Jaundice or icterus
•Jaundice is the hallmark symptom of liver disease and perhaps the most reliable marker of severity.
•Occurs only in the presence of serum hyperbilirubinemia and is a sign of either liver disease or, less often, a hemolytic disorder.
•Slight increases in serum bilirubin are best detected by examining the sclera which have a particular affinity for bilirubin due to their high elastin content.
•Patients usually report darkening of the urine before they notice scleral icterus.
•Jaundice is rarely detectable with a bilirubin level less than 43 umol/L (2.5 mg/dL)
•The presence of scleral icterus indicates a serum bilirubin of at least 3.0 mg/dL. The ability to detect scleral icterus is more difficult if the examining room has fluorescent lighting.
Jaundice: major types
•Prehepatic or unconjugated hyperbilirubinaemia
•Hepatic hyperbilirubinemia
–Hepatocellular disease
–Intrahepatic cholestasis
•Extrahepatic cholestasis
Causes of jaundice
•Prehepatic or unconjugated hyperbilirubinaemia
•haemoiytic anaemias
•Gilbert's syndrome
•Hepatocellular disease
•viral hepatitis (types A, B, C, D and E)
•alcoholic hepatitis
•autoimmune hepatitis (lupoid)
•Drug-induesed hepatitis (halothane, paracetamol)
•decompensated cirrhosis
•Intrahepatic cholestasis
•cholestatic hepatitis
•Primary biliary cirrhosis
•Extrahepatic cholestasis
•
Darkening of the Urine
•Sensitive indicator of S bilirubin
•Is due to the renal excretion of conjugated bilirubin.
•Patients often describe their urine as tea or cola colored.
•Bilirubinuria indicates an of the direct Sbilirubin fraction and therefore the presence of liver disease.
Pale (light) Stools
•Suggest biliary obstruction either intrahepatic or extrahepatic.
–Degradation of bilirubin in the intestine imparts the normal yellow-brown color to the stool.
–Failure of bilirubin to reach the intestine renders the stool pale and grayish.
Liver Pain
•Right upper quadrant discomfort or ache occurs in many liver diseases and is usually marked by tenderness over the liver area.
•The pain arises from stretching or irritation of Glisson's capsule, which surrounds the liver and is rich in nerve endings.
•Severe pain is most typical of gall bladder disease, liver abscess
Ascites
•Definition: free fluid in the abdomen
•Clinical manifestations:
–Distended abdomen
–Fullness in flanks
–Umbilicus everted
–Distended veins, striae
–Dullness (requires at least 2 liters), sonogram or CT best diagnostic tools for smaller amounts
Ascites, umbilical hernia
Ascites
–In most cases ascites appears as part of a well- recognized illness that is, cirrhosis, CHF, nephrosis, or disseminated carcinomatosis
–Diagnostic paracentesis (50 to 100 mL) should be part of the routine evaluation of the patient with ascites.
–The fluid should be examined for its gross appearance; protein content, cell count, and differential cell count should be determined
