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Jaundice (Post-Hepatic
Stool: pale
Pruritus: ++
Dark (Cholestasis…
Jaundice
Post-Hepatic
- Stool: pale
- Pruritus: ++
- Dark
Painful Obstructive Jaundice
- Gallstone
- Choledocholithiasis if pt is well
- Cholangitis if pt is febrile
- Lesser jaundice
- cholelithiasis, cholecystitis
Painless progressive jaundice
- cancer of periampullary region -> compression
- Pt with inventions -> stricture, stent blockage
Cholestasis
Intrahepatic
- Intrahepatic biliary tree dx
- Biliary atresia
- Primary biliary cirrhosis
- Drugs: antibiotics, chlorpromazine, anabolic or contraceptive steroids.
-Cancer
- Biliary excretion defect:
- Systemic sepsis
Extrahepatic
Intraluminal
- Choledocholithiasis
- Cholangitis
- Parasites
Luminal
- Benign stricture: from previous ERCP, cholangitis, or directly from primary sclerosing cholangitis.
- Malignant stricture: cholangiocarcinoma
Extraluminal
- Periampullary CA
- Pancreatitis
- Mirizzi’s syndrome
Hepatic
- Stool: normal
- Pruritus: +
- Urine: Tea
Acute hepatitis
- Infective
- Alcohol
- Other toxins
- Drugs
- Traditional medicine
- Other poisons
- Autoimmune hepatitis
- Budd-Chiari syndrome
- Acute decompensation of chronic causes: sepsis, alcohol, GI bleed
Chronic hepatitis, cirrhosis
- Infective
- Alcoholic
- Autoimmune hepatitis
- Non-alcoholic steatohepatitis
- Obstructive
- Metabolic
- Cardiac congestion
- Malignancy (Late presentation)
- Alpha-1-antitrypsin deficiency
Pre-Hepatic
- Stool: normal/dark
- Pruritus: -
- Urine can be dark if intravascular hemolysis -> hemoglobinuria
Bilirubin overproduction
Acquired RBC hemolysis
- autoimmune (infective,
neoplastic etc), microangiopathic hemolytic anemia,
mechanical hemolysis, or malaria
In neonates also consider: sepsis, hypothyroidism,
reabsorption of large hematoma
Inherited RBC hemolysis
- G6PD deficiency, spherocytosis, thalassemia,
sickle cell anemia
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