Case 11 Gastroenterology

Jaundice

Work it one clue at a time. The diagnosis stays hidden until you reveal it.

Clue 1

This previously healthy woman presents with fatigue and weight gain. We walk into the room to meet her. What findings are present? These findings should generate a hypothesis.

Clue 2

The three primary colors are red, yellow, and blue. Diseases can make skin color shift toward one of the primary colors.

This patient is tending toward yellow (jaundice). (The eyes are an excellent place to look for icterus in patients with darker skin tone.) We also notice the red lesions on her neck and chest. Here’s a close-up video of a different patient with the same finding:

Clue 3

These lesions are a form of telangiectasia known as spider angiomas – characterized by a central pulsating arteriole that feeds branches that radiate outward, like a spider. Hence the name. We continue our hypothesis-driven approach by examining the hands. Finding?

Clue 4

Palmar erythema describes redness in the thenar and hypothenar areas and the base and pads of the fingers, with sparing of the actual palm area (a bit of a misnomer).

We examine her abdomen next. It is symmetrically distended, generating a hypothesis in our minds. So we perform a specific exam maneuver:

Clue 5

So we have a patient with jaundice, spider angiomas, palmar erythema, and ascites. Retrospective history reveals significant daily alcohol consumption. What is the underlying diagnosis?

We diagnosed Laennec’s cirrhosis with our eyes, ears, hands, and a microscope slide.

End of case.