Why jaundice with upper abdominal pain matters
Yellow eyes with dark urine and pale stools mean bile is not reaching the gut. The question is why: a stone, a narrowing or a growth. Ultrasound sorts out many, but the history and her weight tell you how worried to be.
What to ask in the history
- When the yellowing started; itching
- The pain: where, where it goes, link with meals
- Weight loss, appetite
- Fever, shivering
- Alcohol
- Known gallstones or pancreatitis
- New diabetes
- Medicines, including herbal remedies
- Risks for viral hepatitis; family history
Red flags
- Fever and shivering with jaundice
- Weight loss
- Jaundice that keeps deepening
- A palpable gallbladder
- Confusion or bleeding
What to examine
- Jaundice, scratch marks
- Lymph nodes, including above the left collarbone
- Abdomen: tenderness, liver, gallbladder, masses, fluid
- Weight
First investigations
- Liver function, to see the pattern
- Full blood count, clotting
- Kidney function
- Amylase or lipase
- Ultrasound of the abdomen
- CT or MRCP to define the cause
- Endoscopic tests as needed
Differential diagnosis of jaundice with upper abdominal pain
Grouped, not ranked. Which one fits this patient is for you to work out in the case.
Liver
- Hepatitis
- Drug-induced liver injury
In the bile duct
- Gallstones
- Cholangitis
- Benign narrowing
Pancreas
- Chronic pancreatitis
Growths
- Cancer of the head of the pancreas
- Bile duct cancer
- Ampullary tumour
Common mistakes
- Repeating acid-reducing tablets without examining her.
- Going straight to a procedure before imaging.
- Forgetting to check and correct the clotting before a procedure.