Hepatology
| Ascites | Acute liver failure |
| 1) Exudative/low SAAG- i. TB, pancreatitis, ii. Malignancy-hepatic/peritoneal, iii. Others- nephrotic syndrome, hypothyroidism, lymphatic obstruction 2) Transudative /high SAAG- i. Cardiac failure- CCF, constrictive pericarditis ii. Liver failure- cirrhosis iii. Malnutrition- PEM, PLE iv. Hepatic venous occlusion- VOD, BCS v. Meig’s syndrome- ascites + pleural effusion + ovarian fibroma | 1) Drugs– paracetamol, anti-TB(INH, Rifampicin), halothane, MDMA/ecstasy, amphetamine, herbal medicines 2) Infection– HAV, HBV, HEV, non-A-E viral hepatitis 3) Poison– mushroom(Amanita phalloides) 4) Others– Wilson, leptospirosis, shock, cardiac failure, Budd-Chiari syndrome, liver metastasis, lymphoma, acute fatty liver of pregnancy 5) Cryptogenic cirrhosis |
| Jaundice |
| 1) Pre-hepatic: a) Hemolytic- congenital: membrane/enzyme/hemoglobin defect; acquired- autoimmune- CTD, SLE, RA, vasculitis, drugs, malignancy; alloimmune- HDN, transfusion reaction; non-immune- Wilson, MAHA, prosthetic valves, PNH, drugs b) Non-hemolytic- unconjugated- Gilbert’s, Crigler-Najjar; conjugated- Dubin-johnson, Rotor syndrome 2) Hepatocellular: a) Acute- viral hepatitis-ABE, AIH, ALD, Wilson, drugs b) Chronic- HBV, HCV, ALD, NAFLD, Hemochromatosis, Wilson, Alpha 1 antitrypsin deficiency, autoimmune hepatitis, PBC, PSC, VOD-BCS, cryptogenic 3) Obstructive: a) Intrahepatic- PBC, PSC, alcohol, drugs, cardiac cirrhosis, chronic RHF (constrictive pericarditis), severe sepsis b) Extrahepatic- cancer- periampullary, carcinoma head of the pancreas, cholangiocarcinoma, liver metastasis, choledocholithiasis, parasitic- ascaris infection, traumatic biliary stricture, chronic pancreatitis. |
Some others
| Hepatomegaly | Cirrhosis of the liver precipitated by Infection- viral, bacterial Dehydration- paracentesis, diuretics, loose motion, vomiting Constipation Variceal or non-variceal bleeding Hypokalemia- vomiting Drugs- sedatives, antidepressants |
| Hepatic encephalopathy | Cirrhosis of the liver precipitated by 1. Infection- viral, bacterial 2. Dehydration- paracentesis, diuretics, loose motion, vomiting 3. Constipation 4. Variceal or non-variceal bleeding 5. Hypokalemia- vomiting 6. Drugs- sedatives, antidepressants |
Cirrhosis
- Alcoholic liver disease
- Non-alcoholic fatty liver disease
- Chronic viral hepatitis B or C
- Autoimmune- PBC, PSC, AIH
- Genetic- HH, Wilson, a1ATD, CF
- Biliary- secondary biliary cirrhosis
- Chronic venous outflow obstruction
- Any chronic liver disease
- Drugs- MTX, amiodarone
- Cryptogenic (unknown- 15%)
Jaundice
a) Painful jaundice-
- Hepatitis- infective, alcohol, drug, Wilson
- Biliary colic- choledocholithiasis
- Cholecystitis
- Pancreatitis
- Metastatic jaundice
- Budd-Chiari syndrome
b) Painless jaundice-
- Hemolysis – hyperbilirubinemia, gilbert
- Pancreatic, biliary, GB, ampullary malignancy
- Hepatic cirrhosis- alcohol, NASH, hemochromatosis, PBC
