Skip to Main Content

++

Jaundice

++

  • Jaundice is defined as a serum bilirubin level above 19 µmol/L.

  • Clinical jaundice manifests only when the bilirubin exceeds 50 µmol/L.

  • Jaundice is difficult to detect visually below 85 µmol/L if lighting is poor.

  • The most common causes recorded in a general practice population are (in order) viral hepatitis, gallstones, carcinoma of pancreas, cirrhosis, pancreatitis and drugs.

  • Always take a full travel, drug and hepatitis contact history in any patient presenting with jaundice.

++
Table Graphic Jump Location
Table J1

Jaundice (adults): diagnostic strategy model

++
Key history
++

  • Associated symptoms (e.g. rash, pruritus, fever, arthralgia, weight loss)

  • Medical history

  • Contact with people with hepatitis or jaundice

  • Overseas travel, family history, drug history, IV drug use, sexual history, occupational history

++ Key examination
++

  • General inspection including skin for signs of excoriation.

  • The abdominal examination is important with a focus on the liver and spleen.

  • Look for signs of chronic liver disease.

  • Test for hepatitis flap (asterixis) and fetor, which indicate liver failure.

  • Include dipstick urine testing for bilirubin and urobilinogen.

++ Key investigations
++

  • The main ones are the standard LFTs and viral serology for infective causes (hepatitis A, B, C and possibly EBV).

  • Consider hepatobiliary imaging, autoantibodies for autoimmune chronic active hepatitis and primary biliary cirrhosis, tumour markers and iron studies.

++
Table Graphic Jump Location
Table J2

Characteristic liver function tests

++
Infective viral hepatitis
++ ++

  • Hepatitis A, B, C, common esp. B and C

  • A and E—faeco–oral transmission

  • B, C, D—from IV drugs and bodily fluids

  • Sexual transmission with B and C

  • Diagnosed by viral markers for A, ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

Murtagh Collection Full Site: One-Year Subscription

Connect to a suite of general practice resources from one of the most influential authors in the field. Learn the breadth of general practice, including up-to-date information on diagnosis and treatment, as well as key clinical skills like communication.

$145 USD
Buy Now

Pay Per View: Timed Access to all of Murtagh Collection

48 Hour Subscription $34.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.