“Jaundice” A bedside approach for
clinical diagnosis
A 32 years old male noticed yellowing of skin and eyes. He was otherwise healthy but
anorexic and occasional nausea is present.
Jaundice.
Jaundice is defined as yellowing of skin, sclera and mucous membranes due to
deposition of bile pigments.
Clinically jaundice is apparent if bilirubin level is > 3gm/dl.
Approach to patient in OPD
Traditional medical teaching will just provide information about differential diagnosis. In
this case it may be
● Hepatitis
● Obstructive jaundice
● Hemolytic anemias
● Cholangitis
And many more. But it often doesn’t guide you on how to proceed beyond listing these
possibilities. You may know the differentials, but how do you take a history, do the
examination, and order investigations to systematically rule them out?
Here is a detailed clinical approach to exclude all possible differentials in an organized
manner:
Approach thorough History and Examinations
After introduction and consent in proper way.
First thing you have to notice in patient is hepatomegaly.
, ● If hepatomegaly is present then possible differential are gaucher diseases, viral
hepatitis, obstructive jaundice, infectious mononucleosis, cholecystitis,
Cholangitis etc
● If hepatomegaly is not present then possible differential will be hemolytic
anemias, pernicious anemia, Gilbert disease, Dubin jhonson disease etc
Don't worry about so much differentials which are difficult to memorize. In further steps
we will break each of case further to understand better.
1- If hepatomegaly is present.
Then our second step would be to see if hepatomegaly is massive or mild to moderate
2- Massive hepatomegaly
Most possible diagnosis would be gaucher disease( others findings would be bone
pain, neurological features and easy bruising)
2- Mild to Moderate hepatomegaly
If mild to moderate hepatomegaly is noticed than our next step is find out whether
symtoms like Pain, Fever and tenderness at liver is present or not.
3- If Fever, Pain and Tenderness is present
Then most possible diagnosis would be
● Viral hepatitis( additional features are anorexia,nausea and vomiting)
● Cholecystitis ( additional features are vomiting, unable to tolerate fatty meals)
● Cholangitis ( additional features are Pain, fever and sometimes shock)
● Infectious mononucleosis (additional features are sore throat, rash and
lymphadenopathy)
● Hepatic vein thrombosis ( additional features are lower limb edema, ascites
and pain)
● Toxic hepatitis ( additional features are nausea, pain and fatigue)
clinical diagnosis
A 32 years old male noticed yellowing of skin and eyes. He was otherwise healthy but
anorexic and occasional nausea is present.
Jaundice.
Jaundice is defined as yellowing of skin, sclera and mucous membranes due to
deposition of bile pigments.
Clinically jaundice is apparent if bilirubin level is > 3gm/dl.
Approach to patient in OPD
Traditional medical teaching will just provide information about differential diagnosis. In
this case it may be
● Hepatitis
● Obstructive jaundice
● Hemolytic anemias
● Cholangitis
And many more. But it often doesn’t guide you on how to proceed beyond listing these
possibilities. You may know the differentials, but how do you take a history, do the
examination, and order investigations to systematically rule them out?
Here is a detailed clinical approach to exclude all possible differentials in an organized
manner:
Approach thorough History and Examinations
After introduction and consent in proper way.
First thing you have to notice in patient is hepatomegaly.
, ● If hepatomegaly is present then possible differential are gaucher diseases, viral
hepatitis, obstructive jaundice, infectious mononucleosis, cholecystitis,
Cholangitis etc
● If hepatomegaly is not present then possible differential will be hemolytic
anemias, pernicious anemia, Gilbert disease, Dubin jhonson disease etc
Don't worry about so much differentials which are difficult to memorize. In further steps
we will break each of case further to understand better.
1- If hepatomegaly is present.
Then our second step would be to see if hepatomegaly is massive or mild to moderate
2- Massive hepatomegaly
Most possible diagnosis would be gaucher disease( others findings would be bone
pain, neurological features and easy bruising)
2- Mild to Moderate hepatomegaly
If mild to moderate hepatomegaly is noticed than our next step is find out whether
symtoms like Pain, Fever and tenderness at liver is present or not.
3- If Fever, Pain and Tenderness is present
Then most possible diagnosis would be
● Viral hepatitis( additional features are anorexia,nausea and vomiting)
● Cholecystitis ( additional features are vomiting, unable to tolerate fatty meals)
● Cholangitis ( additional features are Pain, fever and sometimes shock)
● Infectious mononucleosis (additional features are sore throat, rash and
lymphadenopathy)
● Hepatic vein thrombosis ( additional features are lower limb edema, ascites
and pain)
● Toxic hepatitis ( additional features are nausea, pain and fatigue)
