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  • 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

Red flags for jaundice: unexplained weight loss, progressive jaundice (including painless jaundice), cerebral dysfunction, e.g. confusion, somnolence.

Table J1Jaundice (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 J2Characteristic liver function tests

Infective viral hepatitis

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

  • A and E—faeco–oral transmission

  • B, C, ...

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