Clinical Assessment

An accurate history and examination will help to identify factors that differentiate the causes of jaundice.

History

It is important to ask about the following risk factors:

• Alcohol intake
• Transfusion of blood products
• Sexual contact with a person known to have hepatitis or promiscuous sexual activity
• Intravenous drug misuse
• Recent tattoos or body piercings
• Recent foreign travel
• Needle stick injury

Clinicians should also specifically ask about:

• Colour of urine and stool
• Weight loss
• Family history of jaundice

Examination

A full examination may provide clues as to the cause of jaundice.

Alcoholic liver disease

Signs of alcoholic liver disease such as palmar erythema, spider naevi, proximal muscle wasting/weakness, hepatic flap, fetter hepaticas, cerebellar signs or encephalopathy.

Acute Cholangitis

Fever and right upper quadrant tenderness in association with jaundice are known as Charcot’s triad.

Metastatic liver disease

A hard nodular liver on a background of known malignancy may indicate metastatic disease.

Malignancy

Painless jaundice with cachexia and an epigastric mass strongly suggests biliary obstruction from malignancy.