PALLOR AND ICTERUS

PICKLE :


P – pallor

I – icterus

C – cyanosis

K – klubbing
L – lymphadenopathy

E – pedal Edema


PALLOR :
Say – NOT PALE / NO PALLOR.

Don’t say not anaemic ( as anaemia alone is not the cause of pallor)

SITE TO LOOK FOR – LOWER PALPEBRAL CONJUNCTIVA !
Y? – the covering (mucosa) over this region is so thin so that the underlying vsls r clearly seen and v can easily judge the colour.


Other areas:
Nail bed, palm ,palmar crease , dorsum of tongue, buccal mucosa, fundus , mucosa of vagina.
CAUSES:
Anaemia , shock , hypopituitarism , hypothyroidism.
:
Instruct the patient what u r going to do. Suddenly taking ur fingers to patient eye without informing wil make the patient anxious also the examiner ! use BoTH UR THUMB to depress the lower eye lid and ask the patient to look up.


NEVER EVER USE SINGLE HAND TO LOOK FOR PALLOR.

ICTERUS
It’s the yellowish discolouration of the tissues due to deposition of bilirubin.
PLACES :
Bulbar conj., soft palate , skin and under surface of tongue .

Y FIRST ICTERUS APPEARS IN THE BULBAR CONJ . ??
Ans: its actually not the bulbar conj wht v look it’s the sclera v look thru the conj.. Sclera is rich in elastin which has high affinity to BILIRUBIN.

GRADES :
Lemon yellow – mild
Orange yellow – moderate
Green yellow – severe

:
Instruct the patient what u r going to do. Suddenly taking ur fingers to patient eye without informing wil make the patient anxious also the examiner ! use BoTH UR THUMB to hold the upper eye lid and ask the patient to look down.

DD: carotenoderma –
excess ingestion of carotene containing fruits and vegetables. from icterus (due to jaundice) . in carotenenoderma oly subcutaneous tissue involved and not the sclera !!
Normal BILIRUBIN:
0.2 – 0.8 mg/dl . out of which 0.2 is conjugated and 0.2 – 0.6 is unconjugated.

ICTERUS CLINICALLY : seen oly bilirubin is >2mg/dl ( Harrison– 3 mg/dl) .

1 – 2 mg/dl of bilirubin - LATENT JAUNDICE . cant be detected clinically.

JAUNDICE:

Hemolytic jaundice	Increase in unconj bilibrubin
Hepatocellular jaundice	Increase in both conj & unconj bilirubin
Obstructive / cholestatic jaundice	Increase in conj bilirubin