DIAGNOSIS CHECKLIST
for Liver symptoms

Why: to determine if acute or chronic.

Why: e.g. enlarged liver, jaundice, liver pain, tender liver.

Why: may indicate increased risk of hydatid disease. Hydatid disease occurs when humans ingest the embryos of the dog tapeworm which may occur with direct contact with infected dogs or by eating uncooked, improperly washed vegetables contaminated with infected canine feces.

Why: e.g. African or Far eastern country of origin, recent consumption of shellfish (may suggest hepatitis A), intravenous drug use, tattoos, male homosexuality, female prostitution, recent travel to areas with increased risk of hepatitis A, needle stick injury.

Why: snake venom may cause jaundice.

Why: e.g. some medical conditions may cause jaundice including haemolytic anemia, gallstones, cancer of the pancreas, cancer of the bile duct, strictures of the bile duct, hepatitis, cirrhosis of the liver and congestive cardiac failure; primary biliary cirrhosis may be associated with Sjogren's syndrome, scleroderma, rheumatoid arthritis; primary liver cancer is associated with Hepatitis B and C, alcoholic cirrhosis and hemochromatosis; liver metastases most commonly originate from breast, lung and colon cancer; right heart failure may be caused by left heart failure, chronic lung disease, pulmonary embolism or valvular heart disease secondary to previous rheumatic fever; Budd-Chiari syndrome may be caused by polycythaemia rubra vera, leukemia, renal cancer, hepatocellular cancer or hydatid cyst; sclerosing cholangitis is a cause of jaundice and may be associated with ulcerative colitis.

Why: e.g. many medications may cause jaundice including isoniazid, methyldopa, halothane, ketoconazole, niacin, nitrofurantoin, disulfiram, rifampin, testosterone, propylthiouracil, oral contraceptives, mercury; androgenic steroids and the contraceptive pill may be associated with hepatocellular carcinoma; contraceptive pill increases the risk of Budd-Chiari syndrome.

Why: e.g. prosthetic heart valve induced hemolysis may cause jaundice; certain anesthetics such as halothane may cause jaundice.

Why: e.g. excessive consumption of carotene due to intemperate eating of carrots, pumpkin, pawpaw or mangoes can cause yellow discoloration of the skin and be confused with jaundice; recent consumption of shellfish may suggest Hepatitis a infection that can cause jaundice; recent consumption of broad beans may indicate favism as a cause of hemolysis and jaundice.

Why: may provide information concerning risk of Hepatitis B and HIV infection.

Why: will indicate risk of alcohol related liver disease.

Why: may indicate risk of Hepatitis B, Hepatitis C and HIV.

Why: to determine if travel is to areas with an increased risk of Hepatitis A infection, yellow fever, malaria, dengue fever, Ebola virus, Marberg virus.

Why: e.g. hemochromatosis, Dubin-Johnson syndrome, Rotor syndrome, thalassemia major, congenital spherocytosis.

Why: e.g. exposure to hazards or animals (e.g. toxoplasmosis, leptospirosis, Q fever) which can cause hepatitis.

Why: e.g. carbon tetrachloride is a cleaning chemical that causes liver damage if inhaled or swallowed.

Why: may suggest biliary obstruction due to gallstones but any cause of enlarged liver may cause abdominal pain due to distention of the liver capsule. Abdominal pain in a person with jaundice may suggest common duct stones, sclerosing cholangitis, pancreatic cancer, bile duct cancer, pancreatitis, viral or alcoholic hepatitis.

Why: may suggest hemolytic anemia; toxic or infectious hepatitis; bile duct obstruction due to gallstones, carcinoma of the pancreas or ampulla of Vater; hepatic abscess or biliary cirrhosis.

Why: occurs with obstructive or cholestatic type jaundice such as gallstones, cancer of the pancreas, cancer of the bile duct, strictures of the bile duct, some medications, recurrent jaundice of pregnancy.

Why: suggests cholestatic liver disease such as viral hepatitis, alcoholic hepatitis, recurrent jaundice of pregnancy, primary biliary cirrhosis, common bile duct gallstones, cancer of the bile ducts, cholangitis, pancreatitis, biliary stricture, some medications.

Why: may suggest viral hepatitis, infectious mononucleosis, leptospirosis, ascending cholangitis, hepatic vein thrombosis, liver abscess and toxic hepatitis.

Why: often suggests cancer ( e.g. metastases, liver cancer, leukemia, lymphoma, cancer of the pancreas or bile ducts).

Why: e.g. weight loss, loss of appetite, fever, ache in the right upper abdomen, swollen abdomen.

Why: e.g. fatigue, shortness of breath, loss of appetite, nausea, swollen ankles, swollen abdomen and symptoms of left heart failure (unable to lie flat in bed due to breathlessness).

Why: e.g. bronze pigmentation, fatigue, loss of libido, painful joints, symptoms of diabetes, symptoms of congestive cardiac failure.

Why: e.g. jaundice (yellow skin), abdominal pain, fever.

Why: e.g. feel unwell with nausea, vomiting, diarrhea, loss of appetite, headaches, distaste for cigarettes, mild fever, mild abdominal discomfort, jaundice, dark urine, pale colored stools, may develop a rash and painful joints.

Why: e.g. abdominal pain, nausea, vomiting, tender enlarged liver, ascites (accumulation of fluid in abdominal cavity).

Why: e.g. fever, chills, reduced appetite, vomiting, weight loss, right sided upper abdominal pain and tender liver. There may be jaundice.