Clinical Assessment

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


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


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.


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