• Duration and time course of jaundice and other symptoms (e.g. fever, abdominal pain)
• Known liver or biliary tract disease?
• Full drug history: including all non-prescription drugs, herbal remedies, dietary supplements, mushroom ingestion or khat, taken over the past year
• Risk factors for viral hepatitis (foreign travel, IV drug use, men who have sex with men, multiple sexual partners, body piercing and tattoos, blood transfusion and blood products, needle-stick injury in health-care worker)?
• Sexual history
• Pregnancy?
• Usual and recent alcohol intake?
• Other medical problems (e.g. cardiovascular disease, transplant recipient, cancer, HIV/AIDS, haematological disease)?
• Family history of jaundice/liver disease?

Examination

• Physiological observations and systematic examination
• Conscious level and mental state; grade of encephalopathy if present:

Impaired work, personality change, sleep disturbance

Abnormal findings on psychomotor testing

Mild confusion, agitation, apathy, oriented in time and place

Fine tremor, asterixis

Drowsiness, lethargy, disoriented in time

Asterixis, dysarthria

Sleepy but rousable, disoriented in time and place

Hyperreflexia, hyperventilation

Signs of chronic liver disease?

Right upper quadrant tenderness (Table 23.4)?

Liver enlargement (seen in early viral hepatitis, alcoholic hepatitis, malignant infiltration, congestive heart failure, acute Budd-Chiari syndrome)?

Splenomegaly?

Ascites (Chapter 24)?