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30YO man with jaundice with tea-coloured urine for 1 day, not feeling well…
30YO man with jaundice with tea-coloured urine for 1 day, not feeling well for past 5-6 days
Stool colour
Normal => Intra-hepatic jaundice. Impaired liver fx: splenomegaly (if portal hypertension present); hepatomegaly; abdominal distension from ascites; RUQ pain; + pruritus
Fever => Infective, commonly viral hepatitis but may be non-viral. Consider non-infective forms of hepatitis. Other sx: right hypochondrial pain; check for risk factors e.g. blood-borne exposures (sexual hx, tattoos, transfusions); family hx; dietary hx; travel hx
Check for chronic infection (family hx, risk factors etc.), only B and C can cause this. Usually asymptomatic but may have vague sx, e.g. poor appetite; fatigue; doesn't feel well
Hepatitis C sx: typically asymptomatic; appetite loss; feeling tired all the time; abdominal pain; flu-like sx (muscle aches and fever)
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Suspect alcohol hx => Alcoholic cause of acute hepatitis. Other sx: may have fever; check for signs of chronic alcohol intake: Dupuytren's contracture; parotidomegaly
Suspect drug hx => Most commonly acetaminophen/paracetamol o/d. Ask for traditional medicine hx. Check for signs of poisoning.
Abdominal pain + ascites => Budd-Chiari syndrome. Other sx: hepatomegaly due to thrombosis; may be chronic
Elevated JVP => Cardiac congestion. Other sx: pulsatile liver; exertional dyspnea; leg swelling; fatigue and weakness
Unintentional weight loss => Cancer (unlikely due to age). Other sx: lymphadenopathy; malaise; check for family hx
Skin pigmentation. Other sx: arthralgia (joint pain); impotence; weakness and lethargy; may present with DM
Primary biliary cirrhosis. Other sx: fatigue; memory and concentration impairment; hyperpigmentation; dry skin; hepatosplenomegaly. Primary sclerosing cirrhosis sx: fever; chills; night sweats
Normal => Pre-hepatic jaundice likely but only with intravascular hemolysis or Gilbert's sydrome (congenital). Other sx: fatigue; dizziness; irritable bowel syndrome
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