J

Published on 02/06/2015 by admin

Filed under Internal Medicine

Last modified 22/04/2025

Print this page

rate 1 star rate 2 star rate 3 star rate 4 star rate 5 star
Your rating: none, Average: 0 (0 votes)

This article have been viewed 1609 times

[level-membership-for-internal-medicine-category]

J

Jaundice

PREDOMINANCE OF DIRECT (CONJUGATED) BILIRUBIN

• Extrahepatic obstruction
• Common duct abnormalities: calculi, neoplasm, stricture, cyst, sclerosing cholangitis
• Metastatic carcinoma
• Pancreatic carcinoma, pseudocyst
• Ampullary carcinoma
• Hepatocellular disease: hepatitis, cirrhosis
• Drugs: estrogens, phenothiazines, captopril, methyltestosterone, labetalol
• Cholestatic jaundice of pregnancy
• Hereditary disorders: Dubin-Johnson syndrome, Rotor’s syndrome
• Recurrent benign intrahepatic cholestasis

PREDOMINANCE OF INDIRECT (UNCONJUGATED) BILIRUBIN

• Hemolysis: hereditary and acquired hemolytic anemias
• Inefficient marrow production
• Impaired hepatic conjugation: chloramphenicol
• Neonatal jaundice
• Hereditary disorders: Gilbert’s syndrome, Crigler-Najjar syndrome

Jaundice in the Adult Patient

PREHEPATIC CAUSES

• Unconjugated hyperbilirubinemia: excessive heme metabolism from hemolysis (e.g., sickle cell disease, spherocytosis, G6PD, immune hemolysis), ineffective erythropoiesis (e.g., thalassemia, folate, severe iron deficiency), or large hematoma reabsorption

INTRAHEPATIC CAUSES

• Unconjugated hyperbilirubinemia: disorders of enzyme metabolism such as Gilbert’s disease (common, benign), Crigler-Najjar syndrome (rare, severe), or drugs such as rifampin and probenecid
• Conjugated hyperbilirubinemia: intrahepatic cholestasis
• Viruses: hepatitis A, B, and C; Epstein-Barr
• Alcohol: alcoholic hepatitis, alcoholic cirrhosis
• Autoimmune: primary biliary cirrhosis, primary sclerosing cholangitis
• Drug induced: acetaminophen, penicillins, oral contraceptives, chlorpromazine (Thorazine), steroids (estrogenic or anabolic), some herbals
• Hereditary metabolic: hemochromatosis, Wilson’s disease, Dubin-Johnson and Rotor’s syndromes, α1-antitrypsin deficiency
• Systemic disease: sarcoidosis, amyloidosis, glycogen storage diseases, celiac disease, tuberculosis, Mycobacterium avium-intracellulare
• Other: sepsis, total parenteral nutrition, pregnancy, graft-versus-host disease, environmental toxins

POSTHEPATIC CAUSES

• Conjugated hyperbilirubinemia: intrinsic or extrinsic obstruction of the biliary system
• Intrinsic blockage: gallstones, cholangitis, strictures, infection (e.g., cytomegalovirus, Cryptosporidium in AIDS patients, parasites, cholangiocarcinoma, gallbladder cancer)
• Extrinsic blockage: pancreatitis, pancreatic carcinoma, pancreatic pseudocyst
• Pseudojaundice: caused by an excessive ingestion of foods containing beta-carotene (carrots, melons, squash); does not result in hyperbilirubinemia or scleral icterus

Joint Pain, Anterior Hip, Medial Thigh, Knee29

ACUTE

• Acute rheumatic fever
• Adductor muscle strain
• Avascular necrosis
• Crystal arthritis
• Femoral artery (pseudo) aneurysm
• Fracture (femoral neck or intertrochanteric)
• Hemarthrosis
• Hernia
• Herpes zoster
• Iliopectineal bursitis
• Iliopsoas tendinitis
• Inguinal lymphadenitis
• Osteomalacia
• Painful transient osteoporosis of hip
• Septic arthritis

SUBACUTE AND CHRONIC

• Adductor muscle strain
• Amyloidosis
• Acute rheumatic fever
• Femoral artery aneurysm
• Hernia (inguinal or femoral)
• Iliopectineal bursitis
• Iliopsoas tendinitis
• Inguinal lymphadenopathy
• Osteochondromatosis
• Osteomyelitis
• Osteitis deformans (Paget’s disease)
• Osteomalacia (pseudofracture)
• Postherpetic neuralgia
• Sterile synovitis (e.g., rheumatoid arthritis [RA], psoriatic, systemic lupus erythematosus [SLE])

Joint Pain, Hip, Lateral Thigh29

ACUTE

• Herpes zoster
• Iliotibial tendinitis
• Impacted fracture of femoral neck
• Lateral femoral cutaneous neuropathy (meralgia paresthetica)
• Radiculopathy: L4–5
• Trochanteric avulsion fracture (greater trochanter)
• Trochanteric bursitis
• Trochanteric fracture

SUBACUTE AND CHRONIC

• Lateral femoral cutaneous neuropathy (meralgia paresthetica)
• Osteomyelitis
• Postherpetic neuralgia
• Radiculopathy: L4–5
• Tumors

Joint Pain, Polyarticular

• Osteoarthritis
• Rheumatoid arthritis (RA)
• Fibromyalgia
• Viral syndrome (e.g., human parvovirus B19 infection)
• Systemic lupus erythematosus (SLE)
• Psoriatic arthritis
• Ankylosing spondylitis

Joint Pain, Posterior Hips, Thigh, Buttocks29

ACUTE

• Gluteal muscle strain
• Herpes zoster
• Ischial bursitis
• Ischial or sacral fracture
• Osteomalacia (pseudofracture)
• Sciatic neuropathy
• Radiculopathy: L5-S1

SUBACUTE AND CHRONIC

• Gluteal muscle strain
• Ischial bursitis
• Lumbar spinal stenosis
• Osteoarthritis of hip
• Osteitis deformans (Paget’s disease)
• Osteomyelitis
• Osteochondromatosis
• Osteomalacia (pseudofracture)
• Postherpetic neuralgia
• Radiculopathy: L5-S1
• Tumors

Joint Swelling

• Trauma
• Osteoarthritis
• Gout
• Pyogenic arthritis
• Pseudogout
• Rheumatoid arthritis (RA)
• Viral syndrome

Jugular Venous Distention

• Right-sided heart failure
• Cardiac tamponade
• Constrictive pericarditis
• Goiter
• Tension pneumothorax
• Pulmonary hypertension
• Cardiomyopathy (restrictive)
• Superior vena cava syndrome
• Valsalva maneuver
• Right atrial myxoma
• Chronic obstructive pulmonary disease (COPD)

Juvenile Idiopathic Arthritis

• Infectious causes of fever
• Systemic lupus erythematosus
• Rheumatic fever
• Drug reaction
• Serum sickness
• “Viral arthritis”
• Lyme arthritis

[/level-membership-for-internal-medicine-category][not-level-membership-for-internal-medicine-category]

J

Jaundice

PREDOMINANCE OF DIRECT (CONJUGATED) BILIRUBIN

• Extrahepatic obstruction
• Common duct abnormalities: calculi, neoplasm, stricture, cyst, sclerosing cholangitis
• Metastatic carcinoma
• Pancreatic carcinoma, pseudocyst
• Ampullary carcinoma
• Hepatocellular disease: hepatitis, cirrhosis
• Drugs: estrogens, phenothiazines, captopril, methyltestosterone, labetalol
• Cholestatic jaundice of pregnancy
• Hereditary disorders: Dubin-Johnson syndrome, Rotor’s syndrome
• Recurrent benign intrahepatic cholestasis

PREDOMINANCE OF INDIRECT (UNCONJUGATED) BILIRUBIN

• Hemolysis: hereditary and acquired hemolytic anemias
• Inefficient marrow production
• Impaired hepatic conjugation: chloramphenicol
• Neonatal jaundice
• Hereditary disorders: Gilbert’s syndrome, Crigler-Najjar syndrome

Jaundice in the Adult Patient

PREHEPATIC CAUSES

• Unconjugated hyperbilirubinemia: excessive heme metabolism from hemolysis (e.g., sickle cell disease, spherocytosis, G6PD, immune hemolysis), ineffective erythropoiesis (e.g., thalassemia, folate, severe iron deficiency), or large hematoma reabsorption

INTRAHEPATIC CAUSES

• Unconjugated hyperbilirubinemia: disorders of enzyme metabolism such as Gilbert’s disease (common, benign), Crigler-Najjar syndrome (rare, severe), or drugs such as rifampin and probenecid
• Conjugated hyperbilirubinemia: intrahepatic cholestasis
• Viruses: hepatitis A, B, and C; Epstein-Barr
• Alcohol: alcoholic hepatitis, alcoholic cirrhosis
• Autoimmune: primary biliary cirrhosis, primary sclerosing cholangitis
• Drug induced: acetaminophen, penicillins, oral contraceptives, chlorpromazine (Thorazine), steroids (estrogenic or anabolic), some herbals
• Hereditary metabolic: hemochromatosis, Wilson’s disease, Dubin-Johnson and Rotor’s syndromes, α1-antitrypsin deficiency
• Systemic disease: sarcoidosis, amyloidosis, glycogen storage diseases, celiac disease, tuberculosis, Mycobacterium avium-intracellulare
• Other: sepsis, total parenteral nutrition, pregnancy, graft-versus-host disease, environmental toxins

POSTHEPATIC CAUSES

• Conjugated hyperbilirubinemia: intrinsic or extrinsic obstruction of the biliary system
• Intrinsic blockage: gallstones, cholangitis, strictures, infection (e.g., cytomegalovirus, Cryptosporidium in AIDS patients, parasites, cholangiocarcinoma, gallbladder cancer)
• Extrinsic blockage: pancreatitis, pancreatic carcinoma, pancreatic pseudocyst
Buy Membership for Internal Medicine Category to continue reading. Learn more here

[/not-level-membership-for-internal-medicine-category]