· A history of mild jaundice and constitutional symptoms (eg, fatigue, nausea), is more consistent with intrahepatic disease, such as acute viral hepatitis (eg, hepatitis A, hepatitis B, or hepatitis C infections)
· The subacute onset of fevers, chills, anorexia, and weight loss in a patient with advanced AIDS and hepatosplenomegaly may be related to disseminated infections, such as MAC, tuberculosis, Bartonella henselae, visceral leishmaniasis, histoplasmosis, or lymphoma. (See appropriate individual topics).
· In contrast, signs of jaundice accompanied by relatively acute abdominal pain suggest extrahepatic disease, such as a solid tumor or lymphadenopathy at the porta hepatis.
· Right upper quadrant pain with or without jaundice may be a presenting complaint in AIDS-related cholangiopathy, papillary stenosis, acalculous cholecystitis, cholelithiasis/choledocholithiasis, or drug-induced liver injury.
· A history of abdominal bloating, nausea, weight loss and right upper quadrant pain may be associated with the lactic acidosis syndrome, which is more common in women than men and usually secondary to chronic nucleoside analogue use with didanosine and/or stavudine. These agents are no longer recommended in the United States and Europe , but are commonly used in resource-limited settings. (See "Mitochondrial toxicity of HIV nucleoside reverse transcriptase inhibitors" and "Adverse effects of antiretroviral therapy in developing countries".)
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