A 70 year old gentleman,a known hypertensive for 10 years presented with fever, abdominal pain and yellowish discoloration of skin for 1 week. Fever was intermittent and moderate. Pain was in right hypochondrium,sudden in onset, severe, intermittent and progressing. Yellowish discoloration of skin was sudden onset and progressive for 1 week.
The pain is associated with episodes of diarrhoea for last 4 days. The stool is clay coloured, soft and there is a trickle of blood when passing stool.Micturition habits are normal, however patient passes tea coloured urine.
No history of Shortness of breath,chest pain, palpitation, giddiness or itching.No history of travelling, intravenous drug usage, tattooing or any sexual promiscuity.
On examination,vitals were stable. Patient had pallor, palmar erythema, icterus, spider naevi ,recent axillary and chest hair loss(stigmata of chronic liver disease).Patients liver was palpable 3 finger breaths below costal margin. Spleen was not palpable. Patient was found to have hemorrhoids as well, explaining the bleeding per rectal.
My provisional diagnosis was Chronic Liver Disease with Obstructive Jaundice.
I also suspected Portal Hypertension to explain the hemarrhoids.
However an ERCP was done, it showed no pathology in the common bile duct ruling out Post Hepatic jaundice,but instead it was found to be intra hepatic type of obstructive jaundice.
* It became clear to me that a patient can have Chronic liver disease without jaundice , and that the jaundice was an acute symptom since it only appeared for last one week.
*I also became aware that a case of obstructive jaundice does not always have to be due to CBD obstruction. .
* question :
Is there a criteria to diagnose someone with with chronic liver disease?
Must a patient present with a certain number of features to be considered? and if so, how many is considered significant?



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