title: The value of clinical assessment in the diagnosis of icterus and cholestasis.
abstract: We studied the reliability of the clinical assessment and the discriminatory value of different symptoms and signs in diagnosing obstructive and non-obstructive diseases causing icterus and/or cholestasis. During a period of two-and-a-half years, clinical assessment done by both physicians-in-training and by senior physicians was completed for 266 patients, and the usefulness of different symptoms and signs was tested in 220 of these. Clinical assessment was found to be a reliable method in distinguishing between obstructive and non-obstructive conditions causing icterus, with the sensitivity of 92% and specificity of 86%. In cases of anicteric cholestasis, the sensitivity and specificity of clinical assessment were 74% and 80%, respectively. Abdominal pain and abdominal tenderness were significantly (p less than 0.01) associated with obstructive diseases, whereas an enlarged liver, fever and excessive consumption of alcohol were associated with non-obstructive diseases (p less than 0.01, p less than 0.05, p less than 0.05, respectively). Itching, vomiting, intolerance to fatty foods, previous cholecystectomy, abdominal tumour and clinical icterus had no discriminatory value. Clinical evaluation is a reliable method in the diagnostic workup of a patient with icterus or anicteric cholestasis, and it is still of crucial importance in directing further investigations.
authors.affiliation: Kirurgian klinikka, Kuopion Yliopistollinen sairaala, Finland.
authors.forename: P A
authors.initials: PA
authors.lastname: Pasanen
authors.forename: P
authors.initials: P
authors.lastname: Pikkarainen
authors.forename: E
authors.initials: E
authors.lastname: Alhava
authors.forename: K
authors.initials: K
authors.lastname: Partanen
authors.forename: A
authors.initials: A
authors.lastname: Pirinen
authors.forename: E
authors.initials: E
authors.lastname: Janatuinen
mesh_terms: D002779:Cholestasis / Q000175:diagnosis* / Q000209:etiology; D001651:Cholestasis, Extrahepatic / Q000175:diagnosis; D002780:Cholestasis, Intrahepatic / Q000175:diagnosis; D003937:Diagnosis, Differential; D006801:Humans; D007565:Jaundice / Q000175:diagnosis* / Q000209:etiology; D008487:Medical History Taking; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity