Jaundice history & symptoms: Difference between revisions
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==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 appears in a 'top to bottom' progression (starting with the face, progressing toward the feet), and resolves in a 'bottom to top' manner. | ||
The caregiver should ask questions regarding | * The caregiver should ask questions regarding Alcohol or hepatotoxic medication use. | ||
''' | ==='''History'''=== | ||
* | Patients with jaundice may have a positive history of: | ||
*:* [[ | ====Social history==== | ||
* '''[[Viral Hepatitis]] | *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 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]] | |||
* '''[[Cirrhosis]] | * '''[[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>''' | ||
** Right upper quadrant [[abdominal pain]] | |||
** [[Fever]] | |||
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 disorder|Menstrual irregularities]] | ||
* [[Abdominal pain]] and bloating | ** Symptoms of [[hypogonadism]]: | ||
* [[Menstrual disorder|Menstrual irregularities]] | *** [[Erectile dysfunction|Impotence]] | ||
* Symptoms of [[hypogonadism]]: | *** [[Infertility]] | ||
** [[Erectile dysfunction|Impotence]] | *** [[Testicular atrophy]] | ||
** [[Infertility]] | *** Loss of [[libido]] | ||
** [[Testicular atrophy]] | ** Easy bruisability | ||
** Loss of [[libido]] | |||
* Easy bruisability | |||
** Symptoms due to [[hepatic encephalopathy]]: | ** Symptoms due to [[hepatic encephalopathy]]: | ||
*** [[Altered mental status]] | *** [[Altered mental status]] | ||
*** [[Confusion]] | *** [[Confusion]] | ||
*** Sleep disturbances | *** Sleep disturbances | ||
** Muscle cramps due to reduction in effective circulating plasma volume | *** Muscle cramps due to reduction in effective circulating plasma volume | ||
** Lower extremity [[edema]] | *** Lower extremity [[edema]] | ||
** '''[[Primary biliary cirrhosis]]''' presents with the following symptoms: | ** '''[[Primary biliary cirrhosis]]''' presents with the following symptoms: | ||
*** [[Fatigue]] out of proportion to the severity of the [[disease]] | *** [[Fatigue]] out of proportion to the severity of the [[disease]] | ||
*** [[Pruritis]] | *** [[Pruritis]]: | ||
**** May be intermittent | **** May be intermittent | ||
**** Increases in the evening | **** Increases in the evening | ||
**** May present in the last trimester of [[pregnancy]] and may be mis-diagnosed as cholestasis of pregnancy | **** May present in the last trimester of [[pregnancy]] and may be mis-diagnosed as cholestasis of pregnancy | ||
* '''[[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> | * '''[[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> | ||
** [[Weight loss|Weight Loss]] (significant) | ** [[Weight loss|Weight Loss]] (significant) | ||
** [[Epigastric|Midepigastric]] [[pain]] which may also radiate either to the lower back region and mid-back region | ** [[Epigastric|Midepigastric]] [[pain]] which may also radiate either to the lower back region and mid-back region | ||
** [[Nausea]] | ** [[Nausea]] | ||
| Line 86: | Line 83: | ||
** [[Dyspepsia]] | ** [[Dyspepsia]] | ||
** [[Ascites]] | ** [[Ascites]] | ||
** | ** [[Dark urine]] | ||
** [[Acholic stools|Light-colored or greasy stools]] | ** [[Acholic stools|Light-colored or greasy stools]] | ||
* '''[[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> | * '''[[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> | ||
** Clay-colored or white stools | ** Clay-colored or white stools | ||
** Dark urine | ** [[Dark urine]] | ||
** Inability to digest certain foods | ** Inability to [[digest]] certain foods | ||
** Itching | ** [[Itching]] | ||
** [[Nausea]] or [[vomiting]] | ** [[Nausea]] or [[vomiting]] | ||
** Pain in the right upper part of the [[abdomen]] | ** Pain in the right upper part of the [[abdomen]] | ||
** Yellow skin or eyes | ** Yellow skin or eyes | ||
* '''[[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> | * '''[[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]] | ** [[Pruritis]] | ||
** [[Abdominal pain]] | ** [[Abdominal pain]] | ||
** [[Fever]] | ** [[Fever]] | ||
** [[Fatigue]] | ** [[Fatigue]] | ||
==='''Less Common Symptoms'''=== | |||
Less common symptoms of jaundice include | |||
*'''[[Primary sclerosing cholangitis]]''' | |||
** [[Fatigue]] | |||
** [[Pruritis]] | |||
** [[Steatorrhea]] | |||
** [[Abdominal pain]], mainly in the [[right upper quadrant]] ([[RUQ]]) | |||
** [[Jaundice|Yellowish discoloration of the skin]] and [[mucous membranes]] ([[jaundice]]) | |||
** [[Fever]] | |||
** [[Weight loss]] | |||
* '''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> | |||
** Increase in abdominal girth due to [[ascites]] | |||
** [[Itch|Pruritus]] | |||
** Signs of [[upper gastrointestinal bleeding]]: | |||
*** [[Hematemesis]] | |||
*** [[Hematochezia]] | |||
*** [[Melena]] | |||
==References== | ==References== | ||
Revision as of 20:42, 1 February 2018
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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 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.
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.
- The caregiver should ask questions regarding 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
- History of infections:[1]
- Hepatitis B
- Hepatitis C
- History of autoimmune disorders:
- History of blood transfusions
Family history
- Family history of liver disease:
Medication history
- History of use of any hepatotoxic drugs
Common Symptoms
Common symptoms of jaundice include:
- Viral Hepatitis[2][3]
- Anorexia
- Dark urine
- Fatigue
- Light-colored stools (acholic stools)
- Pruritis
- Right upper quadrant (RUQ) pain
- Nausea and Vomiting
- Cirrhosis[4][5]
- Right upper quadrant abdominal pain
- Fever
- Anorexia
- Fatigue and weakness
- Nausea and vomiting
- Weight loss
- Abdominal pain and bloating
- Menstrual irregularities
- Symptoms of hypogonadism:
- Impotence
- Infertility
- Testicular atrophy
- Loss of libido
- Easy bruisability
- Symptoms due to hepatic encephalopathy:
- Altered mental status
- Confusion
- Sleep disturbances
- Muscle cramps due to reduction in effective circulating plasma volume
- Lower extremity edema
- Primary biliary cirrhosis presents with the following symptoms:
- Pancreatic cancer[6]
- Weight Loss (significant)
- Midepigastric pain which may also radiate either to the lower back region and mid-back region
- Nausea
- Vomiting
- Malaise
- Fatigue
- Loss of appetite
- Anorexia
- Dyspepsia
- Ascites
- Dark urine
- Light-colored or greasy stools
- Cholestasis[7]
- Cholangiocarcinoma [8]
Less Common Symptoms
Less common symptoms of jaundice include
- Decompensated cirrhosis[9]
- Increase in abdominal girth due to ascites
- Pruritus
- Signs of upper gastrointestinal bleeding:
References
- ↑ 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.
- ↑ Krugman S, Giles JP (1970). "Viral hepatitis. New light on an old disease". JAMA. 212 (6): 1019–29. PMID 4191502.
- ↑ 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.
- ↑ Williams EJ, Iredale JP (1998). "Liver cirrhosis". Postgrad Med J. 74 (870): 193–202. PMC 2360862. PMID 9683971.
- ↑ Schuppan D, Afdhal NH (2008). "Liver cirrhosis". Lancet. 371 (9615): 838–51. doi:10.1016/S0140-6736(08)60383-9. PMC 2271178. PMID 18328931.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.