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A 56-year-old male with a remote history of intravenous drug use

56 years old | Male

Vignette:

A 56-year-old male with a remote history of intravenous drug use presents to an initial visit complaining of increased abdominal girth but denies jaundice. He drinks about 2 to 4 glasses of wine with dinner and recalls having had abnormal liver enzymes in the past. Physical exam reveals spider nevi, a palpable firm liver, mild splenomegaly, and shifting dullness consistent with the presence of ascites. Liver function is found to be deranged with elevated aminotransferases (aspartate aminotransferase [AST]: 90 U/L, alanine aminotransferase [ALT]: 87 U/L), and the patient is positive for anti-hepatitis C antibody.

Summary:

intravenous drug use | increased abdominal girth | alcohol | abnormal liver enzymes | spider nevi | palpable firm liver | splenomegaly | shifting dullness | ascites | elevated aminotransferases | elevated AST | elevated ALT | hepatitis C

Dx:

Liver Cirrhosis Biliary Cirrhosis Primary Biliary Cirrhosis

Ref:

https://online.epocrates.com/diseases/27822/Cirrhosis/Common-Vignette

Rank

Disease

Weight

1 Primary sclerosing cholangitis 723.0
2 Liver Cirrhosis 695.0
3 Biliary cirrhosis 679.0
4 Primary biliary cirrhosis 630.0
5 Autoimmune hepatitis 570.0
6 Alcoholic hepatitis 556.0
7 Chronic Hepatitis 508.0
8 Alcoholic Liver Cirrhosis 485.0
9 Hepatocellular carcinoma 484.0
10 Alcoholic Liver Disease 444.0
11 Alcoholic Fatty Liver 419.0
12 Gallstone pancreatitis 409.0
13 Acute Liver Failure 376.0
14 Hereditary hemochromatosis 358.0
15 Infectious mononucleosis 355.0
16 Cholangiocarcinoma 315.0
17 chronic acalculous cholecystitis 311.0
18 Klebsiella pneumoniae liver abscess 301.0
19 Tuberculous Peritonitis 296.0
20 Wilson disease 277.0
21 Acute intermittent porphyria 277.0
22 Hepatic Encephalopathy 276.0
23 Non-alcoholic Fatty Liver Disease 274.0
24 Ovarian Hyperstimulation Syndrome 274.0
25 Celiac Disease 268.0
26 Common cutaneous drug reactions 268.0
27 Budd Chiari Syndrome 266.0
28 Eclampsia 257.0
29 Acute Hepatitis 256.0
30 Chronic liver disease 252.0
31 Hepatorenal Syndrome 246.0
32 Pyogenic Liver Abscess 243.0
33 Primary Myelofibrosis 242.0
34 Acute Cholangitis 241.0
35 Liver disease 222.0
36 Breast Cancer 220.0
37 Choledocholithiasis 217.0
38 Acalculous Cholecystitis 210.0
39 Autosomal Recessive Polycystic Kidney Disease 205.0
40 Intrahepatic Cholestasis 204.0
41 Hemolytic uremic syndrome 201.0
42 biliary SOD 201.0
43 Gallbladder Dyskinesia 200.0
44 Graves Disease 199.0
45 Chronic atrial fibrillation 197.0
46 Crohn Disease 194.0
47 Acute heart failure 193.0
48 Familial Mediterranean fever 191.0
49 Non-small cell lung cancer 186.0
50 Acute Pancreatitis 179.0
51 Sarcoidosis 179.0
52 Acute Lymphocytic Leukemia in Adults 178.0
53 Autoimmune Pancreatitis 172.0
54 Acute fatty liver of pregnancy 172.0
55 Extraintestinal Entamoeba histolytica amebiasis 171.0
56 Malaria 168.0
57 Acetaminophen overdose 167.0
58 Gastritis 166.0
59 Kawasaki disease 166.0
60 Osteoporosis 163.0
61 Hereditary Angioedema 160.0
62 Systemic lupus erythematosus 159.0
63 Acute Lymphoblastic leukemia in children 159.0
64 Hypertriglyceridemia 158.0
65 Food poisoning 156.0
66 Systemic sclerosis 154.0
67 Foreign body ingestion 153.0
68 Inflammatory Bowel Diseases 151.0
69 Hyperthyroidism 151.0
70 Preeclampsia 151.0
71 Chronic Lymphocytic Leukemia 150.0
72 Typhoid infection 149.0
73 Mesenteric ischemia 146.0
74 Acute viral meningitis 145.0
75 Hyperprolactinemia 144.0
76 Brucellosis 143.0
77 Toxic Megacolon 142.0
78 Cystic Fibrosis 142.0
79 Ovarian Cancer 140.0
80 Ulcerative Colitis 139.0
81 Spontaneous bacterial peritonitis 139.0
82 Portal hypertension 138.0
83 Colorectal cancer 137.0
84 Intrahepatic cholestasis of pregnancy 137.0
85 Intestinal Obstruction 135.0
86 Psoas Abscess 134.0
87 Premenstrual syndrome 132.0
88 Mirizzi Syndrome 132.0
89 Pulmonary Embolism 131.0
90 Chronic Pancreatitis 130.0
91 Cholestasis 130.0
92 Short bowel syndrome 128.0
93 Sigmoid volvulus 125.0
94 Acute Myeloid Leukemia in children 125.0
95 Hypothyroidism 124.0
96 Ascites 124.0
97 Rocky Mountain spotted fever 124.0
98 Peutz-Jeghers Syndrome 123.0
99 Polyarteritis nodosa 123.0
100 Gallstones 122.0
101 Papillary thyroid cancer 120.0
102 Oropharyngeal cancer 119.0
103 Amebic Liver Abscess 115.0
104 Acute bacterial meningitis in adults 110.0
105 chronic biliary obstruction 110.0
106 Leiomyomas 108.0
107 Renal Cell Carcinoma 108.0
108 Toxic thyroid adenoma 108.0
109 Anthrax 107.0
110 Muscle Layer Eosinophilic gastroenteritis 101.0
111 Gallbladder cancer 101.0
112 Laryngeal Cancer 101.0
113 Bruxism 101.0
114 Adrenocortical carcinoma 100.0
115 Umbilical hernia 100.0
116 Ruptured ectopic pregnancy 99.0
117 Lung Cancer 96.0
118 Clostridium difficile infection 95.0
119 Prinzmetal angina 95.0
120 Shigellosis 94.0
121 subserosal eosinophilic gastroenteritis 93.0
122 Deep venous thrombosis 93.0
123 Giardiasis 92.0
124 Abdominal compartment syndrome 91.0
125 Acute Cholecystitis 90.0
126 Acute peritonitis 88.0
127 pancreatic SOD 88.0
128 Atypical pneumonia 88.0
129 Salmonella infection 87.0
130 pancreatic cancer 86.0
131 Dyspepsia 85.0
132 Extrahepatic Cholestasis 84.0
133 Glomerulonephritis 84.0
134 Bacterial pharyngitis 83.0
135 Chronic Myeloid Leukemia 79.0
136 Chronic Mitral regurgitation 78.0
137 Osteomalacia 78.0
138 Gastroparesis 77.0
139 Familial adenomatous polyposis syndrome 75.0
140 Emphysematous cholecystitis 74.0
141 Chronic heart failure 74.0
142 Pneumonia 73.0
143 Acute bacterial meningitis in children 72.0
144 Chronic Clonorchiasis 72.0
145 Non-cholera Vibrio infections 71.0
146 Amyloidosis 71.0
147 Drowning 71.0
148 Eosinophilic gastroenteritis 70.0
149 mucosal Eosinophilic gastroenteritis 70.0
150 Chronic Cholecystitis 70.0
151 Viral pharyngitis 70.0
152 Graves ophthalmopathy 69.0
153 Osteomyelitis 68.0
154 Painless thyroiditis 68.0
155 Chronic Kidney Diseases 68.0
156 Acute peptic ulcer 67.0
157 Lactose intolerance 66.0
158 Rheumatoid Arthritis 66.0
159 Gestational diabetes mellitus 66.0
160 Ileus 65.0
161 Gastric Outlet Obstruction 65.0
162 Mitral Stenosis 65.0
163 Non-diabetic hypoglycemia 65.0
164 Primary hypogonadism 63.0
165 Infertility in women 63.0
166 Meckel diverticulum 62.0
167 Clonorchiasis 61.0
168 Mallory-Weiss syndrome 60.0
169 Thrombotic thrombocytopenic purpura 58.0
170 Campylobacter infection 57.0
171 Testicular cancer 56.0
172 Intraperitoneal bleeding 53.0
173 biliary obstruction 53.0
174 Anemia of chronic disease 53.0
175 Diverticulitis 52.0
176 Gastric cancer 52.0
177 Foodborne E coli infection 52.0
178 Intussusception 51.0
179 Cellulitis 50.0
180 Intestinal Pseudo Obstruction 50.0
181 Endometrial cancer 50.0
182 Travelers diarrhea 50.0
183 Hypogammaglobulinemia 50.0
184 Cataract 50.0
185 Psoriasis 50.0
186 Alzheimer disease 50.0
187 Hyperosmolar Hyperglycemic state 50.0
188 Insomnia in adults 50.0
189 Addison Disease 50.0
190 Splenic abscess 50.0
191 Splenic Rupture 50.0
192 Ankylosing spondylitis 48.0
193 Fungal meningitis 47.0
194 Cryptococcosis 47.0
195 Ovarian Torsion 46.0
196 Guillain-Barre syndrome 45.0
197 Heparin-induced thrombocytopenia 45.0
198 Kidney stones 45.0
199 COVID19 44.0
200 Inguinal hernia 44.0
201 Acute pericarditis 43.0
202 Autosomal Dominant Polycystic Kidney Disease 41.0
203 Acute disseminated encephalomyelitis 41.0
204 Gastric Volvulus 40.0
205 End Stage Renal Disease 40.0
206 Renal and perinephric abscess 40.0
207 Acute Appendicitis 39.0
208 Irritable Bowel Syndrome 37.0
209 Acute Clonorchiasis 37.0
210 Gingivitis 37.0
211 Chronic Renal vein thrombosis 36.0
212 Hyperparathyroidism 36.0
213 Malt lymphoma 35.0
214 Hiatus hernia 34.0
215 Acute perforated appendicitis 34.0
216 Urinary Tract Obstruction 34.0
217 Intestinal malrotation 34.0
218 Exocrine pancreatic insufficiency 34.0
219 Gout 34.0
220 Hypoparathyroidism 34.0
221 Rosacea 34.0
222 Acute respiratory failure 34.0
223 Prolactinoma 33.0
224 Central retinal artery occlusion 32.0
225 Acromegaly 32.0
226 Subdural hematoma 32.0
227 Splenic Infarction 32.0
228 Liver Abscess 31.0
229 Secondary hypogonadism 31.0
230 Type 2 Diabetes mellitus 30.0
231 Acne fulminans 30.0
232 Immune thrombocytopenia 29.0
233 Phenylketonuria 28.0
234 Hyperaldosteronism 28.0
235 Pressure ulcer 27.0
236 Abnormal uterine bleeding 27.0
237 Menopause 26.0
238 Diabetes Mellitus 25.0
239 Type 1 Diabetes mellitus 25.0
240 Chronic pelvic pain in women 25.0
241 Psychogenic polydipsia 25.0
242 Transient ischemic attack 25.0
243 Intestinal Entamoeba histolytica amebiasis 24.0
244 Influenza 24.0
245 Pseudohypoparathyroidism 24.0
246 Gastroesophageal reflux disease 23.0
247 Pancreatic Pseudocyst 23.0
248 Aseptic meningitis 23.0
249 Goiter 23.0
250 Diffuse nontoxic goiter 23.0
251 Toxic multinodular goiter 23.0
252 Obstructive cervical goiters 23.0
253 Cervical goiter 23.0
254 Peptic Ulcer 22.0
255 Duodenal Ulcer 22.0
256 Gastric Ulcer 22.0
257 Acute Myeloid Leukemia in adults 22.0
258 Abetalipoproteinemia 20.0
259 Epilepsy 20.0
260 Sexual abuse and assault 20.0
261 Central diabetes insipidus 20.0
262 Recurrent aphthous stomatitis 20.0
263 Gilbert syndrome 19.0
264 Animal bites 18.0
265 Achalasia 18.0
266 Diabetic Kidney Disease 18.0
267 Annular pancreas 17.0
268 Diabetic Ketoacidosis 17.0
269 Cushing syndrome 17.0
270 Acute atrial fibrillation 16.0
271 ST-elevation myocardial infarction 16.0
272 Diabetic Neuropathy 15.0
273 Anaphylaxis 15.0
274 Stroke 15.0
275 Premature labor 15.0
276 Male factor infertility 15.0
277 Optic neuritis 14.0
278 Neuropapillitis 14.0
279 Acute bacterial meningitis in neonates 14.0
280 Amphetamine use disorder 14.0
281 Multiple endocrine neoplasia 2B 13.0
282 Hypercalcemia 13.0
283 Cholera 13.0
284 Disseminated intravascular coagulation 13.0
285 Granulomatosis with polyangiitis 13.0
286 Insect bites and stings 13.0
287 Acute cervical spine trauma 13.0
288 Analgesic nephropathy 12.0
289 Multiple Myeloma 12.0
290 COPD Exacerbation 12.0
291 Ichthyosis 12.0
292 anterior ischemic optic neuropathy 11.0
293 Ischemic stroke 11.0
294 Discogenic low back pain 11.0
295 Bullous pemphigoid 11.0
296 Intra-abdominal abscess 10.0
297 Dubin-Johnson syndrome 10.0
298 Henoch-Schonlein purpura 8.0
299 Common cold(adults) 8.0
300 Psoriatic arthritis 8.0
301 Thyroid lymphoma 8.0
302 Anaplastic thyroid cancer 8.0
303 Herpes zoster 7.0
304 Non-ST-elevation myocardial infarction 7.0
305 Hemorrhagic stroke 6.0
306 Acute Bronchitis 5.0
307 Alopecia areata 5.0
308 Periorbital and orbital cellulitis 3.0
309 Multiple Sclerosis 2.0
310 Bed bugs 2.0
311 Migraine headache in adults 2.0
312 endocarditis 2.0
313 Musculoskeletal lower back pain 0.0
314 Allergic rhinitis 0.0
315 Bell palsy 0.0
316 Stevens-Johnson syndrome 0.0
317 Hodgkin lymphoma 0.0
318 Measles 0.0
319 Visceral leishmaniasis 0.0
320 Pulmonary regurgitation 0.0
321 Parkinson disease 0.0