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Is there associated dyspnea? If there is associated dyspnea, one should look for congestive heart failure, pulmonary emphysema, and other cardiopulmonary conditions.
Is there hepatomegaly? If there is associated ... DIAGNOSTIC WORKUP
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Is there jaundice? Hepatomegaly with jaundice may make one think of hemolytic anemias; toxic or infectious hepatitis; bile duct obstruction due to stones, carcinoma of the pancreas, or ampulla of Vater; and biliary ... DIAGNOSTIC WORKUP
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Is the jaundice associated with hepatomegaly? There is little or no hepatomegaly associated with hemolytic anemias, pernicious anemia, Gilbert's disease, and Dubin-Johnson syndrome.
Is the hepatomegaly massive? ... DIAGNOSTIC WORKUP
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Hepatomegaly, or enlargement of the liver, usually refers to a liver span of larger than 12 cm at the right midclavicular line or a palpable left lobe in the epigastrium. However, liver size on physical exam is only an approximation and should be accurately measured with an... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Yellow skin pigmentation caused by elevated serum bilirubin level is termed jaundice. Bilirubin is the major breakdown product of hemoglobin that is released from dying or damaged erythrocytes. The normal serum bilirubin is less than 1 mg/dL, less than 5%... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Ascites, the accumulation of serous fluid within the peritoneal cavity, may be caused by a combination of factors, including hypoalbuminemia, portal hypertension, increased aldosterone and antidiuretic hormone secretion, overproduction of lymph, and... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Hepatomegaly represents the clinical appearance of liver enlargement and can occur via five mechanisms, including inflammation, excessive storage, infiltration, congestion, and obstruction. The presence of a palpable liver does not always represent hepatomegaly and is... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Jaundice refers to the presence of a yellow hue of the skin, sclerae, or mucous membranes. Direct, or more specifically, conjugated hyperbilirubinemia represents a pathologic condition of cholestasis. It is defined as a direct bilirubin fraction greater than 2 mg/dL, or greater than... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Jaundice is the presence of a yellow hue of the skin, sclerae, or mucous membranes due to elevation of serum bilirubin; it usually becomes apparent at a total serum bilirubin level of 5 mg/dL. It is present in approximately 60% of term infants and 80% of premature infants during... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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... Two key words to think of here are histology and obstruction. The analysis of the differential diagnosis of hepatomegaly is best begun with a histologic breakdown of the liver tissue ( Table 37 ). Thus, there are parenchymal cells
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... Jaundice is not to be confused with xanthochromia, in which the skin turns orange from carotene deposits but the sclerae remain normal in appearance. Carotenemia is often seen in hypothyroidism and diabetes mellitus, but jaundice is not usually a complication of these two
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... Hepatomegaly, an enlarged liver, indicates potentially reversible primary or secondary liver disease This sign may stem from diverse pathophysiologic mechanisms, including dilated hepatic sinusoids (in heart failure), persistently high venous pressure leading to liver... History and physical examination ... Medical causes ... Special considerations ... Pictures
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...Icterus
A yellow discoloration of the skin, mucous membranes, or sclera of the eyes, jaundice indicates excessive levels of conjugated or unconjugated bilirubin in the blood. In fair-skinned patients, it’s most noticeable on the face, trunk, and... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Pictures
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... Without Peritoneal Disease
Portal hypertension
Cirrhosis
Alcoholic hepatitis
Hepatic congestion
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... Alcoholic
Infectious
Viral hepatitis (especially B and C)
Schistosomiasis
Other
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... Palpable Liver without Hepatic Pathology
Normal variant
Thin or flaccid abdominal wall
Depressed right diaphragm (e.g., emphysema)
Subdiaphragmatic lesion (e
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... Primarily Unconjugated Hyperbilirubinemia
Increased production
Hemolysis, intravascular or extravascular
Ineffective erythropoiesis
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... The patient with alcohol-related disorder experiences a need for the daily intake of large amounts of alcohol for day-to-day functioning. A regular pattern of heavy drinking limited to weekends, with periods of sobriety between weekends, also... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations ... Pictures
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... Cirrhosis is a chronic hepatic disease characterized by diffuse destruction and fibrotic regeneration of hepatic cells. As necrotic tissue yields to fibrosis, this disease alters liver structure and normal vasculature, impairs blood and lymph... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations ... Pictures
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... Hepatomegaly, an enlarged liver, indicates potentially reversible primary or secondary liver disease. This sign may stem from diverse pathophysiologic mechanisms, including dilated hepatic sinusoids (in heart failure), persistently high venous... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Pictures
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... A yellow discoloration of the skin, mucous membranes, or sclera of the eyes, jaundice indicates excessive levels of conjugated or unconjugated bilirubin in the blood. In fair-skinned patients, it’s most noticeable on the face, trunk, and sclera;... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... C. Randall Clinch
Ascites, the accumulation of fluid within the abdominal cavity, is the most common major complication of cirrhosis; it is present in 50% of patients with cirrhosis of 10 years’duration (1). Ascites... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment
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... Darryl G. White and Bruce A. Leibert
Approach Hepatomegaly is a physical sign noted on abdominal examination that is present in hepatobiliary disease but is not specific or sensitive to one cause. Defining... History ... Physical examination ... Testing ... Diagnostic assessment ... Summary ... Pictures
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... James M. Brian and Cara K. Fox
The hepatobiliary system removes bilirubin, a byproduct of hemoglobin metabolism, from the blood stream. Jaundice, a yellowing of the skin and sclera, results from tissue build-up of bilirubin when the... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment ... Pictures
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... Differential Overview
❑ Acute hepatitis
❑ Chronic hepatitis
❑ Cirrhosis
❑ Right heart failure
❑ Fatty liver
... Diagnostic Approach ... Clinical Findings ... Pictures
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... Differential Overview
Conjugated
❑ Viral hepatitis
❑ Gallstone obstruction
❑ Drugs
❑ Carotinemia
&... Diagnostic Approach ... Clinical Findings ... Pictures
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... A chronic disorder, alcoholism is usually described as an uncontrolled intake of alcoholic beverages that interferes with physical and mental health, social and family relationships, and occupational responsibilities. Alcoholism cuts across all social and... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations ... Pictures
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... A chronic hepatic disease, cirrhosis is characterized by diffuse destruction and fibrotic regeneration of hepatic cells. As necrotic tissue yields to fibrosis, cirrhosis alters liver structure and normal vasculature, impairs blood and lymph flow and, ultimately,... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations ... Pictures
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... Hepatomegaly (an enlarged liver) indicates potentially reversible primary or secondary liver disease. This sign may stem from diverse pathophysiologic mechanisms, including dilated hepatic sinusoids (in heart failure), persistently high venous pressure leading to liver... History ... Physical assessment ... Medical causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
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... A yellow discoloration of the skin, mucous membranes, or sclerae of the eyes, jaundice indicates excessive levels of conjugated or unconjugated bilirubin in the blood. Also known as icterus, jaundice is most apparent in natural sunlight. In fact,... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... Liver sizemay be estimated by degree of extension of liver edge below costalmargin or by span of liver dullness to percussion. In children liver edge may be normallypalpable up to 2 cm below right costal margin. However, this assessmentof... Principal Causes of Hepatomegaly ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
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... Jaundice,yellow discoloration of skin and sclera, is produced by depositionof bilirubin in these tissues. Increase in unconjugated or conjugatedbilirubin or both produce jaundice, which is visible when totalserum bilirubin is >2 mg/dL. Conjugated... Principal Causes of Unconjugated Hyperbilirubinemia ... Clinical Features and Diagnosis: Unconjugated Hyperbilirubinemia(Neonatal Onset) ... Clinical Features and Diagnosis: Unconjugated Hyperbilirubinemia(Postneonatal Onset) ... Diagnostic Approach: Unconjugated Hyperbilirubinemia ... Principal Causes of Conjugated Hyperbilirubinemia (NeonatalOnset) ... Clinical Features and Diagnosis: Conjugated Hyperbilirubinemia(Neonatal Onset) ... Principal Causes of Conjugated Hyperbilirubinemia (PostneonatalOnset) ... Clinical Features and Diagnosis: Conjugated Hyperbilirubinemia(Postneonatal Onset) ... Diagnostic Approach: Conjugated Hyperbilirubinemia ... References
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... Hepatomegaly, an enlarged liver, indicates potentially reversible primary or secondary liver disease. This sign may stem from diverse pathophysiologic mechanisms, including dilated hepatic sinusoids (in heart failure), persistently high venous... History and physical examination ... Medical causes ... Nursing considerations ... Patient teaching ... Pictures
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... A yellow discoloration of the skin, mucous membranes, or sclera of the eyes, jaundice indicates excessive levels of conjugated or unconjugated bilirubin in the blood. In fair-skinned patients, it's most noticeable on the face, trunk, and sclera; in dark-skinned... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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Two key words to think of here are histology and
obstruction. The analysis of the differential diagnosis of hepatomegaly is
best begun with a histologic breakdown of the liver tissue (Table
37). Thus, there are ... Pictures
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...
Jaundice is not to be confused with xanthochromia, in which the skin
turns orange from carotene deposits but the sclerae remain normal in
appearance. Carotenemia is often seen in hypothyroidism and diabetes
mellitus, but jaundice is not... Pictures
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... Rose C. Graham-Maar, MD, MSCE Cirrhosis - BASICS Cirrhosis - description Cirrhosis is the end stage of progressive hepatic fibrosis and regenerative nodule formation that may occur as a result of many different... Cirrhosis - DIAGNOSIS ... Cirrhosis - TREATMENT ... Cirrhosis - FOLLOW UP ... Cirrhosis - bibliography ... Cirrhosis - CODES ... Cirrhosis - FAQ
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Most people know that alcohol abuse can cause liver damage. But what exactly does alcohol do to your liver? And how much alcohol puts you at risk?...
For the millions of Americans that suffer from alcoholism, accepting their diagnosis is an important first step. But making it through treatment can...
Alcoholism is a widespread disease. Unfortunately, many sufferers are not aware that they are have a problem. What are the symptoms of alcoholism?...
For all alcoholics, therapy is essential. But it's not always enough. For these patients, there is a variety of medications available to help...