Hepatocellular jaundice (due to hepatitis or very severe liver failure)

Some differential diagnoses and typical outline evidence

	Suggested by: onset of jaundice over days or weeks, stools and urine pale or dark but dark urine.
	Confirmed by: ↑serum (conjugated) bilirubin and thus ↑urine bilirubin. Normal urine urobilinogen. Liver function tests all increasingly abnormal esp. ↑(ALT.

Some differential diagnoses and typical outline evidence

Acute (viral) hepatitis A	Suggested by: tender hepatomegaly.
	Confirmed by: presence of hepatitis A IgM antibody suggests acute infection.
	Management: OHCM p576.
Acute hepatitis B	Suggested by: history of iv drug user, blood transfusion, needle punctures, tattoos, tender hepatomegaly.
	Confirmed by: presence of HBsAg in serum.
	Management: OHCM p576.
Acute hepatitis C	Suggested by: history of iv drug user, blood transfusion, tender hepatomegaly.
	Confirmed by: presence of anti-HCV antibody, HCV-PCR.
	Management: OHCM p576.
Alcoholic hepatitis	Suggested by: history of drinking, presence of spider naevi and other signs of chronic liver disease. AST:ALT ratio >2.
	Confirmed by: resolution with abstinence.
	Management: OHCM p223.
Drug-induced hepatitis e.g. paracetamol halothane	Suggested by: drug history, recent surgery.
	Confirmed by: drug levels improvement after stopping the offending drug.
	Management: OHCM p223.
Primary hepatoma	Suggested by: weight loss, abdominal pain, RUQ mass.
	Confirmed by: ultrasound/CT liver, liver biopsy, ↑alpha-fetoprotein.
	Management: OHCM pp242, 243.
Right heart failure	Suggested by: ↑JVP, hepatomegaly, ankle oedema.
	Confirmed by: CXR: large heart. Echocardiogram: dilated right ventricle.
	Management: OHCM pp136–9.
Glandular fever (infectious mononucleosis)	Suggested by: cervical lymphadenopathy, sharp edge, ± Splenomegaly, ± jaundice.
	Confirmed by: Paul-Bunnell, +ve heterophil antibody test.
	Management: OHCM p570.