Jaundice physical examination
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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
- Patients usually appear weak due to constitutional symptoms such as weight loss, anorexia and muscle atrophy. Yellowish discoloration of skin and abdominal distension may also be present due to ascites.
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
- Pulmonary examination: Normal
Heart
- Cardiovascular examination: Normal
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
- Back examination: Normal
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.