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