liver and gallbladder disorders
Jaundice in Adults
Diagnosis of Jaundice
Jaundice is obvious, but identifying its cause requires a doctor's examination, Liver Blood Tests , and sometimes other tests. In people with jaundice, the following symptoms are cause for concern: Severe abdominal pain and tenderness Changes in mental function, such as drowsiness, agitation, or confusion Blood in stool or tarry black stool Blood in vomit Fever A tendency to bruise or to bleed easily, sometimes resulting in a reddish purple rash of tiny dots or larger splotches (which indicate bleeding in the skin) If people have any warning signs, they should see a doctor as soon as possible. People with no warning signs should see a doctor within a few days. Doctors first ask questions about the person's symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause and the tests that may need to be done (see table Some Causes and Features of Jaundice ). Doctors ask when the jaundice started and how long it has been present. They also ask when urine started to look dark (which usually occurs before jaundice develops). People are asked about other symptoms, such as itching, fatigue, changes in stool, and abdominal pain. Doctors are particularly interested in symptoms that suggest a serious cause. For example, sudden loss of appetite, nausea, vomiting, pain in the abdomen, and fever suggest hepatitis, particularly in young people and people with risk factors for hepatitis. Fever and severe, constant pain in the upper right part of the abdomen suggest acute cholangitis (infection of the bile ducts), usually in people with a blockage in a bile duct. Acute cholangitis is considered a medical emergency. Doctors ask people whether they have had liver disorders, whether they have had surgery that involved the bile ducts, and whether they take any drugs that can cause jaundice (for example, the prescription drugsamoxicillin/clavulanate,chlorpromazine,azathioprine, and oral contraceptives; alcohol; over-the-counter drugs; medicinal herbs; and other herbal products such as teas). Knowing whether family members have also had jaundice or other liver disorders can help doctors identify hereditary liver disorders. Because Overview of Hepatitis is a common cause, doctors ask particularly about conditions that increase the risk of hepatitis, such as Working at a day care center Living in or working at an institution with long-term residents, such as a mental health care facility, prison, or long-term care facility Living in or traveling to an area where hepatitis is widespread Participating in anal sex Eating raw shellfish Injecting illegal or recreational drugs Having hemodialysis Sharing razor blades or toothbrushes Getting a tattoo or body piercing Working in a health care facility without being vaccinated against hepatitis Having had a blood transfusion before 1992 Having sex with someone who has hepatitis Having been born between 1945 and 1965 During the physical examination, doctors look for signs of serious disorders (such as fever, very low blood pressure, and a rapid heart rate) and for signs that liver function is greatly impaired (such as easy bruising, a rash of tiny dots or splotches, or changes in mental function). They gently press on the abdomen to check for lumps, tenderness, swelling, and other abnormalities, such as an enlarged liver or spleen. Tests include the following: Blood tests to evaluate how well the liver is functioning and whether it is damaged (liver tests) Usually imaging tests such as Ultrasonography , Sometimes Biopsy of the Liver or laparoscopy Liver Blood Tests (also called liver enzyme tests) involve measuring blood levels of enzymes and other substances produced by the liver. These tests help doctors determine whether the cause is liver malfunction or a blocked bile duct. If a bile duct is blocked, imaging tests, such as ultrasonography, are usually required. Other blood tests are done based on the disorder doctors suspect and the results of the examination and the initial tests. They may include Tests to assess the blood's ability to clot (prothrombin time and partial thromboplastin time) Tests to check for hepatitis viruses or abnormal antibodies (due to autoimmune disorders) A complete blood count Blood cultures to check for infection of the bloodstream Examination of a blood sample under a microscope to check for excessive destruction of red blood cells If imaging is needed, ultrasonography of the abdomen is often done first. It can usually detect blockages in the bile ducts. Alternatively, computed tomography (CT) or magnetic resonance imaging (MRI) may be done. If ultrasonography shows a blockage in a bile duct, other tests may be needed to determine the cause. Typically, magnetic resonance cholangiopancreatography ( Magnetic Resonance Imaging ) or endoscopic retrograde cholangiopancreatography ( Occasionally, Biopsy of the Liver is needed. It may be done when certain causes (such as viral hepatitis, use of a drug, or exposure to a toxin) are suspected or when the diagnosis is unclear after doctors have the results of other tests. Laparoscopy may be done when other tests have not identified why bile flow is blocked. For this procedure, doctors make a small incision just below the navel and insert a viewing tube (laparoscope) to examine the liver and gallbladder directly. Rarely, a larger incision is needed (a procedure called laparotomy). 