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30yo man. tea-coloured urine day before, malaise for 5-6 days. Jaundiced …

- - - - Drugs - contrast, rifampicin, probenecid
      - CHF/portosystemic shunts (reduced bilirubin delivery to liver)
    - - Gilbert's dz
      - Crigler-Najjar syndrome
- - - - Intraluminal:
        ~choledocholithiasis - biliary colic but pt non-febrile & sick. jaundice may be intermittent (passing stone), fluctuating (if stone impacts & disimpacts), or progressive (impacted stone)
        ~Cholangitis - fever, jaundice, RUQ pain (Raynaud's pentad if there is hypotension & confusion as well)
        ~Parasites (ascaris lumbricodes, liver flukes)- travel Hx
        ~Stent blockage
      - Luminal (stricture in bile duct)
        ~Benign stricture - previous ERCAP, cholangitis, primary sclerosing cholangitis
        ~Malignant stricture - cholangiocarcinoma
      - Extraluminal (external compression)
        ~Pancreatitis
        ~Mirizzi's syndrome - extrinsic compression by a gallstone impacted in Hartmann's pouch of gall bladder
    - - Biliary atresia - congenital
      - Primary biliary cirrhosis - autoimmune
        ~xanthelasma
      - Drugs - Abx, chlopromazine, anabolic/contraceptive steroids