an approach to a pt. with jaundice
TRANSCRIPT
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Approach to a patient with Jaundice
Fahima Sultana & Amena Yasmin5th year studentM A G Osmani medical college, Sylhet
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Discussion Topic
Evaluation of the patient presenting with jaundice, by
Proper History &Complete examination .
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History taking
• Age of patient : children/young/old
• Evaluation of yellow discoloration:onset: sudden/gradualduration: short/lonngprogression: fluctuating/intermittent/progressivecolour of urine: normal/dark
Characteristic of stool : normal/pale, frothy, floats on water
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Evaluation of associated symptoms
* Prodromal symptoms-like anorexia, nausea , vomiting, malaise
* High fever with chills and rigors* Abdominal pain or discomfort* Itching * Weight loss* Abdominal mass* Alteration of bowel habit
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History for detection of aetiology
Accidental needle prick injuryPast history - jaundice with neurological problemPersonal history: IV drug abuse, tattooing sexual exposure Alcohol consumption Drug history: anti tubercular drugTreatment history: recent iv injection/ Infusion/blood transfusion/ surgeryFamily history : jaundice, malignancy,consanguinityTravel history, history of taking unhyegenic foodImmunization history
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History regarding complications:
Mental confusion, disorientation , unconsciousness
Hematemesis , malena Respiratory distress Oliguria, puffiness of face Night blindness Bleeding manifestation Fracture of bone Growth retardation Bone pain, chest pain, hemoptysis
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Clinical Examination
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General Examination
Appearance : toxic/ thalassemic face/ disoriented Body built : below average/ chachexicCo-operation : co-operative or notDecubitus : on choice
Anemia : present/absent Jaundice : Mild/ moderate/ severe
Subicteric lemon yellow (acholuric jaundice) Various shades of yellow, Orange, dark olive green (obstructive jaundice) Have to exclude yellow of carotenaemia.
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Cyanosis : absent/present Clubbing : present/absent Koilonychia : absent Leuconychia : absent/present
Edema : absent/present Dehydration : absent/ present Thyroid gland : not enlarged JVP : not raised Lymph node : palpable or not.
If palpable whether diffuse or single.
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Pulse : with in normal range or raised Blood pressure : with in normal range Temperature : normal or raised Respiratory rate : with in normal range
Flapping tremor : absent/present Bony tenderness: absent/present Acholuric urine : Stigmata of CLD (hepatic facies,
parotid enlargement,spider angioma, xanthelasma)
Skin condition : scratch mark, tattoo, puncture mark, muddy complexion, peculiar greyish bronze colour
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Systemic Examination
Examination of GIT
Inspection
abdomen – normal or distended umbilicus - centrally placed,
normal/everted transverse/vertical slitflanks - norlmal/full
Caput medusaAny visible mass
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Palpation
local temperature – normal Taenderness – no/ present in the right
hypochondrium liver – palpable or not
tender/ non tender consistency hard/firm/soft surface smooth/irregular uni-nodular / multinodular bruit present/absent
Spleen – enlarged or not Gall bladder- palpable or not Testes – normal/ atrophied
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• Percussion: shifting dullness – absent/presentfluid thrill – absent/present
• Auscultationbowel sound: present
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Examination of nervous system• Glasgow Coma Scale : level of consciousness• motor weakness, Loss of peripheral sensation• Planter reflex : bilateral flexor/extensor
Examination of the respiratory system:signs of pleural effusion mass lesion
Examination of precordiumshifted apex beat
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Take home message: Cluster clues
• An appropriate and complete history is always important for a diagnosis.
• A proper examination of the patient helps to find out the underlying cause
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