appearance of the Patient===
*:* Palpable gallbladder
* '''[[Cirrhosis]]:'''
*:* Signs of chronic liver disease
** [[Patient|Patients]] usually appear weak.<ref name="pmid104230702">{{cite journal|year=1999|title=Spider angiomas in patients with liver cirrhosis: role of alcoholism and impaired liver function|url=|journal=Scand. J. Gastroenterol.|volume=34|issue=5|pages=520–3|doi=|pmid=10423070|vauthors=Li CP, Lee FY, Hwang SJ, Chang FY, Lin HC, Lu RH, Hou MC, Chu CJ, Chan CC, Luo JC, Lee SD}}</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>
 
* '''[[Viral hepatitis]]:'''
** The appearance of the patient on presentation depends on the age.<ref name="pmid19399815">{{cite journal |vauthors=Rotman Y, Brown TA, Hoofnagle JH |title=Evaluation of the patient with hepatitis B |journal=Hepatology |volume=49 |issue=5 Suppl |pages=S22–7 |year=2009 |pmid=19399815 |pmc=2881483 |doi=10.1002/hep.22976 |url=}}</ref>
** Younger patients tend to be [[asymptomatic]], while older patients tends to be [[symptomatic]]. 
** [[Symptomatic]] patients may have a range of symptoms that may vary in severity from a mild [[flu]]-like illness to [[fulminant hepatitis]].
** Patients with fulminant hepatitis are usually [[disoriented]] and very ill-looking.
* '''[[Pancreatic cancer (patient information)|Pancreatic cancer]]:'''
** Patients with [[pancreatic cancer]] presents usually in the sixth decade of life and appear [[Cachexia|cachectic]], with signs of [[malnutrition]].<ref name="pmid15522652">{{cite journal |vauthors=Khorana AA, Fine RL |title=Pancreatic cancer and thromboembolic disease |journal=Lancet Oncol. |volume=5 |issue=11 |pages=655–63 |year=2004 |pmid=15522652 |doi=10.1016/S1470-2045(04)01606-7 |url=}}</ref> 
 
===Vital Signs===
* Vitals signs of patients with jaundice due to [[viral hepatitis]] include:<ref name="pmid19399815" />
** [[Fever]]
** [[Tachycardia]]
** [[Hypotension]]
** [[Tachypnea]]


===Skin===
===Skin===
* Jaundice is visible in conjunctiva, skin and mucosa when the serum bilirubin level rises above 2 mg/dL


===Eyes===
* Jaundice is visible in [[conjunctiva]], [[skin]], and [[mucosa]] when the serum bilirubin level rises above 2 mg/dL.
* Jaundice is usually best seen in the periphery of the ocular conjunctivae
* Skin examination of patients with jaundice due to [[viral hepatitis]] include:<ref name="pmid19399815" />
** [[Palmar erythema]]
** [[Spider angiomata]]
** [[Gynecomastia]]
* Skin examination of patients with jaundice due to [[cirrhosis]] include:<ref name="pmid10423070">{{cite journal |vauthors=Li CP, Lee FY, Hwang SJ, Chang FY, Lin HC, Lu RH, Hou MC, Chu CJ, Chan CC, Luo JC, Lee SD |title=Spider angiomas in patients with liver cirrhosis: role of alcoholism and impaired liver function |journal=Scand. J. Gastroenterol. |volume=34 |issue=5 |pages=520–3 |year=1999 |pmid=10423070 |doi= |url=}}</ref>
** [[Pallor]]
** [[Bruises]]
** [[palmar erythema]] on the [[Thenar eminence|thenar]] and [[Hypothenar eminence|hypothenar eminences]]
** [[Spider angioma|Spider angiomata]]
** [[Telangiectasias]]
* Skin examination of patients with jaundice due to [[pancreatic cancer]] include:<ref name="pmid15522652" /><ref name="pmid19190960">{{cite journal |vauthors=Fitzgerald JE, White MJ, Lobo DN |title=Courvoisier's gallbladder: law or sign? |journal=World J Surg |volume=33 |issue=4 |pages=886–91 |year=2009 |pmid=19190960 |doi=10.1007/s00268-008-9908-y |url=}}</ref>
** [[Bullous pemphigoid]]
** [[Cicatricial pemphigoid]]
** [[Trousseau's syndrome|Migratory superficial thrombophlebitis]] (classic [[Trousseau's syndrome]])
** [[Panniculitis|Pancreatic panniculitis]]
 
===HEENT===
* HEENT examination of patients with jaundice due to [[cirrhosis]] include:<ref name="pmid18328931" />
** [[Hyperestrogenism]]
** [[Parotid gland enlargement]]
** [[Fetor hepaticus]]
 
===Neck===
* Neck examination of patients with jaundice due to [[viral hepatitis]] include:<ref name="pmid19399815" />
** [[Cervical]] [[lymphadenopathy]]
* Neck examination of patients with jaundice due to metastatic [[pancreatic cancer]] include:<ref name="pmid94906072">{{cite journal |vauthors=Galvañ VG |title=Sister Mary Joseph's nodule |journal=Ann. Intern. Med. |volume=128 |issue=5 |pages=410 |date=March 1998 |pmid=9490607 |doi= |url=}}</ref>
** Left [[Supraclavicular lymph nodes|supraclavicular]] [[lymphadenopathy]] ([[Virchow's node]])
** Palpable periumbilical mass (''Sister Mary Joseph's node'')
** [[Metastasis|Metastatic]] palpable mass in the [[rectal]] pouch (''Blumer's shelf'')
** Involvement of other [[Lymph node|nodes]] in the [[cervical]] area
===Lungs===
* Pulmonary examination of patients with jaundice is usually normal.
 
===Heart===
* Cardiac examination of patients with jaundice is usually normal.


===Abdomen===
===Abdomen===
* Hepatomegaly may be present
* Abdominal examination of patients with jaundice due to [[viral hepatitis]] include:<ref name="pmid19399815" />
** [[Hepatomegaly]]
** [[Abdominal tenderness|Right upper quadrant tenderness]]
** [[Abdominal distension]]
** [[Splenomegaly]]
** [[Ascites]]
** [[Caput medusae]]
* Abdominal examination of patients with jaundice due to [[cirrhosis]] include:<ref name="pmid18328931" />
** [[Abdominal distension]]
** [[Caput medusae]]
** [[Hepatomegaly]]
** [[Splenomegaly]]
** [[Ascites]]
* Abdominal examination of patients with jaundice due to [[pancreatic cancer]] include:<ref name="pmid3164230">{{cite journal |vauthors=Manabe T, Miyashita T, Ohshio G, Nonaka A, Suzuki T, Endo K, Takahashi M, Tobe T |title=Small carcinoma of the pancreas. Clinical and pathologic evaluation of 17 patients |journal=Cancer |volume=62 |issue=1 |pages=135–41 |year=1988 |pmid=3164230 |doi= |url=}}</ref><ref name="pmid191909602">{{cite journal |vauthors=Fitzgerald JE, White MJ, Lobo DN |title=Courvoisier's gallbladder: law or sign? |journal=World J Surg |volume=33 |issue=4 |pages=886–91 |year=2009 |pmid=19190960 |doi=10.1007/s00268-008-9908-y |url=}}</ref>
** [[Abdominal distention]]
** [[Abdominal tenderness]]
** [[Hepatomegaly]]
** [[Splenomegaly]]
** Fluid thrill and dullness to [[percussion]]
 
===Back===
* Back examination of patients with jaundice is usually normal.
 
===Genitourinary===
* Genitourinary examination of patients with jaundice due to [[cirrhosis]] include:[[Jaundice physical examination#cite note-pmid18328931-4|<sup>[4]</sup>]]
** [[Testicular atrophy]]
* Genitourinary examination of patients with jaundice due to [[pancreatic cancer]] include:<ref name="pmid9490607">{{cite journal |vauthors=Galvañ VG |title=Sister Mary Joseph's nodule |journal=Ann. Intern. Med. |volume=128 |issue=5 |pages=410 |year=1998 |pmid=9490607 |doi= |url=}}</ref>
** [[Metastasis|Metastatic]] palpable mass may be present in the [[rectal]] pouch (''Blumer's shelf'') in advanced stages


===Neurologic===
===Neurologic===
* A flap may be present
* Neurologic examination of patients with jaundice and [[hepatic encephalopathy]] due to [[viral hepatitis]] may include:<ref name="pmid19399815" /><ref name="pmid28533911">{{cite journal |vauthors=Ferenci P |title=Hepatic encephalopathy |journal=Gastroenterol Rep (Oxf) |volume=5 |issue=2 |pages=138–147 |year=2017 |pmid=28533911 |pmc=5421503 |doi=10.1093/gastro/gox013 |url=}}</ref>
** [[Altered mental status]]
** [[Coma]]
** [[Asterixis]]
 
===Extremities===
* Extremities examination of patients with jaundice due to [[viral hepatitis]] include:<ref name="pmid19399815" />
** [[Peripheral edema]]
* Extremities examination of patients with jaundice due to [[cirrhosis]] include:[[Jaundice physical examination#cite note-pmid18328931-4|<sup>[4]</sup>]]<ref name="pmid133161432">{{cite journal |vauthors=MUEHRCKE RC |title=The finger-nails in chronic hypoalbuminaemia; a new physical sign |journal=Br Med J |volume=1 |issue=4979 |pages=1327–8 |year=1956 |pmid=13316143 |pmc=1980060 |doi= |url=}}</ref>
** [[Edema]] of the lower extremities
** [[Muscle atrophy]]
** [[Nail changes]]
** [[Clubbing]]


==References==
==References==
{{reflist|2}}
{{reflist|2}}
{{WH}}
{{WH}}
{{WS}}
{{WS}}
[[Category:Gastroenterology]]
[[Category:Hepatology]]
[[Category:Needs overview]]

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

Jaundice is a yellowish discoloration of the skin and sclerae that is an important symptom of elevated serum bilirubin. Physical examination of patients with jaundice is based on underlying disease, include cervical lymphadenopathy, hepatomegaly, splenomegaly, and peripheral edema.

Physical Examination

Jaundice is seen with a number of disorders. Physical examination of patients with jaundice is based on underlying disease.

Appearance of the Patient

Vital Signs

Skin

HEENT

Neck

Lungs

  • Pulmonary examination of patients with jaundice is usually normal.

Heart

  • Cardiac examination of patients with jaundice is usually normal.

Abdomen

Back

  • Back examination of patients with jaundice is usually normal.

Genitourinary

Neurologic

Extremities

References

  1. ↑ Li CP, Lee FY, Hwang SJ, Chang FY, Lin HC, Lu RH, Hou MC, Chu CJ, Chan CC, Luo JC, Lee SD (1999). "Spider angiomas in patients with liver cirrhosis: role of alcoholism and impaired liver function". Scand. J. Gastroenterol. 34 (5): 520–3. PMID 10423070.
  2. ↑ 2.0 2.1 2.2 Schuppan D, Afdhal NH (2008). "Liver cirrhosis". Lancet. 371 (9615): 838–51. doi:10.1016/S0140-6736(08)60383-9. PMC 2271178. PMID 18328931.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Rotman Y, Brown TA, Hoofnagle JH (2009). "Evaluation of the patient with hepatitis B". Hepatology. 49 (5 Suppl): S22–7. doi:10.1002/hep.22976. PMC 2881483. PMID 19399815.
  4. ↑ 4.0 4.1 Khorana AA, Fine RL (2004). "Pancreatic cancer and thromboembolic disease". Lancet Oncol. 5 (11): 655–63. doi:10.1016/S1470-2045(04)01606-7. PMID 15522652.
  5. ↑ Li CP, Lee FY, Hwang SJ, Chang FY, Lin HC, Lu RH, Hou MC, Chu CJ, Chan CC, Luo JC, Lee SD (1999). "Spider angiomas in patients with liver cirrhosis: role of alcoholism and impaired liver function". Scand. J. Gastroenterol. 34 (5): 520–3. PMID 10423070.
  6. ↑ Fitzgerald JE, White MJ, Lobo DN (2009). "Courvoisier's gallbladder: law or sign?". World J Surg. 33 (4): 886–91. doi:10.1007/s00268-008-9908-y. PMID 19190960.
  7. ↑ Galvañ VG (March 1998). "Sister Mary Joseph's nodule". Ann. Intern. Med. 128 (5): 410. PMID 9490607.
  8. ↑ Manabe T, Miyashita T, Ohshio G, Nonaka A, Suzuki T, Endo K, Takahashi M, Tobe T (1988). "Small carcinoma of the pancreas. Clinical and pathologic evaluation of 17 patients". Cancer. 62 (1): 135–41. PMID 3164230.
  9. ↑ Fitzgerald JE, White MJ, Lobo DN (2009). "Courvoisier's gallbladder: law or sign?". World J Surg. 33 (4): 886–91. doi:10.1007/s00268-008-9908-y. PMID 19190960.
  10. ↑ Galvañ VG (1998). "Sister Mary Joseph's nodule". Ann. Intern. Med. 128 (5): 410. PMID 9490607.
  11. ↑ Ferenci P (2017). "Hepatic encephalopathy". Gastroenterol Rep (Oxf). 5 (2): 138–147. doi:10.1093/gastro/gox013. PMC 5421503. PMID 28533911.
  12. ↑ MUEHRCKE RC (1956). "The finger-nails in chronic hypoalbuminaemia; a new physical sign". Br Med J. 1 (4979): 1327–8. PMC 1980060. PMID 13316143.

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