Case 21 - 52 yo F with jaundice

Question 1

Closure

Answer 1

Run some blood tests and conduct imaging studies

I recommend you stop drinking alcohol and limit your use of Tylenol, as both can harm your liver

Do you have any questions for me?

Question 2

Physical examination

Answer 2

HEENT exam (inspected sclerae and under tongue for jaundice)
CV exam
Pulmonary exam
Abdominal exam (inspection, auscultation, palpation, including Murphy’s sign, percussion, measurement of liver span, palpation for splenomegaly, fluid wave for shifting dullness)
Extremities (asterixis, edema)
Skin (spider nevi, cutaneous telangiectasias, palmar erythema)

Question 3

Differential diagnosis

Answer 3

Extrahepatic biliary obstruction (e.g. pancreatic cancer, cholangiocarcinoma, sphincter of Oddi dysfunction, supported by light stools, dark urine, pruritis, FHx, jaundice, scleral icterus and RUQ tenderness)
Viral hepatitis (h/o blood transfusion, recent travel to Mexico)
Acetaminophen hepatotoxicity (frequent acetaminophen use with alcohol)

Question 4

Diagnostic work-up

Answer 4

AST/ALT/bilirubin/alkaline phosphatase
Lipase
US - RUQ
CBC with differential
Viral hepatitis serologies
ERCP

Question 5

Diagnostic work-up

Answer 5

AST/ALT/bilirubin/alkaline phosphatase
Lipase
US - RUQ abdomen
CBC with differential
Viral hepatitis serologies
ERCP
PT/PTT
Acetaminophen level