tailieunhanh - Chapter 043. Jaundice (Part 5)

History A complete medical history is perhaps the single most important part of the evaluation of the patient with unexplained jaundice. Important considerations include the use of or exposure to any chemical or medication, either physicianprescribed, over-the-counter, complementary or alternative medicines such as herbal and vitamin preparations, or other drugs such as anabolic steroids. The patient should be carefully questioned about possible parenteral exposures, including transfusions, IV and intranasal drug use, tattoos, and sexual activity. . | Chapter 043. Jaundice Part 5 History A complete medical history is perhaps the single most important part of the evaluation of the patient with unexplained jaundice. Important considerations include the use of or exposure to any chemical or medication either physician-prescribed over-the-counter complementary or alternative medicines such as herbal and vitamin preparations or other drugs such as anabolic steroids. The patient should be carefully questioned about possible parenteral exposures including transfusions IV and intranasal drug use tattoos and sexual activity. Other important questions include recent travel history exposure to people with jaundice exposure to possibly contaminated foods occupational exposure to hepatotoxins alcohol consumption the duration of jaundice and the presence of any accompanying symptoms such as arthralgias myalgias rash anorexia weight loss abdominal pain fever pruritus and changes in the urine and stool. While none of these latter symptoms are specific for any one condition they can suggest a particular diagnosis. A history of arthralgias and myalgias predating jaundice suggests hepatitis either viral or drug-related. Jaundice associated with the sudden onset of severe right upper quadrant pain and shaking chills suggests choledocholithiasis and ascending cholangitis. Physical Examination The general assessment should include assessment of the patient s nutritional status. Temporal and proximal muscle wasting suggests long-standing diseases such as pancreatic cancer or cirrhosis. Stigmata of chronic liver disease including spider nevi palmar erythema gynecomastia caput medusae Dupuytren s contractures parotid gland enlargement and testicular atrophy are commonly seen in advanced alcoholic Laennec s cirrhosis and occasionally in other types of cirrhosis. An enlarged left supraclavicular node Virchow s node or periumbilical nodule Sister Mary Joseph s nodule suggests an abdominal malignancy. Jugular venous distention a sign of .