There are three common sources of yellow – (1) liver disease, (2) biliary tract disease, and (3) hemolytic anemia.
Liver questions – toxins (alcohol, tylenol, mushrooms), hepatitis – where did you eat? diarrhea? sex – ivdu?
Biliary questions – the typical biliary diseases (acute chole) generally present with pain, not jaundice. jaundice + biliary disease generally means obstruction (e.g. pancreatic cancer), a dx that you can’t make by history/. Sometimes, you get a positive family history.
Hemolysis questions – you won’t make the dx based on hx here either, unless you get lucky. Patients usually complain of fatigue.
On exam, look for signs of anemia, chronic liver disease (ascites, cutaneous varices), and abdominal mass / tenderness.
Tests include cbc, chem, AST-ALT, PT, direct / total bili, and less common tests if indicated (e.g. haptoglobin, hepatitis titers). Ultrasound or CT scanning is often necessary to look for a mass. I tend to scan more than I sono when the patient does not have pain.
The patient has AST 700 and ALT 800. CBC, chem, PT are otherwise normal. He reports a recent diarrheal illness. The patient is Hep A IgG and Hep A IgM +. What do we do now?