Approach to the jaundiced patient

Vennes, Jack A.; Bond, John H.

doi:10.1016/0016-5085(83)90390-6

Cited by 34 publications

(12 citation statements)

References 19 publications

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“…Patients with malignant disease had a higher mortality than those with benign disease (24 per cent vs. 7 per cent) P < 0,Ol. The causes of death were acute renal failure (7), gastrointestinal haemorrhage (S), septicaemia (I), progress of disease (3) and complications of PTC and drainage (1). Comparison of the mortality with plasma bilirubin is shown in Figure 2.…”

Section: Percutaneous Transhepatic Biliary Drainagementioning

confidence: 99%

Surgical experience of deeply jaundiced patients with bile duct obstruction

Armstrong

Dixon

Taylor

et al. 1984

Journal of British Surgery

166

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One hundred and twenty consecutive deeply jaundiced patients undergoing surgery for bile duct obstruction were analysed. Diagnosis by either ultrasound or percutaneous transhepatic cholangiography was correct in 84 per cent and 86 per cent of patients respectively. Combination of the two procedures resulted in a diagnostic accuracy of 96.5 per cent. Despite pre-operative antibiotics and intravenous fluids, including Mannitol, infective complications and renal failure were common. Gastrointestinal haemorrhage was a major cause of postoperative morbidity and mortality. The operative mortality in this series was 14.2 per cent and was related to the depth of jaundice in patients with benign disease. The same relationship did not appear to occur in those with malignant disease. The median survival after palliative bypass surgery in patients with malignant obstruction was 6.5 months.

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Section: Percutaneous Transhepatic Biliary Drainagementioning

confidence: 99%

Surgical experience of deeply jaundiced patients with bile duct obstruction

Armstrong

Dixon

Taylor

et al. 1984

Journal of British Surgery

166

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“…A popular diagnostic strategy for differentiating between non-obstructive and obstructive jaundice relies on ultrasonographic finding of nondilated or dilated bile ducts, respectively (1 1-15). Apparently all clinical and biochemical information is discarded by this strategy, although in our opinion and in that of other authors (16,17), such information may often allow quite accurate clinical diagnoses to be made as to the patency of the bile ducts. In a study comparing ultrasonographical and clinical diagnoses of obstructive or non-obstructive causes of jaundice, experienced clinicians made a "definite" diagnosis in 53 patients, which proved correct in 52 (6).…”

Section: Discussionmentioning

confidence: 85%

Differential diagnosis of jaundice: a pocket diagnostic chart

Matzen¹,

Malchow-Møller²,

Hilden³

et al. 1984

Liver

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ABSTRACT— Based on extensive clinical and clinical chemical information (107 different items) from 1002 jaundiced patients, we developed a diagnostic algorithm which was evaluated on a test sample of another 110 jaundiced patients. A primary classification into categories of obstructive jaundice (probability of obstruction ≥0.80), non‐obstructive jaundice (probability of obstruction ≤0.20), and of doubtful causes of jaundice (probability of obstruction: 0.20–0.80) was attempted. Among 234 patients in the data base who were classified as obstructive, 220 (94%) proved to be so, as did 36 (97%) of 37 in the test sample. The corresponding figures for non‐obstructive jaundice were 463 (96%) of 483 patients correctly classified in the data base and 47 (92%) of 51 patients in the test sample. Altogether 69% of the patients in the data base and 75% of those in the test sample were correctly classified, in 27% and 20% the cause of jaundice was doubtful, and only 4% and 5%, respectively, were misclassified. A slight majority of the patients in whom the algorithmic diagnoses were doubtful proved obstructive. A close correlation was found between the preliminary diagnoses made by the algorithm and by the clinicians. A secondary classification of the patients by the algorithm into benign versus malignant causes of obstructive jaundice performed equally well in the data base and the test sample.

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“…Las enfermedades que cursan con una disminución en la conjugación de Br 4,6,8 En todas estas entidades, el defecto genéticamente determinado, está en la actividad de la UGT-1 (UDP-glucuronil transferasa), pero lo que varía es el grado de disminución de dicha actividad 2,4,8 . En el cuadro 1 se muestran las características más importantes de las tres entidades 2,3,6 .…”

Section: Conjugación Disminuidaunclassified

“…Tal y como se resume más adelante en la figura 2, la historia clínica, es el primer paso en el abordaje de un paciente ictérico y quizás el más importante, pues esto orientará sobre el cuadro en general y dictará los exámenes de laboratorio y gabinete pertinentes por escoger 4,6 . Es aquí donde deberá recopilarse toda la información clínica pertinente.…”

Section: Anamnesis Y Examen Físicounclassified