Sandbox:Jaundice: Difference between revisions
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(Created page with "==Differential diagnosis== <span style="font-size:85%">'''Abbreviations:''' '''RUQ'''= Right upper quadrant of the abdomen, '''LUQ'''= Left upper quadrant, '''LLQ'''= Left...") |
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==Differential diagnosis== | {{CMG}}; {{AE}} {{MJ}} | ||
==Differential diagnosis of jaundice== | |||
<span style="font-size:85%">'''Abbreviations:''' | <span style="font-size:85%">'''Abbreviations:''' | ||
'''[[RUQ]]'''= Right upper quadrant of the abdomen | '''[[RUQ]]'''= Right upper quadrant of the abdomen, '''LFT'''= Liver function test, SIRS= [[Systemic inflammatory response syndrome]], '''[[ERCP]]'''= [[Endoscopic retrograde cholangiopancreatography]], '''N'''= Normal, '''AMA'''= Anti mitochondrial antibodies, '''[[LDH]]'''= [[Lactate dehydrogenase]], '''GI'''= Gastrointestinal, '''CT'''= [[Computed tomography]]</span><br> | ||
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{| align="center" | {| align="center" | ||
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{| style="border: 0px; font-size: 90%; margin: 3px;" align="center" | {| style="border: 0px; font-size: 90%; margin: 3px;" align="center" | ||
! colspan=" | ! colspan="2" rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Classification of jaundice based on etiology | ||
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Disease | ! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Disease | ||
! colspan="8" align="center" style="background:#4479BA; color: #FFFFFF;" | | ! colspan="4" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |History and clinical manifestations | ||
! colspan=" | ! colspan="8" align="center" style="background:#4479BA; color: #FFFFFF;" |Diagnosis | ||
! rowspan=" | |- | ||
! colspan="6" align="center" style="background:#4479BA; color: #FFFFFF;" |Lab Findings | |||
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Other blood tests | |||
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Other diagnostic | |||
|- | |- | ||
! colspan=" | ! rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |Family history | ||
! colspan=" | ! align="center" style="background:#4479BA; color: #FFFFFF;" |Fever | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" |RUQ Pain | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Pruritis | |||
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |AST | |||
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |ALT | |||
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |ALK | |||
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |BLR Indirect | |||
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |BLR Direct | |||
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |Viral serology | |||
|- | |- | ||
! | ! rowspan="25" align="center" style="background:#4479BA; color: #FFFFFF;" |Jaundice | ||
! align="center" style="background:# | ! colspan="1" rowspan="7" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Hepatocellular Jaundice | ||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Hemochromatosis | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑/N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑/N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Ferritin ↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Liver biopsy | |||
|- | |- | ||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Wilson's disease | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑/N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Serum cerulloplasmin ↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Liver biopsy | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Viral hepatitis | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑/N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Specific viral antibody for each type | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Alcoholic hepatitis | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑/N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Drug induced hepatitis | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑/N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Autoimmune hepatitis | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑/N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Anti-LKM antibody | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Liver biopsy | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Cirrhosis | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑/N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑/N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑/N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Low platelet | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Small liver on ultrasound | |||
|- | |||
! rowspan="6" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Cholestatic Jaundice | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Common bile duct stone | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Dilated ducts on ultrasound | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |CT/ERCP | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Hepatitis A cholestatic type | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |HAV- AB | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Abdominal ultrasound | ||
|- | |- | ||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | | | colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |EBV / CMV hepatitis | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Positive serology | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |- | |||
|- | |- | ||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | | | colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Primary biliary cirrhosis | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N/↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N/↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |AMA positive | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Liver biopsy | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Primary sclerosing cholangitis | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N/↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N/↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Beading on MRCP | |||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Liver biopsy | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | |||
|- | |- | ||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | | | colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Pancreatic carcinoma | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N/↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N/↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Mass on ultrasound | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |CT scan for diagnosis | |||
|- | |- | ||
! rowspan="11" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Isolated Jaundice | |||
| | | colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Crigler-Najjar type 2 | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" align="center" |Genetic testing | |||
|- | |- | ||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | | | colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Gilbert | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" align="center" |Genetic testing | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Rotor syndrome | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Genetic testing | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Liver biopsy | |||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | |||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | |||
|- | |- | ||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | | | colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Dubin-Johnson syndrome | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Genetic testing | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Liver biopsy | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Hereditory spherocytosis | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Genetic testing | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Osmotic fragility | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |G6PD deficiency | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" align="center" |Genetic testing | |||
|- | |- | ||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Thalassemia | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" align="center" |Genetic testing | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Sickle cell disease | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" align="center" |Genetic testing | |||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" | | | colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Paroxismal nocturnal hemoglobinoria | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | colspan="2" style="padding: 5px 5px; background: #F5F5F5;" align="center" |Flocytometery | ||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Immune hemolysis | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| colspan="2" style="padding: 5px 5px; background: #F5F5F5;" align="center" |Autoantibodies | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Hematoma | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Anemia | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Truma or surgery in history | |||
|- | |||
|} | |||
|} | |||
'''The differential diagnosis for jaundice and pruritis are:''' | |||
{| align="center" | |||
|- | |||
| | |||
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center" | |||
| rowspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" |Disease | |||
! colspan="3" rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |History and clinical manifestations | |||
! colspan="8" align="center" style="background:#4479BA; color: #FFFFFF;" |Diagnosis | |||
|- | |||
! colspan="6" align="center" style="background:#4479BA; color: #FFFFFF;" |Lab Findings | |||
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Other blood tests | |||
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Other diagnostic | |||
|- | |- | ||
! colspan="1" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |AST | |||
! colspan="1" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |ALT | |||
! colspan="1" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |ALK | |||
! colspan="1" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |BLR Indirect | |||
! colspan="1" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |BLR Direct | |||
! colspan="1" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Viral serology | |||
|- | |- | ||
| | | align="center" style="background:#4479BA; color: #FFFFFF;" |Type of jaundice | ||
| align="center" style="background:#4479BA; color: #FFFFFF;" |Pruritis | |||
| align="center" style="background:#4479BA; color: #FFFFFF;" |Family history | |||
| | |||
| | |||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" | | | colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Common bile duct stone | ||
! rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" align="center" | '''Cholestatic Jaundice''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Dilated ducts on sono | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |CT/ERCP | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Hepatitis A cholestatic type | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |HAV- AB | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Abdominal ultrasound | ||
|- | |- | ||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |EBV / CMV hepatitis | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Positive serology | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |PCR or ELISA | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Primary biliary cirrhosis | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N/↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N/↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |AMA positive | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Liver biopsy | |||
|- | |- | ||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | | | colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Primary sclerosing cholangitis | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N/↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N/↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Beading on MRCP | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Liver biopsy | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | |- | ||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Autoimmune hepatitis | |||
| rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" align="center" |'''Hepatocellular Jaundice''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑/N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Anti-LKM antibody | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Liver biopsy | |||
|- | |||
|} | |||
|} | |||
'''The differential diagnosis for jaundice, pruritis and RUQ pain are:''' | |||
{| align="center" | |||
|- | |||
| | |||
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center" | |||
! rowspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" |Disease | |||
! colspan="5" rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |History and clinical manifestations | |||
! colspan="8" align="center" style="background:#4479BA; color: #FFFFFF;" |Diagnosis | |||
|- | |||
! colspan="6" align="center" style="background:#4479BA; color: #FFFFFF;" |Lab Findings | |||
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Other blood tests | |||
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Other diagnostic | |||
|- | |- | ||
! colspan="1" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |AST | |||
! colspan="1" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |ALT | |||
! colspan="1" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |ALK | |||
! colspan="1" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |BLR Indirect | |||
! colspan="1" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |BLR Direct | |||
! colspan="1" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Viral serology | |||
|- | |- | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Type of jaundice | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Pruritis | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |RUQ pain | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Fever | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Family history | |||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" | | | colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Common bile duct stone | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | ! rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Cholestatic Jaundice | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Dilated ducts on sono | |||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |CT/ERCP | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | |||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" | | | colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Hepatitis A cholestatic type | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |HAV- AB | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Abdominal ultrasound | |||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" | | | colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |EBV / CMV hepatitis | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Positive serology | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |PCR or ELISA | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" | | | colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Primary biliary cirrhosis | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N/↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N/↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |AMA positive | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Liver biopsy | |||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | |||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | |||
|- | |- | ||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Primary sclerosing cholangitis | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |''' | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N/↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N/↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Beading on MRCP | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Liver biopsy | |||
|- | |||
|} | |||
|} | |||
'''The differential diagnosis for jaundice, pruritis and RUQ pain are:''' | |||
{| align="center" | |||
|- | |||
| | |||
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center" | |||
! colspan="2" rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Classification of jaundice based on etiology | |||
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Disease | |||
! colspan="4" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |History and clinical manifestations | |||
! colspan="8" align="center" style="background:#4479BA; color: #FFFFFF;" |Diagnosis | |||
|- | |||
! colspan="6" align="center" style="background:#4479BA; color: #FFFFFF;" |Lab Findings | |||
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Other blood tests | |||
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Other diagnostic | |||
|- | |||
! rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |Family history | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Fever | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |RUQ Pain | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Pruritis | |||
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |AST | |||
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |ALT | |||
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |ALK | |||
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |BLR Indirect | |||
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |BLR Direct | |||
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |Viral serology | |||
|- | |||
! rowspan="6" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Jaundice | |||
! rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Cholestatic Jaundice | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Common bile duct stone | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Dilated ducts on ultrasond | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |CT/ERCP | |||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" | | | colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Hepatitis A cholestatic type | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |HAV- AB | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Abdominal ultrasound | ||
|- | |- | ||
| | | colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |EBV / CMV hepatitis | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Positive serology | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | | ||
|- | |- | ||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Primary biliary cirrhosis | |||
| | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N/↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N/↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |AMA positive | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Liver biopsy | ||
|- | |- | ||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Primary sclerosing cholangitis | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N/↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N/↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Beading on MRCP | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Liver biopsy | |||
|- | |||
|} | |||
|} | |||
'''The differential diagnosis for jaundice, fever and RUQ pain are:''' | |||
{| align="center" | |||
|- | |- | ||
| style=" | | | ||
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center" | |||
! colspan="2" rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Classification of jaundice based on etiology | |||
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Disease | |||
! colspan="4" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |History and clinical manifestations | |||
! colspan="8" align="center" style="background:#4479BA; color: #FFFFFF;" |Diagnosis | |||
|- | |- | ||
! colspan="6" align="center" style="background:#4479BA; color: #FFFFFF;" |Lab Findings | |||
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Other blood tests | |||
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Other diagnostic | |||
|- | |- | ||
! rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |Family history | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Fever | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |RUQ Pain | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Pruritis | |||
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |AST | |||
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |ALT | |||
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |ALK | |||
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |BLR Indirect | |||
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |BLR Direct | |||
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |Viral serology | |||
|- | |- | ||
! rowspan=" | ! rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Jaundice | ||
! rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" | | ! rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Hepatocellular Jaundice | ||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" | | | colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Alcoholic hepatitis | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑/N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" | | | colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Cirrhosis | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑/N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑/N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑/N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Low platate | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Small liver on ultrasond | |||
|- | |- | ||
! rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" | | ! rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Cholestatic Jaundice | ||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" | | | colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Hepatitis A cholestatic type | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |HAV- AB | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Abdominal ultrasound | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" | | | colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |EBV / CMV hepatitis | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Positive serology | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |PCR or ELISA | ||
|- | |- | ||
|} | |||
! rowspan="3" style=" | |} | ||
'''The differential diagnosis for jaundice and fever are:''' | |||
| style=" | |||
{| align="center" | |||
| style=" | |- | ||
| | |||
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center" | |||
! colspan="2" rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Classification of jaundice based on etiology | |||
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Disease | |||
! colspan="4" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |History and clinical manifestations | |||
! colspan="8" align="center" style="background:#4479BA; color: #FFFFFF;" |Diagnosis | |||
|- | |||
! colspan="6" align="center" style="background:#4479BA; color: #FFFFFF;" |Lab Findings | |||
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Other blood tests | |||
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Other diagnostic | |||
|- | |||
! rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |Family history | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Fever | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |RUQ Pain | |||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Pruritis | |||
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |AST | |||
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |ALT | |||
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |ALK | |||
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |BLR Indirect | |||
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |BLR Direct | |||
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |Viral serology | |||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" | | ! rowspan="9" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Jaundice | ||
! rowspan="4" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Hepatocellular Jaundice | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Viral hepatitis | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑/N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Specific viral antibody for each type | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" | | | colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Alcoholic hepatitis | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑/N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Drug induced hepatitis | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑/N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
|- | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Cirrhosis | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑/N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑/N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑/N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Low platate | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Small liver on ultrasond | |||
|- | |||
! rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Cholestatic Jaundice | |||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Hepatitis A cholestatic type | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |HAV- AB | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Abdominal ultrasound | ||
|- | |- | ||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |EBV / CMV hepatitis | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Positive serology | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |PCR or ELISA | |||
|- | |- | ||
! rowspan="2 | ! rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Isolated Jaundice | ||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Immune hemolysis | |||
| colspan=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | colspan="2" style="padding: 5px 5px; background: #F5F5F5;" align="center" |Autoantibodies | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | |||
|- | |- | ||
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Hematoma | |||
| | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | - | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Anemia | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Truma or surgery in history | |||
|- | |- | ||
|} | |} | ||
|} | |} |
Latest revision as of 21:11, 5 January 2018
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mehrian Jafarizade, M.D [2]
Differential diagnosis of jaundice
Abbreviations:
RUQ= Right upper quadrant of the abdomen, LFT= Liver function test, SIRS= Systemic inflammatory response syndrome, ERCP= Endoscopic retrograde cholangiopancreatography, N= Normal, AMA= Anti mitochondrial antibodies, LDH= Lactate dehydrogenase, GI= Gastrointestinal, CT= Computed tomography
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The differential diagnosis for jaundice and pruritis are:
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The differential diagnosis for jaundice, pruritis and RUQ pain are:
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The differential diagnosis for jaundice, pruritis and RUQ pain are:
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The differential diagnosis for jaundice, fever and RUQ pain are:
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The differential diagnosis for jaundice and fever are:
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