Examination

On general inspection, Amanda is a slightly overweight woman, with clear yellowing of her sclera (icterus) and with jaundice of the skin. She has no signs of disease in the hands, and a normal cardiovascular and respiratory examination. She has a single spider naevus on her shoulder. Her abdomen is not distended, but she has considerable tenderness in her right upper quadrant and epigastrium, which worsens on inspiration. Bowel sounds are normal. Her observations show she is apyrexial.

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