19 yr old male ,driver , complaints of yellowish discoloration of sclera , palms ,soles for 2 mnths .no H/o abdominal pain , loss of appetite ,wt loss ,discolourationof urine &stool , diarrhoea,offers no other complaints O/E .Abdomen non tender, Hepatomegaly (+), splenomegaly (+) .I have attached d investigation report .Give Ur valuable suggestions .

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Dublin johnson syndrome... Autosomal recessive hereditory disorder Do corporphyrin test and liver biopsy needed Because alkaline phosphatase normal and direct bilirubin is increased... It is conjugated hyperbilirubinemia

Dubin*
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Is there hemetemesis or melena???if + do upper gi endoscopy H/o alchoholism or not?? Do usg abdo pelvis with portal venous Doppler.

Doesn't consume alcohol .No such complaints sir
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Hepatosplenomegaly with cholelithiasis. Consider hemolytic anemia. What about cbc and peripheral smear?

CBC yet to be done , PS showed normochromic normocytic picture
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Alkaline phosphates is not increased so it's not obstructive jaundice...

Sgot and sgpt also normal
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Obstructive jaundice

Adv cbc ldh PBS anti hcv anti HEV anti HAV if all negative anti sma anti lkm antibodies...cholestasis due to cholelithiasis is also possibility but detail finding of gall Stone is not available

Do HIV..heptosplenomegaly..Serum ceruloplasmin levels low..Do 24 hour urine copper excretion..Do hcv RNA..Other blood reports...

What's SGPT,SGOT ,S. Bilurubin level, Australia Antigen tests report ,only then can be disscussed

All those test report av been posted
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Adv ...liver function test ...to rule out cirrhosis of liver portal hypertension

LFT has been done . I av attached d Report
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May be a case of obstructive jaundice,do LFT & USG whole Abdomen

LFT reports are attached.usg revealed Hepatomegaly
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