Jaundice physical examination: Difference between revisions
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* [[Cervical]] [[lymphadenopathy]] may be present in [[viral hepatitis]].<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> | * [[Cervical]] [[lymphadenopathy]] may be present in [[viral hepatitis]].<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> | ||
* Signs of [[Metastasis|metastatic disease]] include: | |||
** 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 | |||
may be present in [[pancreatic cancer]]. | |||
===Lungs=== | ===Lungs=== | ||
Revision as of 14:44, 5 February 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
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
- Fever, tachycardia, hypotension, tachypnea may be present in viral hepatitis.[1]
- Weight loss, anorexia, muscle atrophy, ascite may be present in cirrhosis.[2]
Skin
- Jaundice is visible in conjunctiva, skin and mucosa when the serum bilirubin level rises above 2 mg/dL.
- Jaundice, palmar erythema, spider angiomata, gynecomastia may be present in viral hepatitis. [1]
- Pallor, bruises, palmar erythema on the thenar and hypothenar eminences, spider angiomata, telangiectasias may be present in cirrhosis.[3]
HEENT
- Thinning of hair on the scalp due to hyperestrogenism, parotid gland enlargement, fetor hepaticus may be present in cirrhosis. [4]
Neck
- Cervical lymphadenopathy may be present in viral hepatitis.[1]
- Signs of metastatic disease include:
- Left supraclavicular lymphadenopathy (Virchow's node)
- Palpable periumbilical mass (Sister Mary Joseph's node)
- Metastatic palpable mass in the rectal pouch (Blumer's shelf)
- Involvement of other nodes in the cervical area
may be present in pancreatic cancer.
Lungs
Heart
Abdomen
- Hepatomegaly with right upper quadrant tenderness, abdominal distention, abdominal tenderness, splenomegaly, ascites, caput medusae may be present in viral hepatitis. [1]
- Abdominal distension, caput medusa, hepatomegaly, splenomegaly, ascites may be present in cirrhosis. [4]
- Abdominal distention, abdominal tenderness, hepatosplenomegaly, fluid thrill and dullness to percussion may be present due to ascites in pancreatic cancer.
Back
Genitourinary
- Testicular atrophy may be present in cirrhosis.[4]
- Metastatic palpable mass may be present in the rectal pouch.(Blumer's shelf) in advanced stages of pancreatic cancer.
Neurologic
- Altered mental status, encephalopathy may be present in viral hepatitis.[1]
- Alteration of mental status , confusion, coma, asterixis may be present in hepatic encephalopathy.[5]
Extremities
- Peripheral edema, dupuytren's contracture may be present in viral hepatitis.[1]
- Edema of the lower extremities, muscle atrophy, nail changes, clubbing may be present in cirrhosis.[4] [6]
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 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.
- ↑ 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.
- ↑ 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.
- ↑ 4.0 4.1 Schuppan D, Afdhal NH (2008). "Liver cirrhosis". Lancet. 371 (9615): 838–51. doi:10.1016/S0140-6736(08)60383-9. PMC 2271178. PMID 18328931.
- ↑ Ferenci P (2017). "Hepatic encephalopathy". Gastroenterol Rep (Oxf). 5 (2): 138–147. doi:10.1093/gastro/gox013. PMC 5421503. PMID 28533911.
- ↑ MUEHRCKE RC (1956). "The finger-nails in chronic hypoalbuminaemia; a new physical sign". Br Med J. 1 (4979): 1327–8. PMC 1980060. PMID 13316143.