Case Challenge of the day: A previously healthy 50 y/o male presented with a 2-week history of malaise, anorexia and worsening abdominal pain, which progressed to nausea, vomiting and scleral icterus. He initially attributed his symptoms to an influenza-like syndrome; however, he became alarmed when he developed dark urine and generalized jaundice. The patient had no known personal or family history of liver disease. No history of any medications. He denied any changes in his diet or use of alcohol, tobacco or illicit drugs, but endorsed drinking 4–5 energy drinks daily for 3 weeks prior to presentation. . He did get a tattoo in his 20s, but denied any transfusions of blood products or high-risk sexual behavior. On physical examination, the patient had normal vital signs, scleral icterus and jaundice. Abdominal examination was remarkable for right upper quadrant (RUQ) tenderness, but there was no ascites, asterixis, spider angiomata or other signs of chronic liver disease. Laboratory studies revealed normal renal function. Rest you can see in the image. What do you think is the diagnosis and management of this case? Reference: www.ncbi.nlm.nih.gov

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DD Alcoholic liver disease (Elevated AST levels) To do viral markers for ( HbsAg, HCV, HAV) To do MRI to see pancreatic abnormality To take in considaration of CBD stones To do lipid profile also To take detailed History of usage of drugs like Methyldopa, isoniazide, Nitrofourantine, Paracetmol

Acute hepatitis.. Dd. Viral Alcoholic. Sug..clinical correlation Usg correlation Hepatitis B marker profile Hav Hcv

Viral Hepatitis Acute Likely to be Hepatitis A or Hepatitis E Adv Serological /Molecular studies for Viral hepatitis HBV HCV HAV HEV for confirmation

Viral hepatitis.. Adv viral markers Hbv, Hcv, Hav, Hiv Abdominal usg
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With history and lab reports favoring of viral hepatitis Get done viral markers Hep A B C E Usg abdo pelvis Triphagic CT fibro scan Routine lab With PBS for MP Lipid profile Serum ammonia level Gastro opinion Manage CONSERVATIVELY

? Viral hepatitis Needs further investigation like USG abdomen and LFT to rule out nature of phase and prove otherwise for purpose of line of treatment.

Thanks Dr Dinesh Gupta
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?? A case of Acute hepatitis Avoid NSAID Give IV fluids DNS Inj hepamerz Inj petop 40mg Tab Liv 52 Need to HBsAg USG roule out portal vein obstruction Nd need to B.sugar test

Viral HEPATITIS, in obstructive phase . Viral HEPATITIS profile , abdominal ultrasound to rule out obstructive cholangitis

Hepatitis. For further classified confirmation of diagnosis , go for Serological or Molecular studies.

Fulminant Hepatitis (? Viral) Screen for HBsAg, HCV, HAV UDCA + RedlivDS /Liv52

SUGGESTIVE. OF... ACUTE HEPATITIS MAYBE ... VIRAL ...... ALCOHOLIC ADVISABLE.... VIRAL. MARKERS MRI.../. USG... LFT

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