Examination
The clinical examination in jaundiced patients should search for the features of acute and chronic liver disease.
The following points may be helpful:
- haemolytic jaundice is a mild yellow colour; hepatocellular jaundice is orange; prolonged biliary obstruction imparts a deep greenish hue
- cutaneous indicators of cirrhosis include purpura, spider naevi, palmar erythema, and loss of secondary sexual hair
- cutaneous indicators of chronic cholestasis include scratch marks, pigmentation, finger clubbing, xanthomas
- ascites suggests cirrhosis or malignant disease
- hepatomegaly:
- large, nodular liver suggests cancer
- large, smooth liver suggests extrahepatic cholestasis
- small liver may be due to hepatitis or cirrhosis
- arterial murmur over the liver indicates acute alcoholic hepatitis or primary liver cancer
- splenomegaly suggests portal hypertension due to cirrhosis
- palpable gall bladder suggests pancreatic carcinoma
- dark urine and pale stools suggests cholestasis
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