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30-year old Male (Jaundice with “tea-coloured urine” (Hyperbilirubinemia…

- - - - Damaged hepatocytes
        
        Hepatitis
        
        Viral
        
        EBV
        
        prodromal period of 3-5 days includes headache, malaise, myalgia, and fatigue. Fever, pharyngitis, and cervical lymphadenopathy
        
        CMV
        
        HSV
        
        HBV
        
        Fever, urticarial rash, arthralgias, and/or arthritis precede constitutional symptoms (fatigue, anorexia, weight loss) and jaundice, pruritus, nausea, vomiting, right upper quadrant pain, hepatomegaly, dark-colored urine, and clay colored stools.
        
        HCV
        
        Cholestatic hepatitis
        
        low-grade fever, fatigue, dark urine, clay-colored stool, right upper quadrant pain, enlargement of liver, lloss of appetite, nausea, vomiting, arthralgia, and jaundice.
        
        HDV
        
        jaundice, pruritus, anorexia, fatigue, abdominal distention and ascites, and encephalopathy, lowered blood pressure, spider angiomata, hepatosplenomegaly, palmar erythema, Muehrcke nails, and Terry nails.
        
        Alcoholic
        
        malaise, nausea, jaundice, and low-grade fever, tachycardia, tachypnea, tender hepatomegaly, jaundice, ascites, and hepatic encephalopathy: confusion and lethargy. stigmata of liver disease, notably asterixis, spider angiomata, encephalopathy, tender hepatomegaly, and bruising. exanthem appears on the trunk or upper arms
        
        AST: ALT = 2:1
        
        Autoimmune
        
        more common in women, fatigue, pruritus, nausea, or abdominal pain, arthralgia , Hepatosplenomegaly and jaundice
        
        Non-alcoholic
        
        spider angiomata, gynecomastia, ascites, jaundice, and peripheral edema. risk factors for NAFLD are central obesity, type II diabetes mellitus, and hyperlipidemia.
        
        Hepatocellular carcinoma
        
        Cannot conjugate bilirubin
        
        Increase unconjugated bilirubin
        
        Leaks conjugated bilirubin
        
        Metabolic
        
        Wilson disease
        
        often presents in the first or second decade of life
        
        tremor, speech difficulty, movement disorders (similar to Parkinson disease), jaundice, or anemia. Kayser-Fleischer ring
        
        Alpha-1 antitrypsin deficiency
        
        dyspnea, wheezing, cough, recurring respiratory infections, and limited tolerance for exercise, jaundice, hepatomegaly
        
        Hemochromatosis
        
        hyperpigmentation, cirrhosis, and diabetes mellitus. arthropathy, hypopituitarism, hypogonadism, hair loss, and cardiac arrhythmias.
        
        Congenital hepatic fibrosis
        
        Fibropolycystic disease
        
        Systemic
        
        Acute ischemia
        
        Constrictive pericarditis
        
        Budd-chiari syndrome
        
        abdominal pain, ascites, jaundice, lower extremity edema, hepatic encephalopathy
        
        Venooclussive disease
        
        Liver infiltration
        
        Amyloidosis, lymphoma, sarcoidosis, tuberculosis
        
        Drugs
        
        Acetaminophen
        
        jaundice, nausea, vomiting, right upper quadrant pain or tenderness, hepatomegaly, bleeding, confusion, lethargy
        
        right upper quadrant abdominal pain, hepatomegaly, jaundice, pruritus, spider angiomata, palmar erythema, asterixis, and/or encephalopathy.
      - Tea colored urine (urobilinogen+ conjugated), pale stool, Increased total bilirubin, conjugated & unconjugated, decreased uribilinogen. ALT, AST ALP increased, splenomegaly
  - - - Extrahepatic
        
        Cholestasis (obstruction of CBD)
        
        Occlusion
        
        Cholelithiasis
        
        gallstones
        
        Compression
        
        Sclerosing cholangitis
        
        autoimmune
        
        Primary sclerosing cholangitis
        
        1 more item...
        
        Pancreatic carcinoma (head)
        
        Acalculus Cholecystitis
        
        DM, infection, drugs, neoplasm, prolonged immobility, surgery, trauma
      - Intrahepatic
        
        Swelling/fibrosis/obstruction of liver canaliculi
        
        Hepatitis
        
        Cholangitis
        
        autoimmune
        
        Primary biliary cholangitis (cirrhosis)
        
        cholestatic jaundice, pruritus, xanthelasma, hepatomegaly
        
        Pancreatic carcinoma
        
        Drugs
        
        Antibiotics, anti-thyroid drugs, immunosuppressants (female: OCP)
      - Dark urine (conjugated), pale stool, Increased Total and conjugated bilirubin, normal unconjugated. decreased urobilinogen, increased ALT, AST, ALP.
  - - - Urine color normal, stool color brown, normal/increased Total bilirubin, normal conjugated bilirubin, normal/increased unconjugated bilirubin, normal/increased urobilinogen, normal ALT, AST, ALP, splenomegaly
      - Increased bilirubin production
        
        RBC hemolysis
        
        Hemolytic anemia
        
        Hemolytic drugs
        
        Blood transfusion
        
        Sicke cell anemia
      - Decreased uptake
      - Impaired conjugation