Findings Suggesting a Cause of Jaundice
Finding | Possible Causes |
|---|---|
Risk factors | |
Alcohol use (heavy) | Alcohol-related liver disease, including alcoholic hepatitis and cirrhosis |
Gastrointestinal cancer | Extrahepatic biliary obstruction |
Hypercoagulable state | Hepatic vein thrombosis (Budd-Chiari syndrome) |
Inflammatory bowel disease | |
Pregnancy | Intrahepatic cholestasis, steatohepatitis (acute fatty liver due to pregnancy) |
Previous cholecystectomy | Biliary stricture Retained or recurrent common duct stone |
Recent surgery | Benign postoperative intrahepatic cholestasis Lengthy cardiac bypass surgery |
Symptoms | |
Colicky right upper quadrant, right shoulder, or subscapular pain (current or previous) | |
Constant right upper quadrant pain | Acute alcoholic or viral hepatitis, acute cholangitis |
Dark urine | Conjugated hyperbilirubinemia |
Joint pain, swelling, or both | Hepatitis (autoimmune or viral) |
Nausea or vomiting before jaundice | Common bile duct obstruction by a stone (particularly if accompanied by abdominal pain or rigors) |
Pruritus and clay-colored stools | Intrahepatic or extrahepatic cholestasis, possibly severe if stools are clay-colored |
Viral prodrome (eg, fever, malaise, myalgias) | |
Physical examination | |
Abdominal collateral vasculature, ascites, and splenomegaly | Portal hypertension (eg, due to cirrhosis) |
Cachexia in a patient with a hard, lumpy liver | Metastases (common) |
Diffuse lymphadenopathy in a patient with acute jaundice | |
Diffuse lymphadenopathy in a patient with chronic jaundice | |
Dupuytren contractures, palmar erythema, paucity of axillary and pubic hair, and vascular spiders | |
Gynecomastia and testicular atrophy | |
Hyperpigmentation | |
Needle marks | |
Resolving hematoma | Extravasation of blood into tissues |
Xanthomas | |