|
 | Presentation
 | Patient presents with new-onset scleral icterus and rash (thorazine-related hepatitis) |
|
| History
| Ever have it before? |
| History of abdominal pain, change in stool color/urine
color, history of gall stones, pruritis, anybody else have this? |
| Meds: thorazine, chlorpromazine, anabolic steroids,
acetaminophen, OCPs, EtOH, IV drug use |
| Travel history, exposures, transfusions, sexual habits. |
|
| PE
| HEENT: scleral icterus, mucous membranes |
| Abd: usual exam, Murphy's sign, percuss liver and spleen |
| Rectal: hemoccult |
| Extremities: asterixis, Milkmaid's grip, nail changes |
|
| DDx
| Indirect hyperbilirubinemia
 | Hemolysis |
| Gilbert's |
| Crigler-Najjar |
| PE with infarct (?) |
|
| Direct hyperbilirubinemia
| Viral hepatitides |
| EtOH, drug-induced |
| Cholestasis |
| Cirrhosis |
| Rotor's syndrome |
| Dubin-Johnson |
| Cancer (pancreatic or hepatic) |
|
|
| Laboratory
| Hepatitis screen |
| Bilirubin: total and direct |
| CBC w/ diff, retic count |
| BMP |
| AST, ALT, GGT, Alk phos, albumin |
| Haptoglobin (decreases with hemolysis) / serum free
hemoglobin |
| Coags |
| Liver ultrasound (CT?) |
| Hemoccult |
| UA |
|
| Treatment
| D/C drugs |
| No tylenol (mucomyst for overdose) |
| Consult if appropriate |
| Treat underlying cause |
|
| Miscellaneous
| Tylenol overdose (remember to ask) |
|
|
