This is NOT a case of racial profiling. Or if it is, it is acceptable and proper, and for the patient's benefit!
One of my old professors used to play a game of "what is it not?" Which is essentially the same thing played in the negative!
My colleagues should have pointed out by now that Asians and more specifically Southern Chinese suffer two very common cancers - well, common for them, but uncommon here. Their cancers are nasopharyngeal carcinoma and what might just be active here - hepatocellular carcinoma. Now we probably have a liver surgeon expert in the room today so I am not going to blot my copybook by pontificating on a disease that I treat rarely, I'll leave that for NPC where we radiation oncologists can rightly pontificate, but the point here is that you need to recognize the trigger.
This case was presented at a GP case conference that I attended. A popular saying in medicine is "to a hammer everything looks like a nail", which on the one hand is very dangerous, but on the other very rapid! A very old professor of mine told the story of going as a new orthopaedic consultant to a major New York teaching hospital and being asked to discuss a case at Grand Rounds. The case was that of a "Chance" fracture where the vertebral column separates around a fulcrum on the anterior mid-vertebral body. In his summation, he questioned why such a common case should be presented. He was approached afterwards over this question, and he came to realize that Chance fractures, which result from high speed automobile accidents, were common in Australia, but very very uncommon in New York where the only fast drivers are in movies!
So how should this man be investigated? Firstly with an examination. I am thinking acute hepatitis, hepatocellular carcinoma, metastatic carcinoma, decompensated cirrhosis, and common bile duct stone.
So will I have a diagnosis by the end of the examination? Probably not, but I will have a definite order if I 'listen' to my fingers and eyes. I will have a look at his stools and urine as well as his sclera. I will feel his liver expecting it to be nobbly, rough, have a dominant mass, or feel a protuberant gall bladder (what is Courvoisier's sign? And who was Courvoisier anyway?). I will of course be gentle as his liver is obviously a site of pathology. Liver span is crucial and discovery of spleen, spider nevi, caput medusa and superficial veins should also be sought.
Of course beware the single jaundiced eye!. So make sure you examine both eyes.
