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30 year M tea colored urine (1 day) with jaundice, malaise for 5 days…

- - - - Viral Infection (Hep A, B)
        
        Hep A
        
        Hx: History of eating shelfish PE: Hepatomegaly
        
        Hep B
        
        Hx: IV drug use PE: Needle marks
        
        Hep E
        
        Hx: Eating undercooked pork, contaminated water
      - Alcoholic Hepatitis
        
        Hx: Alcohol consumption
      - Autoimmune
      - Non Alcoholic Fatty Liver Disease (Nonalcoholic Steatohepatitis)
      - Hepatocellular Carcinoma
      - Parastiic Infections
        
        Hx: Travel to endemic areas
    - - acetaminophen, penicillin, chlorpromazine
    - - Sarcoidosis
      - Primary Biliary Cirrhosis
        
        Hx: Family history of autoimmune (RA Sjogren's)
      - Alpha trypsin def - COPD
        
        PE: Emphysema
      - Primary Sclerosing Cholangitis
        
        Hx: Ulcerative Colitis
      - Parental Nutrition
      - Tuberculosis
      - Lymphoma
    - - Rotor's Syndrome
        
        Defect in transport
      - Dubin-Johnson Syndrome
        
        Defect in transport
    - - Hx: Tremor, clumsy gait PE: Kayser-Fleischer rings
  - - - glucuronyltransferase enzyme issue
    - - glucuronyltransferase enzyme issue
- - - - Gallbladder Cancer
      - Cholangiocarcinoma
    - - Hx: Worse with meals
    - - Hx: ERCP, cholangitis,
        or directly from primary sclerosing cholangitis
    - - Cholangitis
        
        Hx: Fever, chills, pale stool PE: RUQ tenderness, Hypotension, confusion
  - - - Hx: Gallstone, alcohol use
    - - Hx: Smoking, painless PE: Cachexia, Lymphadenopathy, Courvoisier's Sign