Sky High

Multisystem Processes & Disorders


{"ops":[{"insert":"Diagnosis and reasoning"},{"insert":"\n","attributes":{"header":1}},{"insert":"This patient has presented with two disparate groups of findings which combine to form a very worrying whole:\n\n- Jaundice, hepatomegaly, right hypochondriac tenderness, altered sensorium, and asterixis: i.e. features suggestive of acute liver failure with hepatic encephalopathy.\n\n- Markedly elevated creatinine and urea levels, suggesting at acute kidney injury (AKI).\n\nNote that the combination of hepatic encephalopathy with AKI is uncommon; key diagnoses to consider include acetaminophen (paracetamol) toxicity, alcoholic hepatitis, ischemic hepatitis (shock liver), and cirrhosis with hepatorenal syndrome.\n\nLeptospirosis is another, albeit less common possibility. Note that acute viral hepatitis is usually not associated with renal impairment.\n\nThere are no clinical findings suggestive of prolonged hypotension, making ischemic hepatitis unlikely; in addition, his age, the absence of a history of alcohol abuse, and lack of stigmata of chronic liver disease make cirrhosis and alcoholic he"}]}

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