Gastroenterology Book

Cirrhosis

Examination

  • Jaundice

http://www.fpnotebook.com/

JaundiceAka: Yellow Skin, Dermal Icterus

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  1. See Also
    1. Jaundice in Newborns
  2. Definition
    1. "Yellow skin" related to Hyperbilirubinemia
  3. Pathophysiology
    1. See Hyperbilirubinemia
  4. Causes
    1. See Hyperbilirubinemia
  5. Symptoms
    1. Pruritus
      1. See Cholestasis associated Pruritus
    2. Yellow skin
    3. Abdominal Pain
    4. Weight loss
  6. Signs
    1. See Jaundice in Newborns
    2. Sites of predilection
      1. Face
      2. Trunk
      3. Tongue frenulum (early finding)
      4. Sclera (see Scleral Icterus)
    3. Factors that accentuate jaundice
      1. Tanned skin
    4. Factors that may hide jaundice
      1. Artificial light
    5. Associated findings that may direct to cause
      1. Ecchymosis
      2. Spider angiomas
      3. Gynecomastia
      4. Testicular atrophy
  7. Signs: Findings suggestive of Obstructive Jaundice
    1. Dark yellow or brown colored Urine
      1. Direct Hyperbilirubinemia (increased Urobilinogen)
      2. Shaking specimen results in yellow foam
    2. Acolic Stools
      1. Gray-white, malodorous stools
    3. Sinus Bradycardia
  8. Labs: Initial
    1. Complete Blood Count
    2. Bilirubin: Diagnosis requires Bilirubin fractionation
      1. See Bilirubin
      2. Jaundice visible when Bilirubin >2-4 mg/dl
      3. See Indirect Bilirubin (Hemolytic Jaundice)
      4. See Direct Bilirubin (Obstructive Jaundice)
    3. Other Liver Function Tests
      1. Aspartate transaminase (AST)
      2. Alanine transaminase (ALT)
      3. Gamma-glutamyl transpeptidase (GGT)
      4. Alkaline Phosphatase
    4. Urinalysis
      1. Bilirubin in urine suggests Conjugated Bilirubin
  9. Evaluation: Based on labs above
    1. Unconjugated Hyperbilirubinemia
      1. Consider causes of elevated Indirect Bilirubin
    2. Conjugated Hyperbilirubinemia
      1. Screen for Viral Hepatitis
      2. Consider autoimmune condition screening
        1. Antinuclear Antibody (ANA)
        2. Anti Liver-Kidney microsomal Antibody
        3. Anti-Smooth Muscle Antibody
      3. Consider abdominal ultrasound or abdominal CT
  10. Differential Diagnosis (Yellow skin)
    1. See Hyperbilirubinemia
    2. Carotenemia
    3. Quinacrine
    4. Occupational exposure to Explosive manufacturing
      1. Dinitrophenol
      2. Tetryl
  11. References
    1. Degowin (1987) Diagnostic Exam, Macmillan, p.480-1
    2. Feldman (1998) Sleisenger and Fordtran's, p. 220-231
    3. Pasha (1996) Med Clin North Am 80:995
    4. Roche (2003) Am Fam Physician 69:299

Icterus (C0022346)

Definition (MSH)A clinical manifestation of HYPERBILIRUBINEMIA, characterized by the yellowish staining of the SKIN; MUCOUS MEMBRANE; and SCLERA. Clinical jaundice usually is a sign of LIVER dysfunction.
Definition (CSP)clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes.
Definition (NCI)(JAWN-dis) A condition in which the skin and the whites of the eyes become yellow, urine darkens, and the color of stool becomes lighter than normal. Jaundice occurs when the liver is not working properly or when a bile duct is blocked.
ConceptsPathologic Function (T046)
ICD9782.4
BasqueIKTERIZIA
DanishGulsot icterus
DutchGeelzucht
EnglishIcteric, Icterus, Jaundice, Jaundiced, YELLOW SKIN
FinnishKELTAISUUS
FrenchIctere, Jaunisse
GermanGelbsucht/Ikterus
Hebrewtzahevet
Hungariansargasag
ItalianIttero
NorwegianGULSOTT/IKTERUS
PortugueseIctericia
Spanishictericia
SwedishGULSOT/ICTERUS
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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