Jaundice physical examination: Difference between revisions
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* Jaundice, [[palmar erythema]], [[Spider angioma|spider angiomata]], [[gynecomastia]] 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> | * Jaundice, [[palmar erythema]], [[Spider angioma|spider angiomata]], [[gynecomastia]] 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> | ||
* [[Pallor]], [[Bruise|bruises]], [[palmar erythema]] on the [[Thenar eminence|thenar]] and [[Hypothenar eminence|hypothenar eminences]], [[Spider angioma|spider angiomata]], [[Telangiectasia|telangiectasias]] may be present in [[cirrhosis]].<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]], [[Bruise|bruises]], [[palmar erythema]] on the [[Thenar eminence|thenar]] and [[Hypothenar eminence|hypothenar eminences]], [[Spider angioma|spider angiomata]], [[Telangiectasia|telangiectasias]] may be present in [[cirrhosis]].<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> | ||
* [[Bullous pemphigoid]], [[Mucous membrane pemphigoid|cicatricial pemphigoid]], [[Thrombophlebitis|migratory superficial thrombophlebitis]] (classic [[Trousseau's syndrome]]), [[Panniculitis|pancreatic panniculitis]] may be present in [[pancreatic cancer]].<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> | * [[Bullous pemphigoid]], [[Mucous membrane pemphigoid|cicatricial pemphigoid]], [[Thrombophlebitis|migratory superficial thrombophlebitis]] (classic [[Trousseau's syndrome]]), [[Panniculitis|pancreatic panniculitis]] may be present in [[pancreatic cancer]].<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><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> | ||
===HEENT=== | ===HEENT=== | ||
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* [[Hepatomegaly]] with [[right upper quadrant]] tenderness, [[Abdominal distension|abdominal distention]], [[abdominal tenderness]], [[splenomegaly]], [[ascites]], [[caput medusae]] 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> | * [[Hepatomegaly]] with [[right upper quadrant]] tenderness, [[Abdominal distension|abdominal distention]], [[abdominal tenderness]], [[splenomegaly]], [[ascites]], [[caput medusae]] 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> | ||
* [[Abdominal distension]], [[Caput medusae|caput medusa]], [[hepatomegaly]], [[splenomegaly]], [[ascites]] may be present in [[cirrhosis]]. <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> | * [[Abdominal distension]], [[Caput medusae|caput medusa]], [[hepatomegaly]], [[splenomegaly]], [[ascites]] may be present in [[cirrhosis]]. <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> | ||
* [[Abdominal distention]], [[abdominal tenderness]], [[hepatosplenomegaly]], fluid thrill and dullness to [[percussion]] may be present due to [[ascites]] in [[pancreatic cancer]]. <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> | * [[Abdominal distention]], [[abdominal tenderness]], [[hepatosplenomegaly]], fluid thrill and dullness to [[percussion]] may be present due to [[ascites]] in [[pancreatic cancer]]. <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> | ||
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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]
- Bullous pemphigoid, cicatricial pemphigoid, migratory superficial thrombophlebitis (classic Trousseau's syndrome), pancreatic panniculitis may be present in pancreatic cancer.[4][5]
HEENT
- Thinning of hair on the scalp due to hyperestrogenism, parotid gland enlargement, fetor hepaticus may be present in cirrhosis. [6]
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. [6]
- Abdominal distention, abdominal tenderness, hepatosplenomegaly, fluid thrill and dullness to percussion may be present due to ascites in pancreatic cancer. [7][8]
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.[9]
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.[10]
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] [11]
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.
- ↑ 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.
- ↑ 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.
- ↑ 6.0 6.1 Schuppan D, Afdhal NH (2008). "Liver cirrhosis". Lancet. 371 (9615): 838–51. doi:10.1016/S0140-6736(08)60383-9. PMC 2271178. PMID 18328931.
- ↑ 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.
- ↑ 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.
- ↑ Galvañ VG (1998). "Sister Mary Joseph's nodule". Ann. Intern. Med. 128 (5): 410. PMID 9490607.
- ↑ 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.