1. History Taking and Physical Examination for the Patient with Liver Disease

  1. Eugene R. Schiff MD, MACP, FRCP2,
  2. Willis C. Maddrey MD, MACP, FRCP3 and
  3. Michael F. Sorrell MD, FACP4
  1. Norton J. Greenberger MD

Published Online: 31 OCT 2011

DOI: 10.1002/9781119950509.ch1

Schiff's Diseases of the Liver, Eleventh Edition

Schiff's Diseases of the Liver, Eleventh Edition

How to Cite

Greenberger, N. J. (2011) History Taking and Physical Examination for the Patient with Liver Disease, in Schiff's Diseases of the Liver, Eleventh Edition (eds E. R. Schiff, W. C. Maddrey and M. F. Sorrell), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781119950509.ch1

Editor Information

  1. 2

    Center for Liver Diseases and Schiff Liver Institute, University of Miami Miller School of Medicine, Miami, FL, USA

  2. 3

    Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA

  3. 4

    University of Nebraska College of Medicine, Omaha, NE, USA

Author Information

  1. Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA, USA

Publication History

  1. Published Online: 31 OCT 2011
  2. Published Print: 9 DEC 2011

ISBN Information

Print ISBN: 9780470654682

Online ISBN: 9781119950509

SEARCH

Keywords:

  • Decompensation of chronic liver disease;
  • alcoholic hepatitis;
  • gallstones and their complications;
  • malignancy;
  • sepsis;
  • drug-induced liver disease;
  • hemolysis;
  • especially sickle cell anemia;
  • postoperative jaundice;
  • viral hepatitis;
  • primary biliary cirrhosis and primary sclerosing cholangitis

Summary

A careful history, physical examination, and review of standard laboratory tests should allow a physician to make an accurate diagnosis in 85% of patients presenting with jaundice. This chapter details important history taking and physical examination findings to be applied to jaundiced patients. In adult patients with new-onset jaundice, ten disorders account for 98% of the ultimately established diagnoses. In descending order of frequency they include: (i) decompensation of chronic liver disease; (ii) alcoholic hepatitis; (iii) gallstones and their complications; (iv) malignancy; (v) sepsis; (vi) drug-induced liver disease; (vii) hemolysis, especially sickle cell anemia; (viii) postoperative jaundice; (ix) viral hepatitis; and (x) primary biliary cirrhosis and primary sclerosing cholangitis. The presence of two physical findings (ascites and evidence of portal systemic encephalopathy) and two laboratory findings (hypoalbuminemia and a prolonged prothrombin time) indicates a diagnosis of cirrhosis of the liver.