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Possible Diagnoses
Cholangiocarcinoma
Cholangiocarcinoma
Jaundice
Painless jaundice
Pruritus
Associated with primary sclerosing cholangitis
Pale stool
Right upper quadrant pain
Hepatomegaly
Courvoisiers sign
Fever
Palpable gallbladder
Biliary obstruction
Intermittent jaundice
Symptoms of obstructive jaundice
Constant dull ache
Abdominal pain
Weight loss
Triad of cholestasis and abdominal pain and weight loss
Abdominal mass
Anorexia
Declining performances status
Cholangitis
Acute cholangitis
Charcots triad
Fever
Jaundice
Right upper quadrant pain
Abdominal pain
Biliary pain
Pruritus
Rigors
Right upper quadrant tenderness
Altered mental status
Hypotension
Diffuse right upper quadrant pain
Vague pain
Mental confusion
Severe toxicity
Chills
Reynolds pentad
Sepsis
Confusion
Metabolic acidosis
Intrahepatic cholestasis
Intrahepatic cholestasis
Pruritus
Liver disease
Liver disease
Fatigue
Increased need for sleep
Lack of stamina
Lethargy
Listlessness
Malaise
Poor energy
Weakness
Abdominal distention
Afternoon fatigue
Fatigue after activity
Intestinal bleeding
Itching
Nausea
Poor appetite
Right upper quadrant pain
Intermittent fatigue
Abdominal pain
Bloating
Gynecomastia
Hepatitis
Autoimmune hepatitis
Hepatomegaly
Spider angiomata
Small joints arthralgia
Itching
Nausea
Anorexia
Fatigue
Malaise
Abdominal discomfort
Arthralgias
Fever
Splenomegaly
Gastrointestinal bleeding
Jaundice
Cardiac dysrhythmias
Cardiovascular disease
Chronic disease
Chronic medical illnesses
Diastolic blood pressure
Diastolic hypertension
Crohn disease
Crohn disease
Abdominal tenderness
Perianal skin tag
Sinus tracts
Abdominal pain
Diarrhea
Abdominal mass
Recurrence after surgery
Response to antibiotics
Prolonged diarrhea
Chronic diarrhea
Tender mass is palpable
Fever
Fatigue
Weight loss
Episodes of colonic obstruction
Episodes of small bowel obstruction
Frequently right lower quadrant pain
Crampy abdominal pain
Right lower quadrant mass
Pain relieved by defecation
Common cutaneous drug reactions
Common cutaneous drug reactions
Symmetric eruption of flat-topped erythematous papules
Symmetric eruption of flat-topped violaceous papules
Drug intolerance
Fixed drug reactions
Photoallergic reactions
Phototoxic reactions
Hepatitis
Jaundice
Triggered by antibiotics
Triggered by blood products
Triggered by inhaled mucolytics
Predictable reactions
Morbilliform eruption
Well-demarcated oval dusky black macules
Fever
Lymphadenopathy
Fixed drug eruptions
Stevens-johnson syndrome
Toxic epidermal necrolysis
Diffuse lymphadenopathy
Pityriasis rosea
Pityriasis rosea
Herald patch
Itching
Mother patch
Single oval sharply delimited pink lesion on the back
Single oval sharply delimited pink lesion on the chest
Single oval sharply delimited pink lesion on the neck
Single oval sharply delimited salmon-colored lesion on the back
Single oval sharply delimited salmon-colored lesion on the neck
Single round sharply delimited pink lesion on the back
Single round sharply delimited pink lesion on the chest
Single round sharply delimited pink lesion on the neck
Single round sharply delimited salmon-colored lesion on the chest
Single round sharply delimited salmon-colored lesion on the neck
Fir tree distribution
Christmas tree distribution
Eruption spreads centrifugally
Eruption spreads from the top down
Lesion begins to clear centrally
Lesion soon becomes scaly
Oval lesions on the trunk
Cirrhosis
Primary biliary cirrhosis
Malignancy
Portal hypertension
Urinary tract infection
Anesthesia
Burning sensation in extremities
Crawling sensation in extremities
Creeping sensation in extremities
Increased need for sleep
Lack of stamina
Lethargy
Listlessness
Numbness sensation in extremities
Paresthesia in entire hand
Paresthesia in wrist
Poor energy
Significant fatigue
Somatosensory symptoms
Symptoms of temporal lobe seizures
Tingling sensation in extremities
Concentration impairment
Liver cirrhosis
Anesthesia
Increased need for sleep
Lack of stamina
Lethargy
Listlessness
Neurological manifestations
Poor energy
Symptoms of temporal lobe seizures
Abdominal swelling
Decreased libido
Jaundice
Muscle wasting
Splenomegaly
Weight loss
Palmar erythema
Spider angiomas
Fatigue
Weakness
Abdominal distention
Afternoon fatigue
Extrahepatic cholestasis
Extrahepatic cholestasis
Pruritus
Ascending cholangitis
Jaundice
Right upper quadrant discomfort
Circulatory collapse
Sepsis
Gallbladder cancer
Gallbladder cancer
Anorexia
Nausea
Vomiting
Abdominal pain
Pruritus
Weight loss
Jaundice
Malaise
Resemble cholecystitis
Palpable mass
Ascites
Extraabdominal metastases
Hepatomegaly
Paraneoplastic syndromes
Generalized Pruritus
H/PE
Skin lesions
Consider: Xerosis(dry skin), Atopic dermatitis, Scabies... see Description...
Diagnostic Tests: Skin Biopsy Scabies Preparation Urticaria Workup (see Urticaria)
No skin lesions
Xerosis, Irritant induced, Allergic contact dermatitis
Diagnostic tests
Chest radiography
Abnormal
Consider: Hodgkin’s disease, Carcinoma
Hemogram
Abnormal
Consider: Polycythemia vera, Leukemia, Myeloma, Iron deficiency
Liver function panel
Abnormal
Consider: Biliary cirrhosis, Drug-related condition, Biliary obstruction
Glucose tolerance test
Abnormal
Diabetes mellitus
Thyroid function tests
Abnormal
Consider: Thyrotoxicosis, Hypothyroidism
BUN/creatinine
Abnormal
Renal failure
Complete laboratory profile
Normal
Consider: Psychogenic pruritus, Drug reaction, Carcinoma
Jaundice
H / PE / Lab
Alkaline phosphatase or aminotransferases elevated?
No
Evaluate for hemolysis, hereditary hyperbilirubinemia
Yes
Biliary tract obstruction a consideration?
No
Biochemical studies for specific causes of liver disease
Observe, consider liver biopsy
Yes
Abdominal ultrasound or CT
Nondilated bile ducts
Clinical likelihood of biliary obstruction
Low
Biochemical studies for specific causes of liver disease
Observe, consider liver biopsy
Intermediate
Consider MRCP or EUS
Nondilated bile ducts
Dilated bile ducts
High
ERCP or THC
Biochemical studies for specific causes of liver disease
Biliary obstruction
Dilated bile ducts
ERCP or THC
Biochemical studies for specific causes of liver disease
Observe, consider liver biopsy
Biliary obstruction
Therapeutic intervention