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