Jaundice & Hepatitis


HISTORY_LIST
dull RUQ pain
jaundice color
nausea
vomiting
malaise
anorexia
fever
shaking chills
diarrhea
dark urine
abdominal swelling
arthalgia
pruritis
urticarial rash
headache
somnolence
lethargy
weight loss
weight gain
clay colored stools
melena
hematochezia
hematemesis
alcoholism
recent exposure to hepatitis
exposure to AIDS
IV drug use
needle sticks
unprotected sex
recent transfusions
foreign travel
oral-fecal exposure
day care centers
nursing home
residential institutions
INFECTIOUS DISEASES
hepatitis immunizations
hepatotoxins
CHRONIC DISEASE
SYSTEMIC DISORDERS
gallstones
SURGERY
PREVIOUS HOSPITALIZATIONS
abdominal surgery
liver biopsy
PREVIOUS TESTS
LFT's
TRAUMA OR INJURIES
abdominal trauma
SOCIAL HISTORY
smoking
alcohol
caffeine
illicit drugs - cocaine
ALLERGY
medications
foods
seasonal
FAMILY HISTORY
alcoholism
liver dz.


MEDS_LAB_TESTS
**** MEDS
acetaminophen
isoniazid
phenytoin
methyldopa
phenothiazines
halothane
oral contraceptives
**** LAB
Electrolytes
BUN
creatnine
CBC
LFT
ammonia
conjugated bilirubin
unconjugated bilirubin
anti-HAV
HBsAg
HBeAg
anti-HBc
anti-HBs
anti-HBe
anti-HCV
anti-HDV
HIV
PT/PTT
UA
**** TESTS
abdominal CT or MRI


REVIEW_OF_SYSTEMS_1
GENERAL
weight changes
appetite changes
anorexia
difficulty sleeping
fever
chills
polyphagia
hypophagia
changes in thirst
sleeping habit change
bowel habit change
fatigue
hypertension
previous physical exams
SKIN
pigmentation changes
texture changes
lesions
eruptions
pruritis
easy bruising
easy bleeding
unusual hair loss
changes in hair distribution
skin masses
finger/toe nail change
rashes
hives
striae
skin atrophy
uremic frost
hirsutism
plethora
neurofibromatosis lesion
HEENT
head trauma
skull fractures
head masses
hearing loss
vertigo
chronic ear infection
ear discharge
ear pain
hearing aid use
loss of vision
recent change in vision
photophobia
diplopia (double vision)
glaucoma
exudates
dry eyes
eye pain
cataracts
eye surgery
itchy eyes
excessive tearing
corrective lenses
nose bleeds
chronic sinusitis
nasal fractures
nasal drainage
polyps
changes in sense of smell
edentulous (without teeth)
partial plate
full plate
recent dental work
oral lesions
tonsillitis
strep throat
tongue problems
voice changes
chronic hoarseness
chronic halitosis
NECK
neck masses
enlarged thyroid gland
brachial cleft cysts
neck injury

REVIEW_OF_SYSTEMS_2
CHEST
chronic coughing
sputum production
hemoptysis
wheezing
pneumonia
bronchitis
TB
TB exposure
SOB
SOB altered by position
edema
chest pains
pacemaker
HEART
MI
coronary artery disease
heart murmur
heart valve disease
left ventricular hypertrophy
mistral valve stenosis
pericarditis
palpitations
DOE
paroxysmal nocturnal dyspnea
orthopnea
edema
hypertension
rheumatic fever
cardiomyopathy
ectopic heart beats
arrhythmia
exercise intolerance
claudication
heart medications
ABDOMEN
abdominal pain
nausea
vomiting
diarrhea
constipation
hematochezia
hematemesis
hemorrhoids
GI x-rays
GI scopings
rectal bleeding
ulcers
bowel polyps
bowel incontinence
gall bladder disease
gall stones
hepatitis
cirrhosis
hepatomegaly
splenomegaly
GU
renal insufficiency
renal failure
dialysis
kidney stones
kidney disease
kidney cyst
flank pain
hematuria
pyuria
dysuria
chronic cystitis
nocturia
anuria
hesitancy
enuresis
change in urine color
prostatitis
epididymitis
scrotal problems
TURP
pain on intercourse
genital lesions
genital discharge

REVIEW_OF_SYSTEMS_3
OB/GYN
metorrhagia
menorrhagia
irregular menses
problems in pregnancy
use of contraception
breast masses
nipple discharge
breast skin changes
changes in axillary nodes
monthly breast exam
breast feeding children
EXTREMITIES
difficulty with gait
weakness
joint swelling
joint stiffness
muscle pain
muscle swelling
muscle injuries
sagittal plan scoliosis
coronal plane scoliosis
fractured bones
SLE
osteoarthritis
rheumatoid arthritis
fibromyalgia
NEURO
seizures
head injury
LOC
loss of coordination
difficulty in balance
sciatica
difficulty in fine motor skills
difficulty speaking
CVA (stroke)
weakness in arms
weakness in legs
tingling in legs and feet
tingling in arms
PSYCHIATRIC
depression
bipolar disorder
suicide attempts
hospitalization for 
    psychiatric problems
personality disorders
ENDOCRINE
goiter
exophthalmos
dry skin
dry hair
intolerance to heat
intolerance to cold
changes in growth
sterility
impotence
decreased libido
LYMPHATIC AND HEMATOLOGICAL
lymphadenopathy
transfusion
anemia


PHYSICAL_EVAL_1
VITALS
BP
Pulse
Temp
Heart rate
GENERAL
lethargic
SKIN
jaundice
needle tracks
sclerotic veins
hand edema
urticaria
bronze color (hemochromatosis)
umbilical venous collaterals 
    (caput medusae)
spider angiomas
HEENT
scleral icterus
sublingual jaundice
Kayser-Fleisher rings 
     (bronze cornea - Wilson's Dz.)
parotid gland hypertrophy
NECK
lymphadenopathy

PHYSICAL_EVAL_2
CHEST
gynecomastia
ABDOMEN
scar
bowel sounds
RUQ tenderness
liver span
liver margins
hepatomegaly
spleen size
splenomegaly
ascites
guarding
rebound tenderness
guaiac (occult blood)
hemorrhoids
GU
testicular atrophy
EXTREMITIES
joint tenderness
arthritis
palmar erythema
Dupuytren's contracture
NEURO
Mental status
orientation confusion
asterixis (flapping when 
    wrists are hyper-extended)




DIFF_DIAGNOSIS
Cirrhosis
Hepatic failure
CAUSES OF ACUTE HEPATITIS
VIRAL HEPATITIS
hepatitis A virus
hepatitis B virus
hepatitis C virus
hepatitis D virus
Epstein-Barr virus
cytomegalovirus
CHEMICAL AGENTS & DRUGS
excessive alcohol (ethanol)
oral contraceptives
isoniazid
acetaminophen
halothane
chlorpromazine
erythromycin
chemical solvents 
	(carbon tetrachloride)
mushroom poisoning
METABOLIC LIVER DZ.
Wilson's Dz.
CAUSES OF CHRONIC HEPATITIS
VIRAL HEPATITIS
hepatitis B virus
hepatitis B virus with D virus
hepatitis C virus
hepatitis D virus
CHEMICAL AGENTS & DRUGS
isoniazid
amiodarone
methyldopa
CLASSIFICATIONS OF LIVER DZ.
UNCONJUGATED HYPERBILRUBINEMIA
hemolysis
ineffective erythropoiesis
DECREASED HEPATIC UPTAKE
Gilbert's Syndrome
Drugs (rifampin, contrast media)
Neonatal jaundice
DECREASED CONJUGATION
Gilbert's Syndrome
Crigler-Najjar Syndrome I & II
Neonatal jaundice
Hepatocellular Dz.
Drug inhibition (chloramphenicol)
CONJUGATED HYPERBILIRUBINEMIA
IMPAIRED HEPATIC EXCRETION
Familial disorders 
   (Dubin-Johnson syndrome, 
    Rotor syndrome, benign
    recurrent cholestasis, 
    cholestasis of pregnancy)
Hepatocellular dz.
Drug-induced cholestasis
primary biliary cirrhosis
Sepsis
Postoperative
BILIARY OBSTRUCTION
gallstones
tumors of pancreas head
tumors of bile duct
tumor of ampulla of Vater
post-cholecystectomy 
	biliary stricture
primary sclerosing cholangitis
biliary atresia
STIGMATA OF LIVER DISEASE
umbilical venous collaterals 
    (caput medusae)
jaundice
spider angiomas
parotid gland hypertrophy
gynecomastia


