Jaundice physical examination
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farnaz Khalighinejad, MD [2]
Overview
Jaundice is a yellowish discoloration of the skin and sclerae that is an important symptom of elevated serum bilirubin. Physical examination of patients with jaundice is based on underlying disease, include cervical lymphadenopathy, hepatomegaly, splenomegaly, and peripheral edema.
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
- Viral hepatitis:
- The appearance of the patient on presentation depends on the age.[3]
- Younger patients tend to be asymptomatic, while older patients tends to be symptomatic.
- Symptomatic patients may have a range of symptoms that may vary in severity from a mild flu-like illness to fulminant hepatitis.
- Patients with fulminant hepatitis are usually disoriented and very ill-looking.
- Pancreatic cancer:
- Patients with pancreatic cancer presents usually in the sixth decade of life and appear cachectic, with signs of malnutrition.[4]
Vital Signs
- Vitals signs of patients with jaundice due to viral hepatitis include:[3]
Skin
- Jaundice is visible in conjunctiva, skin, and mucosa when the serum bilirubin level rises above 2 mg/dL.
- Skin examination of patients with jaundice due to viral hepatitis include:[3]
- Skin examination of patients with jaundice due to cirrhosis include:[5]
- Skin examination of patients with jaundice due to pancreatic cancer include:[4][6]
HEENT
Neck
- Neck examination of patients with jaundice due to viral hepatitis include:[3]
- Neck examination of patients with jaundice due to metastatic pancreatic cancer include:[7]
- 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
Lungs
- Pulmonary examination of patients with jaundice is usually normal.
Heart
- Cardiac examination of patients with jaundice is usually normal.
Abdomen
- Abdominal examination of patients with jaundice due to viral hepatitis include:[3]
- Abdominal examination of patients with jaundice due to cirrhosis include:[2]
- Abdominal examination of patients with jaundice due to pancreatic cancer include:[8][9]
- Abdominal distention
- Abdominal tenderness
- Hepatomegaly
- Splenomegaly
- Fluid thrill and dullness to percussion
Back
- Back examination of patients with jaundice is usually normal.
Genitourinary
- Genitourinary examination of patients with jaundice due to cirrhosis include:[4]
- Genitourinary examination of patients with jaundice due to pancreatic cancer include:[10]
- Metastatic palpable mass may be present in the rectal pouch (Blumer’s shelf) in advanced stages
Neurologic
- Neurologic examination of patients with jaundice and hepatic encephalopathy due to viral hepatitis may include:[3][11]
Extremities
- Extremities examination of patients with jaundice due to viral hepatitis include:[3]
- Extremities examination of patients with jaundice due to cirrhosis include:[4][12]
- Edema of the lower extremities
- Muscle atrophy
- Nail changes
- Clubbing
References
- ↑ 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.
- ↑ 2.0 2.1 2.2 Schuppan D, Afdhal NH (2008). “Liver cirrhosis”. Lancet. 371 (9615): 838–51. doi:10.1016/S0140-6736(08)60383-9. PMC 2271178. PMID 18328931.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 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.
- ↑ 4.0 4.1 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.
- ↑ 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.
- ↑ 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 (March 1998). “Sister Mary Joseph’s nodule”. Ann. Intern. Med. 128 (5): 410. PMID 9490607.
- ↑ 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.
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