I need 3 possible diagnoses thats can be causing this symptoms. Please take note

Question

I need 3 possible diagnoses thats can be causing this symptoms. Please take note of the family history and past illness when diagnosing. please detail why you chose those 3 diagnoses, and how they can be tested for

Question Completion Status: UESTION 100 points Save Answer A 55 year old male who are HIV positive since 6 years ago came to the walk-in clinic for yellowing of the skin. He is under anti-retroviral therapy with successful results, the last time he came to the clinic was 6 months ago and the viral titer is low and showed no signs/symptoms. He admitted to have a monogamous protected sexual intercourse with his 10-year-male sexual partner. He has no other complaints besides the yellow skin color he experience since 5 days ago. He and his partner have been using heroine injection using shared needles routinely since 10 years ago. He said the last time he used it was about a month ago using a shared needle with his partner. This is his first time experiencing this condition and his partner did not complained of any signs/symptoms so far. Physical exam: A middle age male, normal weight, yellow-appearing, Looks alert to the place and time. Temperature: 380 Celsius (normal: 36.10-37.20) Blood pressure: 105/70 mmHg normal 120/80 mmHg) heart rate: 95 beat/minute (normal 60-100 x/minute) respiratory rate: 14/minute (normal 12 20 x/minute) Skin and sclera of the eyes appear yellow, conjunctivae look normal. Heart: heart sound normal, no heart enlargement, no murmur Lung: clear to auscultation. Liver and spleen: no enlargement.

Explanation / Answer

Chief complaint: Skin and sclera of the eyes appearing yellow.

History of the present illness:  

History of past illness:

Famiy history: None

Possible diagoses (diffrential diagnoses):

Explanation of pathophysiology of each of the differential diagnoses:

Obstructive jaundice is a particular type of jaundice and occurs when the essential flow of bile to the intestine is blocked and remains in the bloodstream. Symptoms of obstructive jaundice include yellowing of the skin and whites of the eyes; paler stools and darker urine; and intense itching. So given patient might be the case of obstructive jaundice because of yellowing of skin and eyes.

Some of the anti retroviral drug has side effects also. It might be possible that symptoms which are experienced by the patients is because of the side effect of the drug.

Suggestion of what extra work- up/ laboratory/ diagnostic- tests/ information needed to come to a more definite diagnosis for this patient:

Urine test: to examine the level of Bilirubin

Blood test: to examine the level of Bilirubin

Ultrasound of the liver and bile ducts:to find out the exact cause of the obstruction.

SGOT and SGPT: are reasonably sensitive indicators of liver damage or injury from different types of diseases or conditions, and collectively they are termed liver tests or liver blood tests.

HBsAg: is the surface antigen of the hepatitis B virus (HBV). It indicates current hepatitis B infection.

Diagnosis should be done on the patient's partner also since they are sharing drugs and also sexually attached to each other. It might bbe possible that patient's partner is suffering from some communicable disease but not showing any signs ans symptoms.

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