JAU ND IC E

B Y: K A R A S M I T H
NURS 6917
DIFFERENTIAL DIAGNOSIS
O C TO B E R 11 , 2 0 22
COMPLAINT

A 35-YEAR-OLD FEMALE PRESENTS WITH YELLOWNESS OF HER EYES AND

ITCHING
 ETIOLOGIES
Hyperbilirubinemia
• Elevation of unconjugated bilirubin
• Elevation of both unconjugated and conjugated
Pancreatic or biliary carcinoma, gallstone, alcoholic cirrhosis

Sickle cell anemia

Total Parental Nutrition

AIDS

EMERGENT!
SYMPTOMATOLOGY

Experiences
Has noticed the The yellowness
nausea and Husband states
itchiness for a of her eyes just Has a loss of
vomiting that she is
week and a began over the appetite
almost daily & confused
half last two days
diarrhea
QUESTIONS

• Have you had any recent travel?

• When did you notice the yellowness color of your skin?
• Any change to the color of urine or stool?
• Any alcohol or drug use (especially IV)? How often?
• Any HIV, abdominal surgery, transplant, or liver disease history?
• Have you been taking Tylenol?
• Are you having pain?
MEDICAL HISTORY
• Medical diagnoses include depression, anxiety, OCD, and
past suicidal attempts
• Has significant history of alcohol abuse: drinks up to a
case of beer a day some days
• Medications: Takes Xanax, Zoloft, and Zofran
• No recent travel
• Is not currently sexually active: does not know HIV
status
• No past surgeries
• Does not exercise
• Poor diet
 Temperature: 98.5

PHYSICAL EXAM Pulse: 125

Blood pressure: 124/65
SPO2: 97 on room air
Respiration:14

Dry mucous
Patient is ill Looks older than Yellowing of the
membranes, poor
appearing stated age sclera and skin
skin turgor

Appears to be Is confused-not
Has normal
dehydrated and Abdominal able to answer all
respiratory depth,
malnourished, is distention is noted questions
rate, and effort
underweight appropriately

Patient is Pulses are +2

tachycardic, S1 & throughout, Bowel changes-
S2 noted, no capillary refill less Diarrhea
murmurs than 3 seconds
 Liver cirrhosis related
to alcohol use

DIFFERENTIAL
DIAGNOSES
Biliary cirrhosis

Viral hepatitis
 LAB
CBC with differential TESTING
AST & ALT
Amylase
Lipase
Alkaline Phosphate
Ultrasound & CT Scan
Any additional questions you would
have asked when you reviewed
symptoms and history with the
patient?

What medications, if any, would you QUESTIONS

prescribe?
FOR CLASS
Are there any additional lab or
diagnostic testing that you would like
to complete?
REFERENCES

• Rhodes, J., Penick Julie C., (2018). Formulating a Differential Diagnosis for the
Advanced Practice Provider, second edition, New York: Springer.