Jaundice physical examination: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
Line 9: Line 9:
* Jaundice is seen with a number of disorders. Physical examination of patients with jaundice is based on underlying [[disease]].
* Jaundice is seen with a number of disorders. Physical examination of patients with jaundice is based on underlying [[disease]].
===Appearance of the Patient===
===Appearance of the Patient===
* [[Cirrhosis]]:
* '''[[Cirrhosis]]:'''
** [[Patient|Patients]] usually appear weak due to constitutional [[Symptom|symptoms]] such as [[weight loss]], [[anorexia]] and [[muscle atrophy]].
** [[Patient|Patients]] usually appear weak.<ref name="pmid104230702">{{cite journal|year=1999|title=Spider angiomas in patients with liver cirrhosis: role of alcoholism and impaired liver function|url=|journal=Scand. J. Gastroenterol.|volume=34|issue=5|pages=520–3|doi=|pmid=10423070|vauthors=Li CP, Lee FY, Hwang SJ, Chang FY, Lin HC, Lu RH, Hou MC, Chu CJ, Chan CC, Luo JC, Lee SD}}</ref><ref name="pmid18328931">{{cite journal |vauthors=Schuppan D, Afdhal NH |title=Liver cirrhosis |journal=Lancet |volume=371 |issue=9615 |pages=838–51 |year=2008 |pmid=18328931 |pmc=2271178 |doi=10.1016/S0140-6736(08)60383-9 |url=}}</ref>  
** Yellowish discoloration of [[skin]] and [[abdominal distension]] may also be present due to [[ascites]].<ref name="pmid104230702">{{cite journal|year=1999|title=Spider angiomas in patients with liver cirrhosis: role of alcoholism and impaired liver function|url=|journal=Scand. J. Gastroenterol.|volume=34|issue=5|pages=520–3|doi=|pmid=10423070|vauthors=Li CP, Lee FY, Hwang SJ, Chang FY, Lin HC, Lu RH, Hou MC, Chu CJ, Chan CC, Luo JC, Lee SD}}</ref><ref name="pmid18328931" />


* [[Viral hepatitis]]:
* '''[[Viral hepatitis]]:'''
** The appearance of the patient on presentation depends on his/her age.
** The appearance of the patient on presentation depends on the age.
** Younger patients tend to be [[asymptomatic]], while [[symptomatic]] patients tend to be older. 
** Younger patients tend to be [[asymptomatic]], while older patients tends to be [[symptomatic]]. 
** [[Symptomatic]] patients may have a range of symptoms that can vary in severity from a mild [[flu]]-like illness to [[fulminant hepatitis]].  
** [[Symptomatic]] patients may have a range of symptoms that may vary in severity from a mild [[flu]]-like illness to [[fulminant hepatitis]].  
** Patients with fulminant hepatitis are usually [[disoriented]] and very ill-looking.<ref name="pmid19399815" />
** Patients with fulminant hepatitis are usually [[disoriented]] and very ill-looking.<ref name="pmid19399815">{{cite journal |vauthors=Rotman Y, Brown TA, Hoofnagle JH |title=Evaluation of the patient with hepatitis B |journal=Hepatology |volume=49 |issue=5 Suppl |pages=S22–7 |year=2009 |pmid=19399815 |pmc=2881483 |doi=10.1002/hep.22976 |url=}}</ref>
* [[Pancreatic cancer (patient information)|Pancreatic cancer]]:
* '''[[Pancreatic cancer (patient information)|Pancreatic cancer]]:'''
** Patients with [[pancreatic cancer]] are usually in the sixth decade of life and appear [[Cachexia|cachectic]], with signs of [[malnutrition]].<ref name="pmid15522652" /> 
** Patients with [[pancreatic cancer]] presents usually in the sixth decade of life and appear [[Cachexia|cachectic]], with signs of [[malnutrition]].<ref name="pmid15522652">{{cite journal |vauthors=Khorana AA, Fine RL |title=Pancreatic cancer and thromboembolic disease |journal=Lancet Oncol. |volume=5 |issue=11 |pages=655–63 |year=2004 |pmid=15522652 |doi=10.1016/S1470-2045(04)01606-7 |url=}}</ref> 


===Vital Signs===
===Vital Signs===
* [[Fever]], [[tachycardia]], [[hypotension]], [[tachypnea]] may be present in [[viral hepatitis]].<ref name="pmid19399815">{{cite journal |vauthors=Rotman Y, Brown TA, Hoofnagle JH |title=Evaluation of the patient with hepatitis B |journal=Hepatology |volume=49 |issue=5 Suppl |pages=S22–7 |year=2009 |pmid=19399815 |pmc=2881483 |doi=10.1002/hep.22976 |url=}}</ref>
* Vitals signs of patients with jaundice due to viral hepatitis include:<ref name="pmid19399815" />
** [[Fever]]
** [[Tachycardia]]
** [[Hypotension]]
** [[Tachypnea]]


===Skin===
===Skin===


* Jaundice is visible in [[conjunctiva]], [[skin]], and [[mucosa]] when the serum bilirubin level rises above 2 mg/dL.
* Jaundice is visible in [[conjunctiva]], [[skin]], and [[mucosa]] when the serum bilirubin level rises above 2 mg/dL.
* Jaundice, [[palmar erythema]], [[Spider angioma|spider angiomata]], [[gynecomastia]] may be present in [[viral hepatitis]]. <ref name="pmid19399815">{{cite journal |vauthors=Rotman Y, Brown TA, Hoofnagle JH |title=Evaluation of the patient with hepatitis B |journal=Hepatology |volume=49 |issue=5 Suppl |pages=S22–7 |year=2009 |pmid=19399815 |pmc=2881483 |doi=10.1002/hep.22976 |url=}}</ref>
* Skin examination of patients with jaundice due to viral hepatitis include:<ref name="pmid19399815" />
* [[Pallor]], [[Bruise|bruises]], [[palmar erythema]] on the [[Thenar eminence|thenar]] and [[Hypothenar eminence|hypothenar eminences]], [[Spider angioma|spider angiomata]], [[Telangiectasia|telangiectasias]] may be present in [[cirrhosis]].<ref name="pmid10423070">{{cite journal |vauthors=Li CP, Lee FY, Hwang SJ, Chang FY, Lin HC, Lu RH, Hou MC, Chu CJ, Chan CC, Luo JC, Lee SD |title=Spider angiomas in patients with liver cirrhosis: role of alcoholism and impaired liver function |journal=Scand. J. Gastroenterol. |volume=34 |issue=5 |pages=520–3 |year=1999 |pmid=10423070 |doi= |url=}}</ref>
** [[Palmar erythema]]
* [[Bullous pemphigoid]], [[Mucous membrane pemphigoid|cicatricial pemphigoid]], [[Thrombophlebitis|migratory superficial thrombophlebitis]] (classic [[Trousseau's syndrome]]), [[Panniculitis|pancreatic panniculitis]] may be present in [[pancreatic cancer]].<ref name="pmid15522652">{{cite journal |vauthors=Khorana AA, Fine RL |title=Pancreatic cancer and thromboembolic disease |journal=Lancet Oncol. |volume=5 |issue=11 |pages=655–63 |year=2004 |pmid=15522652 |doi=10.1016/S1470-2045(04)01606-7 |url=}}</ref><ref name="pmid19190960">{{cite journal |vauthors=Fitzgerald JE, White MJ, Lobo DN |title=Courvoisier's gallbladder: law or sign? |journal=World J Surg |volume=33 |issue=4 |pages=886–91 |year=2009 |pmid=19190960 |doi=10.1007/s00268-008-9908-y |url=}}</ref>
** [[Spider angiomata]]
** [[Gynecomastia]]
* Skin examination of patients with jaundice due to cirrhosis include:<ref name="pmid10423070">{{cite journal |vauthors=Li CP, Lee FY, Hwang SJ, Chang FY, Lin HC, Lu RH, Hou MC, Chu CJ, Chan CC, Luo JC, Lee SD |title=Spider angiomas in patients with liver cirrhosis: role of alcoholism and impaired liver function |journal=Scand. J. Gastroenterol. |volume=34 |issue=5 |pages=520–3 |year=1999 |pmid=10423070 |doi= |url=}}</ref>
** [[Pallor]]
** [[Bruises]]
** [[palmar erythema]] on the [[Thenar eminence|thenar]] and [[Hypothenar eminence|hypothenar eminences]],
** [[Spider angioma|Spider angiomata]]
** [[Telangiectasias]]
* Skin examination of patients with jaundice due to pancreatic cancer include:<ref name="pmid15522652" /><ref name="pmid19190960">{{cite journal |vauthors=Fitzgerald JE, White MJ, Lobo DN |title=Courvoisier's gallbladder: law or sign? |journal=World J Surg |volume=33 |issue=4 |pages=886–91 |year=2009 |pmid=19190960 |doi=10.1007/s00268-008-9908-y |url=}}</ref>
** [[Bullous pemphigoid]]
** [[Cicatricial pemphigoid]]
** [[Trousseau's syndrome|Migratory superficial thrombophlebitis]] (classic [[Trousseau's syndrome]])
** [[Panniculitis|Pancreatic panniculitis]]


===HEENT===
===HEENT===
* Thinning of hair on the scalp due to [[hyperestrogenism]], [[Parotid gland|parotid gland]] enlargement, and [[fetor hepaticus]] may be present in [[Cirrhosis|cirrhosis.]] <ref name="pmid18328931">{{cite journal |vauthors=Schuppan D, Afdhal NH |title=Liver cirrhosis |journal=Lancet |volume=371 |issue=9615 |pages=838–51 |year=2008 |pmid=18328931 |pmc=2271178 |doi=10.1016/S0140-6736(08)60383-9 |url=}}</ref>
* HEENT examination of patients with jaundice due to cirrhosis include:<ref name="pmid18328931" />
 
** [[Hyperestrogenism]]
** [[Parotid gland enlargement]]
** [[Fetor hepaticus]]


===Neck===
===Neck===
* [[Cervical]] [[lymphadenopathy]] may be present in [[viral hepatitis]].<ref name="pmid19399815">{{cite journal |vauthors=Rotman Y, Brown TA, Hoofnagle JH |title=Evaluation of the patient with hepatitis B |journal=Hepatology |volume=49 |issue=5 Suppl |pages=S22–7 |year=2009 |pmid=19399815 |pmc=2881483 |doi=10.1002/hep.22976 |url=}}</ref>
* Neck examination of patients with jaundice due to viral hepatitis include:<ref name="pmid19399815" />
* Signs of [[Metastasis|metastatic disease]] include:
** [[Cervical]] [[lymphadenopathy]]
* Neck examination of patients with jaundice due to metastatic pancreatic cancer include:
** Left [[Supraclavicular lymph nodes|supraclavicular]] [[lymphadenopathy]] ([[Virchow's node]])
** Left [[Supraclavicular lymph nodes|supraclavicular]] [[lymphadenopathy]] ([[Virchow's node]])
** Palpable periumbilical mass (''Sister Mary Joseph's node'')
** Palpable periumbilical mass (''Sister Mary Joseph's node'')
** [[Metastasis|Metastatic]] palpable mass in the [[rectal]] pouch (''Blumer's shelf'')
** [[Metastasis|Metastatic]] palpable mass in the [[rectal]] pouch (''Blumer's shelf'')
** Involvement of other [[Lymph node|nodes]] in the [[cervical]] area  
** Involvement of other [[Lymph node|nodes]] in the [[cervical]] area  
may be present in [[pancreatic cancer]].
===Lungs===
===Lungs===
* Pulmonary examination: Normal
* Pulmonary examination of patients with jaundice is usually normal.


===Heart===
===Heart===
* Cardiovascular examination: Normal
* Cardiac examination of patients with jaundice is usually normal.


===Abdomen===
===Abdomen===
* [[Hepatomegaly]] with [[right upper quadrant]] tenderness, [[Abdominal distension|abdominal distention]], [[abdominal tenderness]],  [[splenomegaly]], [[ascites]], [[caput medusae]] may be present in [[viral hepatitis]]. <ref name="pmid19399815">{{cite journal |vauthors=Rotman Y, Brown TA, Hoofnagle JH |title=Evaluation of the patient with hepatitis B |journal=Hepatology |volume=49 |issue=5 Suppl |pages=S22–7 |year=2009 |pmid=19399815 |pmc=2881483 |doi=10.1002/hep.22976 |url=}}</ref>
* Abdominal examination of patients with jaundice due to viral hepatitis include:<ref name="pmid19399815" />
* [[Abdominal distension]], [[Caput medusae|caput medusa]], [[hepatomegaly]], [[splenomegaly]], [[ascites]] may be present in [[cirrhosis]]. <ref name="pmid18328931">{{cite journal |vauthors=Schuppan D, Afdhal NH |title=Liver cirrhosis |journal=Lancet |volume=371 |issue=9615 |pages=838–51 |year=2008 |pmid=18328931 |pmc=2271178 |doi=10.1016/S0140-6736(08)60383-9 |url=}}</ref>
** [[Hepatomegaly]]
* [[Abdominal distention]], [[abdominal tenderness]], [[hepatosplenomegaly]], fluid thrill and dullness to [[percussion]] may be present due to [[ascites]] in [[pancreatic cancer]]. <ref name="pmid3164230">{{cite journal |vauthors=Manabe T, Miyashita T, Ohshio G, Nonaka A, Suzuki T, Endo K, Takahashi M, Tobe T |title=Small carcinoma of the pancreas. Clinical and pathologic evaluation of 17 patients |journal=Cancer |volume=62 |issue=1 |pages=135–41 |year=1988 |pmid=3164230 |doi= |url=}}</ref><ref name="pmid191909602">{{cite journal |vauthors=Fitzgerald JE, White MJ, Lobo DN |title=Courvoisier's gallbladder: law or sign? |journal=World J Surg |volume=33 |issue=4 |pages=886–91 |year=2009 |pmid=19190960 |doi=10.1007/s00268-008-9908-y |url=}}</ref>
** [[Abdominal tenderness|Right upper quadrant tenderness]]
** [[Abdominal distension]]
** [[Splenomegaly]]
** [[Ascites]]
** [[Caput medusae]]
* Abdominal examination of patients with jaundice due to cirrhosis include:<ref name="pmid18328931" />
** [[Abdominal distension]]
** [[Caput medusae]]
** [[Hepatomegaly]]
** [[Splenomegaly]]
** [[Ascites]]
* Abdominal examination of patients with jaundice due to [[pancreatic cancer]] include:<ref name="pmid3164230">{{cite journal |vauthors=Manabe T, Miyashita T, Ohshio G, Nonaka A, Suzuki T, Endo K, Takahashi M, Tobe T |title=Small carcinoma of the pancreas. Clinical and pathologic evaluation of 17 patients |journal=Cancer |volume=62 |issue=1 |pages=135–41 |year=1988 |pmid=3164230 |doi= |url=}}</ref><ref name="pmid191909602">{{cite journal |vauthors=Fitzgerald JE, White MJ, Lobo DN |title=Courvoisier's gallbladder: law or sign? |journal=World J Surg |volume=33 |issue=4 |pages=886–91 |year=2009 |pmid=19190960 |doi=10.1007/s00268-008-9908-y |url=}}</ref>
** [[Abdominal distention]]
** [[Abdominal tenderness]]
** [[Hepatomegaly]]
** [[Splenomegaly]]
** Fluid thrill and dullness to [[percussion]]


===Back===
===Back===
* Back examination: Normal
* Back examination of patients with jaundice is usually normal.


===Genitourinary===
===Genitourinary===
* [[Testicular atrophy]] may be present in [[cirrhosis]].[[Jaundice physical examination#cite note-pmid18328931-4|<sup>[4]</sup>]]
* Genitourinary examination of patients with jaundice due to cirrhosis include:[[Jaundice physical examination#cite note-pmid18328931-4|<sup>[4]</sup>]]
* [[Metastasis|Metastatic]] palpable mass may be present in the [[rectal]] pouch (''Blumer's shelf'') in advanced stages of [[pancreatic cancer]].<ref name="pmid9490607">{{cite journal |vauthors=Galvañ VG |title=Sister Mary Joseph's nodule |journal=Ann. Intern. Med. |volume=128 |issue=5 |pages=410 |year=1998 |pmid=9490607 |doi= |url=}}</ref>
** [[Testicular atrophy]]
* Genitourinary examination of patients with jaundice due to [[pancreatic cancer]] include:<ref name="pmid9490607">{{cite journal |vauthors=Galvañ VG |title=Sister Mary Joseph's nodule |journal=Ann. Intern. Med. |volume=128 |issue=5 |pages=410 |year=1998 |pmid=9490607 |doi= |url=}}</ref>
** [[Metastasis|Metastatic]] palpable mass may be present in the [[rectal]] pouch (''Blumer's shelf'') in advanced stages


===Neurologic===
===Neurologic===
* [[Altered mental status]], [[encephalopathy]] may be present in [[viral hepatitis]].<ref name="pmid19399815">{{cite journal |vauthors=Rotman Y, Brown TA, Hoofnagle JH |title=Evaluation of the patient with hepatitis B |journal=Hepatology |volume=49 |issue=5 Suppl |pages=S22–7 |year=2009 |pmid=19399815 |pmc=2881483 |doi=10.1002/hep.22976 |url=}}</ref>
* Neurologic examination of patients with jaundice and [[hepatic encephalopathy]] due to viral hepatitis may include:<ref name="pmid19399815" /><ref name="pmid28533911">{{cite journal |vauthors=Ferenci P |title=Hepatic encephalopathy |journal=Gastroenterol Rep (Oxf) |volume=5 |issue=2 |pages=138–147 |year=2017 |pmid=28533911 |pmc=5421503 |doi=10.1093/gastro/gox013 |url=}}</ref>
* Alteration of [[Mental status examination|mental status,]] confusion, [[coma]], and asterixis may be present in [[hepatic encephalopathy]].<ref name="pmid28533911">{{cite journal |vauthors=Ferenci P |title=Hepatic encephalopathy |journal=Gastroenterol Rep (Oxf) |volume=5 |issue=2 |pages=138–147 |year=2017 |pmid=28533911 |pmc=5421503 |doi=10.1093/gastro/gox013 |url=}}</ref>
* [[Altered mental status]]
* [[Coma]]
* [[Asterixis]]


===Extremities===
===Extremities===
* [[Peripheral edema]], [[dupuytren's contracture]] may be present in [[viral hepatitis]].<ref name="pmid19399815">{{cite journal |vauthors=Rotman Y, Brown TA, Hoofnagle JH |title=Evaluation of the patient with hepatitis B |journal=Hepatology |volume=49 |issue=5 Suppl |pages=S22–7 |year=2009 |pmid=19399815 |pmc=2881483 |doi=10.1002/hep.22976 |url=}}</ref>
* Extremities examination of patients with jaundice due to viral hepatitis include:<ref name="pmid19399815" />
* [[Edema]] of the lower extremities, [[muscle atrophy]], nail changes, and [[clubbing]] may be present in [[cirrhosis]].[[Jaundice physical examination#cite note-pmid18328931-4|<sup>[4]</sup>]]<ref name="pmid133161432">{{cite journal |vauthors=MUEHRCKE RC |title=The finger-nails in chronic hypoalbuminaemia; a new physical sign |journal=Br Med J |volume=1 |issue=4979 |pages=1327–8 |year=1956 |pmid=13316143 |pmc=1980060 |doi= |url=}}</ref>
** [[Peripheral edema]],
* Extremities examination of patients with jaundice due to cirrhosis include:[[Jaundice physical examination#cite note-pmid18328931-4|<sup>[4]</sup>]]<ref name="pmid133161432">{{cite journal |vauthors=MUEHRCKE RC |title=The finger-nails in chronic hypoalbuminaemia; a new physical sign |journal=Br Med J |volume=1 |issue=4979 |pages=1327–8 |year=1956 |pmid=13316143 |pmc=1980060 |doi= |url=}}</ref>
* [[Edema]] of the lower extremities
* [[Muscle atrophy]]
* [[Nail changes]]
* [[Clubbing]]


==References==
==References==

Revision as of 21:39, 21 February 2018

Jaundice Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Jaundice from other Conditions

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Chest X Ray

Electrocardiogram

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Jaundice physical examination On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Jaundice physical examination

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Jaundice physical examination

CDC on Jaundice physical examination

Jaundice physical examination in the news

Blogs on Jaundice physical examination

Directions to Hospitals Treating Jaundice

Risk calculators and risk factors for Jaundice physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farnaz Khalighinejad, MD [2]

Overview

Jaundice is a yellowish discoloration of the skin and sclerae that is an important symptom of elevated serum bilirubin. Physical examination of patients with jaundice is based on underlying disease, include cervical lymphadenopathy, hepatomegaly, splenomegaly, and peripheral edema.

Physical Examination

  • Jaundice is seen with a number of disorders. Physical examination of patients with jaundice is based on underlying disease.

Appearance of the Patient

Vital Signs

Skin

HEENT

  • HEENT examination of patients with jaundice due to cirrhosis include:[2]

Neck

Lungs

  • Pulmonary examination of patients with jaundice is usually normal.

Heart

  • Cardiac examination of patients with jaundice is usually normal.

Abdomen

Back

  • Back examination of patients with jaundice is usually normal.

Genitourinary

  • Genitourinary examination of patients with jaundice due to cirrhosis include:[4]
  • Genitourinary examination of patients with jaundice due to pancreatic cancer include:[9]
    • Metastatic palpable mass may be present in the rectal pouch (Blumer's shelf) in advanced stages

Neurologic

Extremities

References

  1. ↑ Li CP, Lee FY, Hwang SJ, Chang FY, Lin HC, Lu RH, Hou MC, Chu CJ, Chan CC, Luo JC, Lee SD (1999). "Spider angiomas in patients with liver cirrhosis: role of alcoholism and impaired liver function". Scand. J. Gastroenterol. 34 (5): 520–3. PMID 10423070.
  2. ↑ 2.0 2.1 2.2 Schuppan D, Afdhal NH (2008). "Liver cirrhosis". Lancet. 371 (9615): 838–51. doi:10.1016/S0140-6736(08)60383-9. PMC 2271178. PMID 18328931.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Rotman Y, Brown TA, Hoofnagle JH (2009). "Evaluation of the patient with hepatitis B". Hepatology. 49 (5 Suppl): S22–7. doi:10.1002/hep.22976. PMC 2881483. PMID 19399815.
  4. ↑ 4.0 4.1 Khorana AA, Fine RL (2004). "Pancreatic cancer and thromboembolic disease". Lancet Oncol. 5 (11): 655–63. doi:10.1016/S1470-2045(04)01606-7. PMID 15522652.
  5. ↑ Li CP, Lee FY, Hwang SJ, Chang FY, Lin HC, Lu RH, Hou MC, Chu CJ, Chan CC, Luo JC, Lee SD (1999). "Spider angiomas in patients with liver cirrhosis: role of alcoholism and impaired liver function". Scand. J. Gastroenterol. 34 (5): 520–3. PMID 10423070.
  6. ↑ Fitzgerald JE, White MJ, Lobo DN (2009). "Courvoisier's gallbladder: law or sign?". World J Surg. 33 (4): 886–91. doi:10.1007/s00268-008-9908-y. PMID 19190960.
  7. ↑ Manabe T, Miyashita T, Ohshio G, Nonaka A, Suzuki T, Endo K, Takahashi M, Tobe T (1988). "Small carcinoma of the pancreas. Clinical and pathologic evaluation of 17 patients". Cancer. 62 (1): 135–41. PMID 3164230.
  8. ↑ Fitzgerald JE, White MJ, Lobo DN (2009). "Courvoisier's gallbladder: law or sign?". World J Surg. 33 (4): 886–91. doi:10.1007/s00268-008-9908-y. PMID 19190960.
  9. ↑ Galvañ VG (1998). "Sister Mary Joseph's nodule". Ann. Intern. Med. 128 (5): 410. PMID 9490607.
  10. ↑ Ferenci P (2017). "Hepatic encephalopathy". Gastroenterol Rep (Oxf). 5 (2): 138–147. doi:10.1093/gastro/gox013. PMC 5421503. PMID 28533911.
  11. ↑ MUEHRCKE RC (1956). "The finger-nails in chronic hypoalbuminaemia; a new physical sign". Br Med J. 1 (4979): 1327–8. PMC 1980060. PMID 13316143.

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Jaundice_physical_examination&oldid=1446997"