Medically Fit For Exams
Medically Fit For Exams

Jaundice history taking

 

  • Wash hands and introduce yourself

Differential diagnoses

Cirrhosis

Cholangitis

Liver cancer/metastases

Gallstones

Hepatitis (viral, alcoholic, autoimmune, drug induced)

Haemolysis

Hepatic congestion (heart failure)

Cancer head of pancreas

Congenital hyperbilirubinemia (Gilbert’s syndrome)

  • Check the patient’s name and DOB
  • Ask if you can talk to the patient before they see the doctor

 

History of presenting complaint

  • Ask what has brought the patient in today
  • Ask them to tell you a bit more about the yellowing
  • Site
    • Where did you notice it first? Eyes, trunk, face?
  • Onset
    • When did you first notice it?
    • How has it progressed?
    • Constant or come and go?
    • Have you had it before?
  • Is there anything that makes it worse?
  • Ask about the following associated symptoms:
    • Loss of appetite/weight loss (cancer, cirrhosis)
    • Dark urine (biliary obstruction, haemolysis)
    • Pale stools (biliary obstruction)
    • Skin itching/pruritis
    • Fever (hepatitis, cholangitis)
    • Fatigue/malaise (cancer, cirrhosis)
    • Rash (hepatitis)
    • Confusion (hepatic encephalopathy, cirrhosis, cancer, fulminant hepatitis)
    • Abdominal swelling/ascites (cirrhosis, congestion, cancer)
    • Abdominal pain
      • SOCRATES
      • Biliary colic, radiation to right shoulder – gallbladder/cholangitis
    • Recent bug/viral illness (exacerbates Gilbert’s syndrome)
  • Alcoholism CAGE screen
    • Do you ever think you should cut down on alcohol?
    • Do you get annoyed when others comment on your alcohol intake?
    • Do you every feel guilty about how much you drink?
    • Do you ever have a drink in the morning?
  • Heart failure screen
    • SOB on exertion
    • Short of breath in the night?
    • Extra pillows at night
    • Leg oedema
    • Cough, frothy sputum
  • ICE
    • Is there anything particular you are concerned about?
  • Systems review
    • Ask the patient if you can ask a few quick questions about their general health
    • Headaches, faints, fits
    • Changes in vision or sensation
    • Cough
    • SOB
    • Chest pain
    • Abdominal pain
    • Change in bowel habits
    • Change in waterworks
    • Aches and pains
  • Summarise and check what they have told you

 

Past medical history

  • Ask if the patient has any current or past medical problems
  • Ask if they have been jaundiced before
  • Ask if they have had a blood transfusion before

 

Drug history

  • Ask if they take any medications, or if there have been any changes recently
  • Ask about drugs that can cause hepatotoxicity
    • Steroids
    • Antibiotics
    • Indomethacin
    • Captopril
    • Labetalol
  • Ask if they take any over the counter medications
  • Ask if they take any supplements

 

Allergies

  • Ask if they have any allergies
  • Ask what happens

 

Family history

  • Ask if anyone in their family has had jaundice before
  • Ask about liver and gallbladder problems in the family
  • Ask about any serious medical problems in their close family

 

Social history

  • Ask about smoking
  • Ask about drinking, should have already covered
    • Work out units
    • What, when, with what, how often they drink
  • Ask about recreational drugs, ask specifically about injecting drugs
  • Ask about travel abroad (hepatitis)
  • Ask about tattoos (hepatitis)
  • Ask if there is any chance they could have picked up an STI in the last year (hepatitis)

 

Summary

  • Ask if they have any questions or other concerns
  • Ask if there is anything they think you missed
  • Summarise again if appropriate
  • Thank the patient for talking to you

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