History

Important points in a history concerning jaundice include:

• duration of illness:
  • short history, preceding nausea, anorexia - suggests hepatitis
  • cholestatic jaundice develops slowly, usually with persistent pruritus
  • pyrexia, fevers, rigors - suggests cholangitis associated with gallstones or biliary stricture
    
    
• family history - congenital hyperbilirubinaemia, hepatitis, gallstones
  
  
• recent community outbreak of jaundice - suggests hepatitis A
  
  
• recent consumption of shellfish - suggests hepatitis A
  
  
• note recent travel to areas where hepatitis is endemic
  
  
• male homosexuality, recent injections - intravenous drug abuse, blood tests, tuberculin testing - increased risk of hepatitis B
  
  
• recent blood or plasma transfusion - increased risk of hepatitis C in developed countries; of hepatitis B in developing countries
  
  
• alcohol consumption - may complain of morning nausea, anorexia, diarrhoea, right upper quadrant pain
  
  
• recent surgery:
  • jaundice following biliary tract surgery may indicate residual calculi
  • may be due to anaesthesia e.g. halothane
    
    
• rarely the patient may complain that everything has a yellow tinge - xanthopsia