I. Acute jaundice 1, hemolytic jaundice, the onset of certain drugs or infection and other triggers before the onset of the disease, often with defects in the red blood cells themselves. The manifestations are anemia, lumbago, fever, soy sauce-like urine; there is facial pallor, jaundice, hepatosplenomegaly, jaundice is proportional to anemia. There is anemia, hemoglobinuria, reticulocytosis, jaundice is mostly mild, serum bilirubin is usually not greater than 85umol/L, with indirect bilirubin predominating. 2, drug hepatitis, jaundice appeared before the application of drugs that can damage the liver, showing hepatomegaly with pressure pain, jaundice and liver function damage, but no symptoms of pre-viral hepatitis, hepatitis virus markers negative, gastrointestinal symptoms are not as obvious as viral hepatitis, liver function can be significantly improved or completely recovered after discontinuation of drugs. 3, extrahepatic obstructive jaundice, hepatomegaly is more common, gallbladder enlargement is common, liver function impairment is light, direct bilirubin is predominant, there are signs and symptoms of the original disease, such as biliary colic, radioactive right shoulder pain, chills and high fever, positive murphy’s sign, intra-abdominal mass, etc., laboratory tests such as ALP and Ch are significantly elevated, X-ray and ultrasound examination can reveal stone disease, dilated bile ducts inside and outside the liver, etc. 4, Infectious mononucleosis (children), with fever, significant pharyngitis, superficial lymph node enlargement, rash, hepatosplenomegaly as the main manifestation, while jaundice and gastrointestinal symptoms are mild and short-lived. The peripheral blood leukocyte count is increased, and the lymphocytes are significantly increased (>10% in heterogeneous gonorrhea), and the anti-EBV antibody is positive. 5, intrahepatic cholestasis syndrome in pregnancy, mostly occurs in the second trimester of pregnancy), first itchy skin, especially at night, then jaundice, which subsides 7-14 days after delivery, and then jaundice can be found in another pregnancy. Serum TB is often below 85umol/L, ALT can be normal or increased to more than 3-4 times the normal value, ALP and Ch can be increased. 6, chronic cholecystocholangitis support points, only show loss of appetite, nausea, anorexia, abdominal distension (epigastric pain), light jaundice, mild enlargement of the liver; unsupported points, no significant weakness, no right quarter rib vague pain and fever (right upper abdominal pain is not induced or aggravated after eating fatty diet), no pressure pain in the gallbladder area, Murphy’s sign negative, liver function tests jaundice obvious, (duodenal drainage of bile without white blood cells (no increase in the number of white blood cells in the duodenal drainage bile). Acute non-jaundiced hepatitis 1, fatty liver, may have a history of alcoholism, malnutrition or long-term history of hormone use, more obese body type. There are often no conscious symptoms, jaundice is rare, and the liver is mildly or moderately enlarged. There may be significant elevation of Ch, TG or β-lipoprotein, negative hepatitis virus markers, and fatty liver waveforms visible on ultrasound. 2, cirrhosis, history of chronic hepatitis B (hepatitis C) or alcoholism, or history of schistosomiasis, etc. Show long-term weakness, loss of appetite, abdominal distension and other symptoms, there may be increased liver hardness, splenomegaly is more obvious, more dull face, spider nevus and liver palms. Laboratory tests are A/G inversion, X-ray (or gastroscopy) can find varices in the lower esophagus. 3, schistosomiasis, living or having been to schistosomiasis endemic areas, with a history of exposure to infected water. Acute often have fever, caecal dermatitis and enteritis symptoms; chronic often have abdominal pain, diarrhea symptoms. The hepatomegaly is mainly in the left lobe, with a hard texture and little pressure pain, often with splenomegaly. The eosinophils are increased, the ring egg precipitation test, caecal membrane test and schistosome intercoagulation test are positive, and the rectal mucosal biopsy is positive for worm eggs. 4, drug-related hepatitis 3, chronic hepatitis 1, alcoholic chronic hepatitis, with a long history of heavy drinking, the condition will improve rapidly after quitting alcohol. Liver biopsy shows Mallory vesicles and negative hepatitis virus markers. 2, drug hepatitis, jaundice before the appearance of the application of drugs that can damage the liver, showing hepatomegaly and pressure pain, jaundice and liver function damage, but no symptoms of pre-viral hepatitis, hepatitis virus markers negative, gastrointestinal symptoms are not as obvious as viral hepatitis, liver function can be significantly improved or completely recovered after discontinuation of drugs. 3, primary biliary cirrhosis, the initial stage is also manifested as CH, patients are mostly middle-aged women, often with obvious skin itching, jaundice and hepatosplenomegaly. The increase of TBIL is mainly direct bilirubin, and CH, ALP and IgM are significantly increased. 90% of patients have positive AMA (characteristic changes of the disease). 4, autoimmune hepatitis, common in young women, symptoms similar to CH, some patients have rash, arthralgia, chronic thyroiditis and other autoimmune phenomena. Laboratory tests are negative for hepatitis virus markers, significantly elevated immunoglobulin (IgG, IgM), positive for various autoantibodies such as ANA, SMA, AMA, and increased ESR. 4, liver failure 1, deep jaundice of acute (chronic) hepatitis, serum TB in 171umol / L or more, but systemic toxic symptoms such as weakness, general malaise, gastrointestinal symptoms are mild, the liver does not shrink, no ascites and bleeding tendency. PT is not significantly prolonged, PTA is generally in the normal range. 2, sludge type hepatitis, light GI symptoms but deep jaundice, skin pruritus and hepatomegaly are obvious, stool color becomes lighter. Laboratory tests show increased serum ALT, increased TBIL, mainly increased direct bilirubin, and abnormally elevated ALP, GGT and CHE. 3, extrahepatic obstructive jaundice, hepatomegaly is more common, gallbladder enlargement is common, liver function impairment is mild, direct bilirubin is the main cause, there are signs and symptoms of the original disease, such as biliary colic, radioactive right shoulder pain, chills and high fever, positive murphy’s sign, intra-abdominal mass, etc., laboratory tests such as ALP and CHE are significantly elevated, X-ray and ultrasound examination can reveal stone disease, dilated bile ducts inside and outside the liver, etc. 4, acute fatty liver in pregnancy (AFLP), mostly occurs at the end of the first trimester, mostly with acute abdominal pain or complications of acute pancreatitis, deep jaundice, liver shrinkage. Severe hypoglycemia and hypoproteinemia, urine bilirubin test is always negative, ultrasound has typical fatty liver waveform. 5. Hepatomegaly (Willson’s disease), common in children (>6y) and adolescents, with familial tendency. It is characterized by cirrhosis of the liver, softening and degeneration of the basal ganglia of the brain and corneal pigment rings (K-F rings), often with tremor, hyperactivity, myotonia, and developmental disorders. Laboratory tests are low in serum copper and copper cyanine not. Liver biopsy liver copper content is significantly higher. V. Post-hepatitis cirrhosis 1. Primary hepatocellular carcinoma, often slow onset, with wasting, loss of appetite, pain in the liver, fever, jaundice and other manifestations, jaundice is obstructive performance, the liver can be significantly enlarged, hard, and nodules can be found. Serum AFP is often elevated, and imaging and tumor markers can confirm the diagnosis. 2, with ascites need to identify diseases ① tuberculous peritonitis, mostly secondary to other sites of tuberculosis lesions, generally more acute onset, there are obvious symptoms of systemic toxicity, may have abdominal pressure, tenderness, abdominal masses, etc., ascites adenosine deaminase (ADA) activity measurement significantly increased, barium X-ray examination of the stomach and intestines can help diagnose, anti-tuberculosis treatment is effective. ② cancerous ascites, abdominal metastasis of gastrointestinal cancer, may have abdominal pressure pain and exudative ascites, mostly bloody or celiac, ascites can often find cancer cells, with the manifestation of the original disease, imaging and tumor marker examination can confirm the diagnosis. ③ Pancreatic origin ascites, mostly seen in young and middle-aged men, mostly with history of alcoholism, chronic abdominal pain, history of acute and chronic pancreatitis, with aggressive condition, and significantly elevated amylase and lipase in ascites. 3, with upper gastrointestinal bleeding need to identify diseases peptic ulcer, bleeding mainly manifested as vomiting blood and black stool, mostly seen in young adults, with chronic, periodic and rhythmic epigastric pain as its holding point, gastroscopy can confirm the diagnosis. 4, with hepatic encephalopathy need to identify diseases ① hypoglycemia, hypoglycemic coma often rapid onset, pale, cold sweat, tachycardia and nausea and vomiting; episodes of blood sugar below 2.8 mmmol/L; intake or intravenous glucose can be immediately recovered. ② diabetic ketoacidosis, several days before the appearance of impaired consciousness, polyuria, irritable thirst, excessive drinking and weakness, rotten apple smell in the breath, severe water loss, low blood pressure and other signs of peripheral circulatory failure, most of the blood glucose is 16.7-33.3 mmol/L, elevated blood ketone bodies, and reduced CO2 binding capacity. Six, hepatitis B virus carriage 1, subclinical hepatitis B, infection with HBV may be a transient subclinical process, no symptoms and signs. HBsAg is transiently positive and then turn negative, generally within 6 months anti-HBs can be detected. 2, hepatitis B latent period, after infection with HBV, when the serum ALT is elevated 10-60 days before and clinical symptoms appear before HBsAg is positive, because Hepatitis B incubation period does not exceed 6 months, the need for close follow-up of infected patients, such as the emergence of ALT elevation and hepatitis manifestations can confirm the diagnosis of hepatitis B.