Jaundice accompanies many pathologies of the hepatobiliary system, as well as some pathological processes associated with the hematopoietic system. Jaundice for reasons of development is divided into 3 types – suprahepatic, hepatic and subhepatic. Clinic – laboratory examination of the patient should be carried out as soon as possible. It consists of an examination, collection of anamnesis data, as well as laboratory tests. Diagnosis of jaundice and its causes allows the doctor to determine the correct tactics for treating the patient. What are the distinguishing features of obstructive and hepatic jaundice?
Jaundice diagnosis. Physical Examination Results for Chronic Liver Disease
During a physical examination to diagnose jaundice, it is necessary to assess the condition of the skin and mucous membranes, primarily their color, the presence of pallor or pigmentation, xanthoma or xanthelasma, scratching, telangiectasia, palmar erythema.
As a rule, icterus of the skin appears when the concentration of bilirubin in the blood is more than 35 mmol / l.
Since hyperbilirubinemia can be conjugated or unconjugated, its origin needs to be investigated. This can be done with a urine test. The unconjugated form of bilirubinemia is not filtered through the kidneys, while the urine has a normal yellow color.
Clinical features of chronic liver disease at diagnosis of jaundice:
- ascites;
- spider veins;
- testicular atrophy;
- loss of pubic and underarm hair;
- loss of muscle mass;
- Dupuytren's contracture;
- peripheral edema;
- leukonychia (white nail symptom) or telangiectasia;
- enlargement or decrease in the size of the liver.
Laboratory evidence of chronic liver disease in the diagnosis of jaundice
History data in the diagnosis of jaundice in hepatic pathologies consist of such complaints – muscle pain, weakness, lack of appetite, flu-like condition. In such patients, the presence of blood transfusions or the influence of a probable hepatotoxic factor is often found out.
Laboratory findings in the diagnosis of jaundice, characteristic of liver pathologies:
- specific markers of liver disease (autoantibodies, positive viral markers);
- prothrombin time does not normalize when vitamin K is prescribed;
- predominant increase in serum aminases;
- urinalysis reveals a mixture of urobilinogen and bilirubin.
When examining a patient, the doctor identifies symptoms and signs that indicate chronic liver disease or biliary obstruction, which automatically identifies the cause of jaundice.
Clinical and laboratory signs of biliary obstruction in the diagnosis of jaundice
In obstructive jaundice, patients complain of abdominal pain and fever. Often in such patients, the history reveals the presence of surgical interventions on the biliary tract.
Signs of biliary obstruction at diagnosis of jaundice:
- xanthomas;
- traces of scratching (excoriation);
- polished nails (result of itchy skin);
- dark urine;
- light feces;
- gallbladder, which is palpable – symptom of Courvoisier;
- hepatomegaly.
Laboratory signs of biliary obstruction in the diagnosis of jaundice:
- Prothrombin time is normal or normalizes with vitamin K administration;
- severe bilirubinemia, little or no urobilinogen;
- predominant increase in serum alkaline phosphatase and bilirubin;
- increase in serum amylase.
The diagnosis of jaundice is an important process that determines the further tactics of patient management. When obturation of the bile ducts is detected, the issue of surgical intervention is decided. If hepatic jaundice is detected, treatment with hepatoprotectors is carried out.
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