- Means yellowing of the skin from elevated bilirubin, either from the destruction of red blood cells in hemolysis or more commonly from liver disease or obstruction of bile ducts.
- Not seen until the bilirubin level is about twice the upper limit of normal (2.5-3 mg/dL).
- Best seen in natural light, it’s often better seen in the sclera (whites) of the eyes, where it is known as scleral icterus
- Can be seen early under the tongue.
- Patients often don’t notice when they develop jaundice. “Jaundice is the disease that your friends diagnose.” -Sir William Osler.
A form of telangiectasias where a central arteriole feeds telangiectasias, and is seen in conditions of estrogen excess, such as pregnancy and liver disease. In liver disease, the spider angiomas are most often seen in the face and chest areas (drained by the SVC), and is more commonly seen in alcoholic liver disease compared to other etiologies.
Erythema of the thenar/hypothenar portion of the hand with a pale central palm, seen in liver disease (likely from imbalance of estrogens to androgens).
Growth in breast tissue due to an imbalance of estrogens to androgens.
Medusa was a Gorgon in Greek mythology, with snakes for hair. In IVC obstruction, the pattern of collateral veins is upwards towards the SVC, not radiating outwards. In portal vein thrombosis the pattern is towards the umbilicus (opposite of caput Medusa).
Inspection of the abdomen in patients with ascites reveals symmetric distention with bulging flanks.
Terry’s nails describes white-colored opacification of most of the nail bed, sparing a narrow 1 to 2 mm band of normal pink to brown tissue at the distal end. The opacification results in disappearance of the lunula. Terry’s nails are a sign of systemic disease, such as cirrhosis, chronic heart failure, and chronic kidney disease.
Thickening of the palmar fascia, caused by a variety of conditions (hereditary, trauma, diabetes) but also associated with alcoholic liver disease.
Periumbilical hemorrhage rarely reported in retroperitoneal bleeding.
Grey Turner sign
Flank hemorrhage from retroperitoneal bleeding.
Inflammatory bowel disease
Characterized by red, painful nodules (histologically it is a panniculitis) most often seen on the lower extremities (shins, calves, thighs, ankles) and it generally flares when the inflammatory bowel disease flares. Erythema nodosum is also seen in TB, sarcoidosis, some strep infections, and as an allergic response to certain medications.
Painful nodules or pustules that progressively grow and ulcerate. Associated with autoimmune conditions, including inflammatory bowel disease.
In a patient who previously underwent surgery for ocular melanoma and now has glass eye, the presence of unilateral icterus (of the normal eye) should raise suspicion for subsequent development of liver metastases.