Differential Diagnosis for a 17-year-old with Yellow Sclera
Single Most Likely Diagnosis
- Viral Hepatitis: This is a common cause of jaundice (yellowing of the skin and sclera) in adolescents, often resulting from hepatitis A, B, or C infection. The justification for this being the most likely diagnosis is the age of the patient and the presentation of jaundice, which is a hallmark symptom of hepatitis.
Other Likely Diagnoses
- Gilbert Syndrome: A benign condition that affects the liver's ability to process bilirubin, leading to intermittent jaundice. It's more common in males and often becomes apparent during adolescence.
- Choledochal Cysts: Congenital anomalies of the bile duct that can cause obstructive jaundice. While less common, they are a significant consideration in adolescents presenting with jaundice.
- Hemolytic Anemias: Conditions like sickle cell disease or autoimmune hemolytic anemia can lead to increased bilirubin production due to red blood cell breakdown, resulting in jaundice.
Do Not Miss Diagnoses
- Pancreatic Cancer: Although extremely rare in adolescents, any cause of obstructive jaundice needs to be thoroughly investigated, including the possibility of pancreatic cancer.
- Budd-Chiari Syndrome: A condition characterized by thrombosis of the hepatic veins, leading to liver dysfunction and jaundice. It's crucial to diagnose due to its potential for severe complications.
- Wilson's Disease: An inherited disorder that causes copper accumulation in the liver, leading to liver damage and potentially jaundice. Early diagnosis is critical for effective management.
Rare Diagnoses
- Dubin-Johnson Syndrome: A rare genetic disorder affecting the liver's ability to transport bilirubin, leading to chronic jaundice.
- Crigler-Najjar Syndrome: A rare congenital condition characterized by a severe deficiency of the enzyme responsible for converting bilirubin into a water-soluble form, resulting in severe jaundice.
- Primary Sclerosing Cholangitis (PSC): A chronic liver disease that leads to scarring and narrowing of the bile ducts, potentially causing jaundice. It's rare in adolescents but can be associated with inflammatory bowel disease.