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TWELVE POINTS WHICH A GP SHOULD KNOW ABOUT JAUNDICE
OP Kapoor
Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.
1.Jaundice is not the same as hyperbilirubinaemia. Only if the bilirubin is more than 3 mg, can icterus be appreciated clinically.
2.Jaundice - without jaundice is the most dangerous clinical condition e.g. Reye’s syndrome in children following administration of aspirin and in patients who have swallowed rat poison (yellow phosphorus). Both types of patients die before jaundice appears clinically.
3.Jaundice with anaemia - When this combination occurs acutely, common causes are falciparum malaria and any febrile illness, with G6PD deficiency. Vice versa, chronic haemolytic anaemia usually does not present with clinical jaundice.
4.Iatrogenic (drug) jaundice is more dangerous than viral hepatitis. This is because, if the diagnosis is missed (e.g. rifampicin hepatitis) and the drug is continued, the patient can die.
5.The last trimester of pregnancy is a very dangerous period. If a female patient develops jaundice during this period, the mortality rate is very high.
6.Although there are more than half a dozen viruses which can cause ‘clinical jaundice’, virus B is the only bad virus.
7.Once the jaundice patient complains of ‘pain’, look out for a proper diagnosis. If it is abdominal pain-biliary calculi, pancreatic conditions, alcoholic hepatitis or liver infarction should be considered. If the pain is severe in the muscles and the patient has fever, think of leptospirosis.
8.‘Fulminant’ hepatitis should be diagnosed by neuro-psychiatric symptoms occurring in a patient of jaundice. Such a patient should always be sent to an intensive care unit.
9.An ‘incidental’ jaundice detected on a routine health check-up should make you think of a ‘benign’ hyperbilirubinaemia which need not be treated.
10.An undiagnosed patient having pruritus and bile pigments in the urine but no clinical jaundice should remind you of cholestatic jaundice which calls for extensive investigations.
11.Presence of leucocytosis should remind you of a liver abscess (amoebic, pyogenic or anaerobic), Weil’s disease, alcoholic hepatitis, or hepatic infarction occurring due to a local vascular thrombosis.
12.Finally, do not forget to elicit the history of ‘malaise’ which is diagnostic of a viraemic phase of viral hepatitis. It lasts for a few days before jaundice appears and thus can differentiate viral hepatitis from drug hepatitis.
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