Differential Diagnosis

The patient presents with jaundice, spider angioma, and a history of non-alcoholic hepatitis, among other symptoms. Considering these findings, the differential diagnosis can be organized into the following categories:

• Single Most Likely Diagnosis
  • Acute Decompensation of Cirrhosis: Given the patient's history of non-alcoholic hepatitis, jaundice, spider angioma, and edema, this diagnosis is highly plausible. The patient's lack of medication adherence for three months could have exacerbated his liver condition, leading to decompensation.
• Other Likely Diagnoses
  • Viral Hepatitis: Although the patient has a history of non-alcoholic hepatitis, viral hepatitis could be a contributing factor, especially if he has been exposed to hepatitis viruses.
  • Alcoholic Liver Disease: Despite the patient's history of non-alcoholic hepatitis, it's essential to consider alcoholic liver disease, as the patient's social history and potential for underreporting alcohol use could be relevant.
  • Hemochromatosis: This genetic disorder can cause liver damage and is a possible consideration given the patient's presentation.
• Do Not Miss Diagnoses
  • Hepatocellular Carcinoma: Given the patient's history of liver disease, it's crucial to consider the possibility of hepatocellular carcinoma, which could be life-threatening if missed.
  • Budd-Chiari Syndrome: This rare condition, caused by hepatic vein thrombosis, can present with similar symptoms and is essential to consider due to its high mortality rate if untreated.
  • Wilson's Disease: Although rare, Wilson's disease can cause liver damage and psychiatric symptoms, making it a critical diagnosis not to miss.
• Rare Diagnoses
  • Alpha-1 Antitrypsin Deficiency: This genetic disorder can cause liver disease and is a rare consideration in this patient's differential diagnosis.
  • Autoimmune Hepatitis: Although less likely, autoimmune hepatitis could be a contributing factor to the patient's liver disease and should be considered in the differential diagnosis.

Given the patient's presentation, an urgent referral to Gastroenterology would be the most appropriate step, as it would allow for a thorough evaluation and management of the patient's liver disease.