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A 45-year-old woman presents with insidious onset of fatigue

45 years old | Female

Vignette:

A 45-year-old woman presents with insidious onset of fatigue, malaise, lethargy, anorexia, nausea, abdominal discomfort, mild pruritus, and arthralgia involving the small joints. Her past medical history includes celiac disease. Physical examination reveals hepatomegaly and spider angiomata.

Summary:

fatigue | malaise | lethargy | anorexia | nausea | abdominal discomfort | mild pruritus | small joints arthralgia | small joints | celiac disease | hepatomegaly | spider angiomata

Dx:

Autoimmune hepatitis Chronic Hepatitis Hepatitis

Ref:

https://online.epocrates.com/diseases/13022/Autoimmune-hepatitis/Common-Vignette

Rank

Disease

Weight

1 Autoimmune hepatitis 700.0
2 Primary biliary cirrhosis 580.0
3 Addison Disease 467.0
4 Systemic lupus erythematosus 466.0
5 Klebsiella pneumoniae liver abscess 464.0
6 Liver disease 463.0
7 Pyogenic Liver Abscess 445.0
8 Acute Hepatitis 440.0
9 Infectious mononucleosis 437.0
10 Primary sclerosing cholangitis 423.0
11 Alcoholic Liver Disease 421.0
12 Liver Cirrhosis 419.0
13 Alcoholic Liver Cirrhosis 407.0
14 Biliary cirrhosis 405.0
15 Sarcoidosis 396.0
16 Hereditary hemochromatosis 396.0
17 Brucellosis 385.0
18 Alcoholic hepatitis 384.0
19 Chronic heart failure 379.0
20 pancreatic cancer 371.0
21 Systemic sclerosis 371.0
22 Alcoholic Fatty Liver 363.0
23 Crohn Disease 346.0
24 Acute Lymphoblastic leukemia in children 334.0
25 Acute Pancreatitis 328.0
26 Rocky Mountain spotted fever 313.0
27 Ulcerative Colitis 300.0
28 Chronic Pancreatitis 298.0
29 Multiple Sclerosis 288.0
30 Celiac Disease 284.0
31 Giardiasis 280.0
32 Graves Disease 280.0
33 Cholangiocarcinoma 277.0
34 Malaria 274.0
35 Type 1 Diabetes mellitus 273.0
36 Chronic Myeloid Leukemia 271.0
37 Diabetic Ketoacidosis 268.0
38 Chronic Hepatitis 267.0
39 Gallbladder cancer 260.0
40 Gallstone pancreatitis 260.0
41 Intestinal Obstruction 258.0
42 Acute Appendicitis 255.0
43 Chronic bacterial prostatitis 253.0
44 Renal and perinephric abscess 247.0
45 Adrenal crisis 247.0
46 Hereditary Angioedema 244.0
47 Hyperparathyroidism 244.0
48 Acute bacterial meningitis in adults 242.0
49 End Stage Renal Disease 240.0
50 Osteoarthritis 240.0
51 Travelers diarrhea 240.0
52 Toxic Megacolon 239.0
53 Granulomatosis with polyangiitis 237.0
54 Acute Liver Failure 236.0
55 Ovarian Cancer 236.0
56 Acute fatty liver of pregnancy 235.0
57 Acromegaly 233.0
58 Non-alcoholic Fatty Liver Disease 230.0
59 Acute viral meningitis 224.0
60 Acute Myeloid Leukemia in adults 220.0
61 Chronic Kidney Diseases 216.0
62 Acute Clonorchiasis 214.0
63 Hypercalcemia 211.0
64 Hypothyroidism 209.0
65 Common cutaneous drug reactions 207.0
66 Polyarteritis nodosa 206.0
67 Gastroparesis 206.0
68 Lactose intolerance 205.0
69 Acute perforated appendicitis 205.0
70 Hepatic Encephalopathy 205.0
71 Amyloidosis 205.0
72 Chronic Mitral regurgitation 204.0
73 Acute Lymphocytic Leukemia in Adults 204.0
74 Obstructive Sleep Apnea 203.0
75 Cystic Fibrosis 203.0
76 Shigellosis 203.0
77 Fibromyalgia 201.0
78 mucosal Eosinophilic gastroenteritis 200.0
79 Glomerulonephritis 200.0
80 Migraine 199.0
81 Gilbert syndrome 199.0
82 Adrenocortical carcinoma 198.0
83 Cushing syndrome 198.0
84 Gastritis 195.0
85 Non-small cell lung cancer 195.0
86 Hyperaldosteronism 193.0
87 Salmonella infection 193.0
88 Hemolytic uremic syndrome 193.0
89 Chronic pelvic pain in women 191.0
90 Aseptic meningitis 191.0
91 Viral Gastroenteritis 190.0
92 Adrenal Suppression 189.0
93 Central hypothyroidism 188.0
94 Mesenteric ischemia 185.0
95 Gastric cancer 185.0
96 Ovarian Hyperstimulation Syndrome 182.0
97 Anemia of chronic disease 179.0
98 Hyperprolactinemia 178.0
99 Mitral Stenosis 177.0
100 Pheochromocytoma 176.0
101 Acute Myeloid Leukemia in children 176.0
102 Wilson disease 175.0
103 Inflammatory Bowel Diseases 175.0
104 Aortic stenosis 175.0
105 Amebic Liver Abscess 174.0
106 Milk-alkali syndrome 174.0
107 Acute Milk-alkali syndrome 174.0
108 Chronic Milk-alkali syndrome 174.0
109 Colorectal cancer 169.0
110 Hyperthyroidism 168.0
111 Premenstrual syndrome 168.0
112 Short bowel syndrome 168.0
113 Muscle Layer Eosinophilic gastroenteritis 167.0
114 Choledocholithiasis 167.0
115 Acetaminophen overdose 167.0
116 Acute Cholecystitis 166.0
117 Emphysematous cholecystitis 166.0
118 Listerial gastroenteritis 166.0
119 Bacterial gastroenteritis 163.0
120 Primary Myelofibrosis 161.0
121 anterior ischemic optic neuropathy 161.0
122 Hemorrhagic stroke 160.0
123 Ischemic stroke 160.0
124 Chronic Clonorchiasis 159.0
125 Acute bacterial meningitis in children 158.0
126 Typhoid infection 157.0
127 Acute intermittent porphyria 156.0
128 Diabetic Kidney Disease 156.0
129 Multiple Myeloma 156.0
130 Ankylosing spondylitis 156.0
131 Migraine headache in adults 156.0
132 Amphetamine use disorder 156.0
133 Bacterial pharyngitis 155.0
134 Foodborne E coli infection 155.0
135 Dyspepsia 155.0
136 Spontaneous bacterial peritonitis 151.0
137 Cryptococcosis 151.0
138 Extraintestinal Entamoeba histolytica amebiasis 150.0
139 Non-diabetic hypoglycemia 150.0
140 COPD Exacerbation 148.0
141 Acute bacterial rhinosinusitis 148.0
142 Thrombotic thrombocytopenic purpura 147.0
143 Duodenal Ulcer 145.0
144 Gastric Ulcer 145.0
145 Viral pharyngitis 144.0
146 cholestatic liver disease 143.0
147 Churg-Strauss Syndrome 143.0
148 Goiter 143.0
149 Diffuse nontoxic goiter 143.0
150 Toxic multinodular goiter 143.0
151 Obstructive cervical goiters 143.0
152 Cervical goiter 143.0
153 Campylobacter infection 143.0
154 Acute pyelonephritis in adults 143.0
155 Pneumonia 142.0
156 Stable angina 142.0
157 Chronic pyelonephritis 142.0
158 Autoimmune Pancreatitis 141.0
159 Irritable Bowel Syndrome 141.0
160 Hepatorenal Syndrome 140.0
161 Rheumatoid Arthritis 140.0
162 Acute peptic ulcer 140.0
163 Intussusception 140.0
164 Hepatocellular carcinoma 139.0
165 Secondary hyperparathyroidism 139.0
166 Motion Sickness 138.0
167 Diverticulitis 138.0
168 Tuberculous Peritonitis 137.0
169 Esophagitis 137.0
170 Analgesic nephropathy 136.0
171 Secondary Peritonitis 135.0
172 Peutz-Jeghers Syndrome 135.0
173 Painless thyroiditis 135.0
174 Osteoporosis 134.0
175 Abetalipoproteinemia 134.0
176 Balanitis 133.0
177 Chronic liver disease 131.0
178 Autoimmune hemolytic anemia 130.0
179 Pharyngitis 130.0
180 STI HIV Pharyngitis 130.0
181 Herpes pharyngitis 130.0
182 Acute Rhinosinusitis 130.0
183 Allergic rhinitis 130.0
184 Insomnia in adults 130.0
185 Acute viral rhinosinusitis 130.0
186 Aortic coarctation 128.0
187 Stroke 127.0
188 Ischemic optic neuropathy 126.0
189 posteriorischemic optic neuropathy 126.0
190 Clostridium difficile infection 126.0
191 Graves ophthalmopathy 124.0
192 Insect bites and stings 124.0
193 Anaphylaxis 124.0
194 Meckel diverticulum 123.0
195 Endometritis 122.0
196 Familial adenomatous polyposis syndrome 121.0
197 Ruptured ectopic pregnancy 121.0
198 Autosomal Recessive Polycystic Kidney Disease 120.0
199 Erectile dysfunction 120.0
200 Acalculous Cholecystitis 119.0
201 Parkinson disease 118.0
202 chronic acalculous cholecystitis 118.0
203 Food poisoning 118.0
204 Panic disorder in adults 118.0
205 Non-ST-elevation myocardial infarction 117.0
206 Acute heart failure 116.0
207 Hyperosmolar Hyperglycemic state 115.0
208 Acute bacterial meningitis in neonates 115.0
209 Choledochal Cyst 115.0
210 Clonorchiasis 114.0
211 ST-elevation myocardial infarction 113.0
212 Primary ciliary dyskinesia 112.0
213 Kartagener syndrome 112.0
214 Intestinal Pseudo Obstruction 112.0
215 Cholera 111.0
216 Intrahepatic cholestasis of pregnancy 111.0
217 Hiatus hernia 110.0
218 Acute pericarditis 109.0
219 Systemic vasculitis 108.0
220 Pancreatic Pseudocyst 107.0
221 Henoch-Schonlein purpura 107.0
222 Peptic Ulcer 107.0
223 Influenza 106.0
224 Ovarian and fallopian tube torsion 106.0
225 Annular pancreas 104.0
226 chronic cholestatic liver disease 103.0
227 Autosomal Dominant Polycystic Kidney Disease 103.0
228 Acute Bacterial Prostatitis 102.0
229 Anthrax 101.0
230 Anaplastic thyroid cancer 100.0
231 Foreign body ingestion 100.0
232 Budd Chiari Syndrome 99.0
233 Herpes zoster 99.0
234 Cellulitis 99.0
235 Lung Cancer 96.0
236 Chronic fatigue syndrome 95.0
237 Sigmoid volvulus 95.0
238 Bladder Cancer 94.0
239 Peritoneal dialysis associated peritonitis 94.0
240 Acute disseminated encephalomyelitis 94.0
241 Stable ischemic heart disease 94.0
242 Ileus 94.0
243 Gastrointestinal Hemorrhage 91.0
244 Lower gastrointestinal hemorrhage 91.0
245 Upper gastrointestinal hemorrhage 91.0
246 Bullous pemphigoid 91.0
247 Acute Cholangitis 91.0
248 Hypoparathyroidism 90.0
249 Malt lymphoma 90.0
250 Ascites 88.0
251 Acute Mitral regurgitation 88.0
252 Abnormal uterine bleeding 88.0
253 Chronic atrial fibrillation 88.0
254 Nasal polyps 88.0
255 Labyrinthitis 88.0
256 Non-cholera Vibrio infections 88.0
257 Osteomalacia 88.0
258 Multiple endocrine neoplasia 2B 87.0
259 Unstable angina 86.0
260 Kawasaki disease 85.0
261 Gallstones 84.0
262 Acute otitis media 82.0
263 Pseudohypoparathyroidism 82.0
264 Multiple endocrine neoplasia 2A 82.0
265 Intra-abdominal abscess 82.0
266 Gastric Outlet Obstruction 82.0
267 Sunburn 81.0
268 Stevens-Johnson syndrome 81.0
269 subserosal eosinophilic gastroenteritis 80.0
270 Ruptured Tuboovarian abscess 80.0
271 Subdural hematoma 80.0
272 Aortic Dissection 79.0
273 Primary hypogonadism 79.0
274 Secondary hypogonadism 79.0
275 Acne fulminans 78.0
276 Diabetes Mellitus 78.0
277 Psoriasis 76.0
278 Gastroesophageal reflux disease 75.0
279 Periorbital and orbital cellulitis 75.0
280 Familial Mediterranean fever 75.0
281 Ovarian Torsion 74.0
282 Hypertriglyceridemia 73.0
283 Chronic Lymphocytic Leukemia 72.0
284 Psoas Abscess 72.0
285 Liver Abscess 71.0
286 Empyema 70.0
287 Eclampsia 70.0
288 Genital herpes 70.0
289 Charcot-Marie-Tooth Disease 70.0
290 Intestinal Entamoeba histolytica amebiasis 70.0
291 Fungal meningitis 70.0
292 Common cold(adults) 68.0
293 Atopic dermatitis 68.0
294 Guillain-Barre syndrome 68.0
295 COVID19 67.0
296 Urinary Tract Obstruction 66.0
297 Eosinophilic gastroenteritis 65.0
298 Endometrial cancer 65.0
299 Miliaria 65.0
300 Gallbladder Dyskinesia 65.0
301 Sphincter of Oddi Dysfunction 65.0
302 biliary SOD 65.0
303 pancreatic SOD 65.0
304 Renal Artery Stenosis 64.0
305 Musculoskeletal sprains and strains 64.0
306 Pityriasis rosea 64.0
307 Ectopic Pregnancy 63.0
308 Inguinal hernia 63.0
309 Zollinger-Ellison Syndrome 62.0
310 Prolactinoma 62.0
311 Psychogenic polydipsia 62.0
312 Rotator Cuff Tears 61.0
313 Pyelonephritis 61.0
314 Osteomyelitis 60.0
315 Asthma 60.0
316 Deep venous thrombosis 60.0
317 Renal Cell Carcinoma 58.0
318 Type 2 Diabetes mellitus 58.0
319 Acute respiratory failure 57.0
320 Varicose veins 57.0
321 Angiodysplasia of the colon 56.0
322 Toxic thyroid adenoma 56.0
323 Common cold(children) 55.0
324 Heparin-induced thrombocytopenia 55.0
325 Angle Closure Glaucoma 55.0
326 Croup 54.0
327 Rotor syndrome 52.0
328 Menopause 52.0
329 Papilledema 51.0
330 Preeclampsia 50.0
331 Breast Cancer 50.0
332 Paraneoplastic Syndromes 48.0
333 Abdominal compartment syndrome 48.0
334 Gingivitis 48.0
335 Kidney stones 46.0
336 Hypogammaglobulinemia 45.0
337 Diabetic Neuropathy 45.0
338 Vulvovaginal candidiasis 45.0
339 biliary colic 44.0
340 Portal hypertension 43.0
341 Acute peritonitis 43.0
342 Gastric Volvulus 43.0
343 Exocrine pancreatic insufficiency 43.0
344 Gallbladder Empyema 42.0
345 Tinea versicolor 42.0
346 Candidal intertrigo 42.0
347 Meniere disease 40.0
348 Hemorrhoids 39.0
349 Mallory-Weiss syndrome 39.0
350 Testicular cancer 35.0
351 Leiomyomas 34.0
352 Prinzmetal angina 34.0
353 Alzheimer disease 33.0
354 Pelvic inflammatory disease 32.0
355 Splenic Infarction 32.0
356 Achalasia 31.0
357 Acute pelvic inflammatory disease 31.0
358 Gout 31.0
359 Chlamydia pneumoniae infection 30.0
360 Drowning 30.0
361 Male factor infertility 30.0
362 Simple kidney cyst 30.0
363 Bacterial conjunctivitis 29.0
364 Viral conjunctivitis 29.0
365 Substernal goiter 29.0
366 Atypical pneumonia 29.0
367 Laryngeal Cancer 29.0
368 Myasthenia Gravis 29.0
369 Neonatal Myasthenia Gravis 29.0
370 Congenital Myasthenic Syndromes 29.0
371 biliary obstruction 28.0
372 chronic biliary obstruction 28.0
373 Blepharitis 28.0
374 Nephrogenic diabetes insipidus 27.0
375 Central diabetes insipidus 27.0
376 Alopecia areata 27.0
377 Endometriosis 26.0
378 Extrahepatic Cholestasis 26.0
379 Disseminated intravascular coagulation 24.0
380 Erythema nodosum 23.0
381 Animal bites 22.0
382 Medullary thyroid cancer 22.0
383 Umbilical hernia 22.0
384 Rumination Syndrome 21.0
385 Limited cutaneous systemic sclerosis 19.0
386 Splenic abscess 19.0
387 Cholestasis 19.0
388 Intrahepatic Cholestasis 19.0
389 Keloid 19.0
390 Acute atrial fibrillation 18.0
391 Psoriatic arthritis 18.0
392 Chronic Cholecystitis 18.0
393 Phenylketonuria 18.0
394 Pulmonary Embolism 16.0
395 Pressure ulcer 16.0
396 Dacryocystitis 15.0
397 Epiploic appendagitis 15.0
398 Dystonia 15.0
399 Benign Prostatic Hyperplasia 14.0
400 Intestinal malrotation 14.0
401 Thyroid lymphoma 12.0
402 Diabetic Amyotrophy 12.0
403 Ruptured ovarian cyst 12.0
404 Von willebrand disease 12.0
405 Bed bugs 12.0
406 Amebiasis 11.0
407 Dubin-Johnson syndrome 10.0
408 Acute Bronchitis 9.0
409 Immune thrombocytopenia 9.0
410 Rosacea 9.0
411 Acute cervical spine trauma 6.0
412 Cryptorchidism 4.0
413 Dermatophyte infections 3.0
414 endocarditis 1.0
415 Acute Cystitis(Men) 0.0
416 Carpal Tunnel Syndrome 0.0
417 Bell palsy 0.0
418 Penis Carcinoma 0.0
419 Optic neuritis 0.0
420 Neuropapillitis 0.0
421 Discogenic low back pain 0.0
422 Orthostatic hypotension 0.0
423 Pulmonary regurgitation 0.0
424 Tetanus 0.0
425 Recurrent aphthous stomatitis 0.0
426 Conjunctivitis 0.0
427 Epidemic keratoconjunctivitis 0.0
428 Allergic conjunctivitis 0.0
429 Ligneous conjunctivitis 0.0
430 Vernal keratoconjunctivitis 0.0
431 Atopic keratoconjunctivitis 0.0
432 Noninfectious nonallergic conjunctivitis 0.0
433 Acute epididymitis 0.0
434 Transient ischemic attack 0.0
435 Androgenetic alopecia 0.0
436 Vitamin B12 and folate deficiencies 0.0
437 Hodgkin lymphoma 0.0
438 Temporomandibular joint syndrome 0.0