25 yrs. Old male

Doctor, I have fever and severe anorexia since 2 days. I don’t even feel like looking at food. I am feeling very weak.

Such severe anorexia? Is it infective hepatitis?

Is your urine dark yellow or red? “Yes, doctor,”

Do you get pain in the right upper abdomen? “Yes”.

Do you get a lot of itching? “I get mild itching”.

(This is suggestive of Jaundice, let me see)

Inspect the sclera in direct sunlight for icterus. Take the patient to a window ask him to look down, life the upper eyelid & inspect the upper sclera for icterus.

Ask the patient to lie down, flex the legs and palpate for the liver.

(soft, tender Liver is typical of infective Hepatitis. Even tenderness under the costal margin is suggestive)

Icterus may be apparent 2-3 days after anorexia and fever. So ask the patient to keep a watch on urine color & eyes.

This is a clear-cut case of infective Hepatitis. Yet ask about other causes of jaundice.

Had you taken any injections, Blood transfusion? Were you exposed to STD? (For hepatitis B). Are you immunized against hepatitis B?

Did you have colicky pains in the right upper abdomen? (For Gallstones)

Were you taking any drugs? (for hepatotoxic drugs like Rifampicin)

If the jaundice is deep, is the patient drowsy or irritable? Does he have flapping tremors? Beware of impending Hepatic coma. Refer the patient immediately.

If jaundice is recurrent or chronic, test blood for Hepatitis-B.