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A 30-year old man noted that he has had tea-coloured urine since the…

- - - - Can present as a predominantly cholestatic syndrome with marked pruritus. Patient can have risk factors for viral hepatitis: blood-borne exposure (sexual Hx, IV drug, transfusions, tattoos) family Hx (vertical transmission), dietary Hx (uncooked shellfish), travel Hx
      - Other infections include EBV, CMV (immunocompromised)
    - - Cholestasis with fever and leukocytosis often distinctive sign of alcoholic hepatitis.
      - 5 to 10yrs of alcohol abuse (>50 to 60g/day for men and 20 to 30g/day for women), abdominal pain, pruritus, generalised malaise, weight loss, fatigue, cachexia, anorexia, pale stool etc.
      - P/E shows parotid gland enlargement, Dupuytren's contracture, generalised wasting, gynecomastia, altered mental state, asterixis, altered deep tendon reflexes, spider angioma, ascites, hepatosplenomegaly etc.
- - - - Painful obstructive jaundice, choledocholithiasis if patient is well, or cholangitis if patient is febrile. To have jaundice, there has to be common bile duct obstruction
    - - Gallbladder or bile duct surgery, abdominal pain, pruritus, fatigue, anorexia, pale stool, dark urine
    - - Bile duct cancer, composed of mutated epithelial cells that originate in the bile duct causing obstruction
    - - Cholangitis, usually caused by bacterial infections, may occur when duct is blocked by gallstone or tumour, infection can spread to the liver. Parasites such as Ascaris lumbricodes, liver flukes.
  - - - Often asymptomatic until late disease, depression, weight loss, early satiety, new-onset diabetes, abdominal pain, pruritus, generalised malaise, fatigue, anorexia, dark urine. P/E: positive Courvoisier's sign, palpable gallbladder, ill-appearing, cachectic
    - - Inflammation of pancreas, Sx: upper abdominal pain, pain radiates to back, and pain is worse after eating, fever, tachycardia, nausea, vomiting, tenderness when touching abdomen
    - - Extrinsic compression by a gallstone impacted in Hartmann's pouch of the gallbladder. RARE!!