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66yo female with 6 weeks jaundice (Check Urinalysis Serum total…

- - - - ↑Bilirubin production
        
        Hemolysis (Hereditary Spherocytosis, G6PD deficiency)
        
        Wilson Disease
      - Impaired Hepatic Bilirubin Uptake
        
        Heart Failure
        
        Drugs (Rifampin, Probenecid etc)
      - Impaired Bilirubin Conjugation
        
        Gilbert Syndrome
        
        Hyperthyroidism
        
        Liver Diseases
        
        Hepatitis
        
        Cirrhosis
        
        Hx: Weight loss, Weakness, Fatigue, Jaundice, Pruritus, Upper GI bleeding, Confusion, Easy bruising, Diarrhea, Fever
        
        PE: Spider Angiomata, Splenomegaly, Palmar erythema, Clubbing, Dupuytren's contracture, Asterixis, ↓BP, Distended abdo, Ascites, LL edema, Caput medusae
  - - - Do Liver Function Tests
        (AST, ALT, AP, GGT, CBC)
        
        Screen for Hepatitis
        
        Screen for Autoimmune (ANA, Anti-LKM, Anti-SM)
        
        Extrahepatic Cholestasis (Biliary Obstruction)
        
        Pancreatitis
        
        Alcohol, Smoking, Systemic (SLE, CF, ↑PTH, ↑TG)
        Hx: Abdo pain (Severe, RUQ/Epigastric, Radiates to back, Relieved by sitting upright/leaning forward, Worse after eating), N/V. Loose, greasy, foul-smelling stool.
        
        Malignancy
        e.g. Cholangiocarcinomas
        
        Hx: Jaundice, Pruritus, Clay-colored stools, Dark urine, Abdo pain (Dull, RUQ, 30-50%), Weight loss (30-50%). Malaise, Fatigue, Night sweats may be present.
        
        PE: Jaundice, Hepatomegaly (25-40%), RUQ mass (10%)
        
        Choledocholithiasis
        (Gallstones in bile duct)
        
        Hx: Abdo pain (RUQ/Epigastric), N/V
        
        PE: Jaundice, RUQ/Epigastric tenderness, Courvoisier's sign (Palpable gallbladder)
        
        Primary sclerosing cholangitis
        
        Hx: Pruritus, Fatigue. Fever, Chills, Night sweat may be present.
        
        PE: Abdo pain (RUQ), Jaundice, Hepatomegaly, Splenomegaly.
        
        Intrahepatic Cholestasis
        
        Hepatitis
        
        Alcoholic
        Hx: Jaundice (3M prior), Anorexia, Fever, Abdo pain (Severe, RUQ/Epigastric)
        PE: Tender Hepatomegaly, Distended abdo, Ascites, Proximal muscle weakness due to wasting, Bruit heard over liver.
        
        Autoimmune
        Hx: Jaundice, Arthralgia, Fatigue, Lethargy, Malaise, Anorexia, N/V, Abdo pain, Pruritus.
        Other autoimmune: Hemolytic anemia, ITP, DM Type I, UC
        
        Viral
        Hx: Jaundice, N/V, Dark urine, White stool, Abdo pain (RUQ). Fatigue, Low-grade fever, chills, Pruritus, Joint pain.
        PE: Hepatomegaly, Splenomegaly
        
        Drugs
        
        Infiltrative diseases
        
        Amyloidosis, Lymphoma, Sarcoidosis, Tuberculosis