Jaundice Presentation

QUIZ
W H I C H O F T H E F O L LO W I N G I S A P R E - H E PAT I C C A U S E F O R
?JAUNDICE
• Primary Biliary Sclerosis

• Sickle cell anaemia
• Cholelithiasis
• Haemochromatosis
Jaundice
Done by
Ibrahim Al-sailamy
etc
TABLE OF CONTENTS
Approach to
What is Jaundice? Jaundice
01 Definiation and
Pathophysiology of
Jaundice
02 How To approach
jaundice Pt.
Investigation Treatment
03 Investigation that
should be done.
04 Basic Information of
how to treat this Pt.
01
What is
Jaundice?
Jaundice
Is a yellow discoloration of the sclera and

skin as a result of a raised serum bilirubin,
It is usually detectable clinically when the
bilirubin exceeds 3mg/dl (as eye
discoloration)
The point at which is jaundice can be

observed in Pt. Skin depends on the skin
tone and ambient of light.
Yellow Discoloration of the
eye
Physiology of
bilirubin
Pathophysiology of
Jaundice
Hepatocellular
(Hepatic)
Increase
Cholestatic
Production
(Post-Hepatic)
(Pre-Hepatic)
Jaundice
Pre-Hepatic Jaundice
This occurs duo to increased
destruction of RBC, either
1. Intra-vascular
2. Extra-vascular
Hepatic Jaundice
This occurs duo to either
1. Abnormal conjugation of bilirubin.
2. Intrahepatic cholestasis.
Post-Hepatic
Jaundice
Resulting from obstruction of bile flow at
any point.
Post Hepatic Hepatic Causes Pre-Hepatic Causes
Extrahepatic Intrahepatic Defects in Extravascular Intravascular

cholestasis cholestasis conjugation hemolysis hemolysis
1- Choledocholithiasis 1- Hepatitis 1- Gilbert’s syndrome. 1- SCA 1- Prosthetic cardiac

2- cholangitis. 2- Cirrhosis 2- Crigler-Najjar 2- Thalassemia valves.
3- Malignancy. 3- Infiltration 3- Heart Failure 3- hereditary 2- (G6PD) deficiency.
4- biliary stricture. 4- Cholestasis of (Congestive spherocytosis 3- TTP.
5- parasitic infection. pregnancy Hepatopathy). 4- Hyperspleenism 4- DIC.
5- Primary biliary 5-Transfusion of ABO
cirrhosis. incompatible blood.
6- PND
7- Infections: Malaria.
• Parasitic infections.
• Primary sclerosing cholangitis.
• AIDS cholangiopathy.
According To USA studies
Most common causes of Acute Jaundice are:
1. Gilbert syndrome.
2. Alcoholic liver disease.
3. Viral Hepatitis.
4. Choledocholithiasis.
Most common causes of chorionic
5. Liver cirrhosis.
6. Pancreatic Cancer.
Jaundice Mimics
Carotenmia.
Condition characterized by yellowish skin
pigmentation.
Duo to excessive consumption of keratein rich food
like carrots.
02
Clinical
Approach to
Jaundice
Clinical Approach to
Jaundice
1st thing 1st:
Check if the Pt. is stable and fit
for taking history and
examination.
If Stable
History
Look for data suggestive of hepatobiliary,
hemolytic anemia disease.
Look for symptoms of Hepatobiliary, hemolytic
anemia disease.
IN DETAILS
Personal Data
Sex:- Female > Male in autoimmune Hepatitis +
cholestasis of pregnancy.
Age:-
• >13, think about different etiology, such
Inherited hemolytic causes, such thalassemia.
• Adults
• Elder, Cardiac cirrhosis are more common.
Personal Data
Living Place:- If its area of endemic disease
such Malaria
Occupation:-
• Medical Employee are in greater risk factor for
blood transmitted disease such, Hepatitis B
and C
• Sewage and garbage men are in greater risk
factors for blood transmitted disease, Hepatitis
A, B and C
Education:-
Sp. Habits:-
Onset of Jaundice
Slow Onset:-
Think of alcoholic and NAFLD and liver metasets
and hepatitis C.
Rapid onset:-
Hepatitis A, E and autoimmune disorders and
pregnancy.
AOPI
Abdominal pain:-
1. If the pain is focused on Rt. hypo-chondirum
pain then think about causes the make liver
congestion, such hepatitis, cholecystitis.
2. If the pain is radiated to the Rt. Shoulder, then
think about cholecystitis.
3. If its ass. With nausea, vomiting and Pale
Diarrhea and dark urine then its mostly
Hepatitis A.
4. If its ass. Without nausea and vomiting Dark
urine and pale stool the its mostly obstructive
AOPI
Shortness of breath:-
1. Pallor  Hemolytic Anemia.
2. Heart failure ass. symptoms.
Fever
3. intermittent or continuous high grade fever,
Pallor, (Splenomegaly on examination) 
Malaria infection
4. Low grade fever with wt. lose, anorexia, and
fatigue  Malignancy.
Past History
Medical history:-
1. Pervious history of jaundice  consider chronic
active viral hepatitis.
2. Search for autoimmune disease
3. Drug use 
4. Sickles cell crisis.
5. Heart Failure.
Surgical history :-
6. Infectious hepatitis.
7. Malignancies.
Past History
Blood Transfusion:-
• Regular blood transfusion:- Inherited hemolytic
anemia, mostly Thalassemia.
• Any past Blood transfusion followed by
jaundice:- consider chronic active viral
hepatitis.
• Up to 4 weeks near blood transfusion followed
by jaundice:- Blood incompatibility.
Family History
Similar history in the family:- Look for symptoms
of inherited hemolytic anemia, Malignancy or
autoimmune disease.
Social History
Poor income and bad housing condition like bad
water sources increases the risk of infectious
hepatitis.
Traveling History
Important in case of traveling to places that are
endemic with malaria.
Drug History
Co-Amoxiclave (Cholestasis).
Isoniazid, Rifampicin (Anti-TB drug).
Oral Contraceptive.
Examination
• Level of consciousness,
1st
Imp
Distress, Body Built, Pallor,
ress
ion
cyanosis, JVP.
Vita
• Pulse, RR, Temp., blood
l
Sig
pressure,
ns
Wh • Signs of: Liver disease,
at
to Hemolytic anemia, Heart
Loo
k Failure.
For
?
IN DETAILS
1st Impression
A: Appearance
Well  Mild hemolytic anemia, Chronic liver disease.
Toxic  Hepatitis, Liver failure
In pain  Hepatitis, Sickle Cell Anemia Crisis
Alertness
Level of consciousness  Impaired = Liver failure.
B: Body built
Below Average  Chronic liver disease
Above Average  fatty Liver
C: Color
Cyanosis  Heart failure.
Pallor  Hemolytic anemia
Jaundice  Color, Green (Lemon) 
Orange or yellow 
Spread, Sclera 
Abdomen 
1st Impression
C: Color
Petechia* ??
1st Impression
D: Distress
Shortness of breath: Anemia, Cardiac cirrhosis.
Dysmorphic Features:
Thalassemic Face
E: Equipment
Blood transfusion: Hemolytic Anemia.
Albumin in take: Liver Failure.
On General
Examination
Vital Signs:
Check Pulse For Heart Conditions
Check Blood pressure for Hypertension
Check CRR for Anemia
Check Temp. for Hepatitis
Check Respiratory rate and movement for (No
Full chest expansion) and Shortness of breath
for Anemia.
On General
Examination
Generally Look for Signs of Liver disease,
Hemolytic Anemia, Heart Failure
Hand:- Clubbing, Palmar erythema, Muscle

wasting.
Face:- Pallor, Jaundice, Cyanosis.
Neck:- Raised JVP.
Leg:- Lower Limb Edema.
Then do abdominal examination, if you suspect

cardiac causes then exam the heart.
Look for Hepato-megaly or Liver shrinkage

If Unstable
Try To take brief
history
Focus on C/C and AOPI
Take More focused history of Jaundice  onset and

duration
On Review of other symptoms look for Cardiac Disease,

Liver disease And Anemia.
If you suspect acute heart
failure
Suggestive history, Shortness
of breath, LL edema, Raised
JVP, High Blood Pressure,
Abnormal Pulse, Abnormal
chest exam.
General Steps for acute heart
failure
ABC.
Vasodilators.
Diuretics.
General Steps for acute heart
failure
ABC.
Vasodilators.
Diuretics.
If you suspect Acute Liver
Failure
Encephalopathy
Coagulopathy
Kidney failure
Inflammation and infection
Metabolic derangements
Drug History

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QUIZ

• Primary Biliary Sclerosis

Is a yellow discoloration of the sclera and

The point at which is jaundice can be

Extrahepatic Intrahepatic Defects in Extravascular Intravascular

1- Choledocholithiasis 1- Hepatitis 1- Gilbert’s syndrome. 1- SCA 1- Prosthetic cardiac

Hand:- Clubbing, Palmar erythema, Muscle

Then do abdominal examination, if you suspect

Look for Hepato-megaly or Liver shrinkage

Take More focused history of Jaundice  onset and

On Review of other symptoms look for Cardiac Disease,

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