Which are the early (prodromal) clinical manifestations of hepatitis. (Select all that apply).

A. Brain, blood, cerebrospinal fluid (CSF): These are the three main components within the cranial vault as described by the Monro-Kellie doctrine. The total volume of these components remains constant, and any increase in one must be offset by a decrease in another to prevent elevated ICP.

B. Cerebrospinal fluid (CSF), blood, oxygen: While CSF and blood are intracranial components, oxygen is not a physical substance occupying volume in the cranial cavity. It is transported within the blood and does not contribute to changes in ICP in terms of physical space.

C. Brain, cerebrospinal fluid (CSF), air: Air is not a normal component of the cranial cavity. The presence of air would indicate pathology, such as a skull fracture with pneumocephalus, which is abnormal and can contribute to increased ICP but is not a standard component.

D. Brain, blood, lymphatic fluid: While the brain and blood are correct components, the central nervous system, including the brain, does not have a conventional lymphatic system like other parts of the body. Waste products are primarily cleared by the glymphatic system, which utilizes CSF, rather than traditional lymphatic fluid.

A. Obtunded: Obtunded patients show decreased alertness and respond slowly to stimuli, often requiring repeated stimulation to maintain attention. This level of consciousness is more severe than confusion and typically involves reduced awareness.

B. Coma: Coma is a state of deep unconsciousness where the patient is unarousable and unresponsive to external stimuli. It is much more severe than confusion or disorientation and is unlikely in a patient who is still able to interact, even if confused.

C. Stupor: Stupor refers to a condition where the patient is mostly unresponsive and only responds to vigorous or painful stimuli. It is more severe than confusion and involves markedly diminished awareness.

D. Delirium: Delirium is characterized by acute onset of confusion, disorientation, impaired attention, and fluctuating levels of consciousness. It best matches the patient's symptoms of confusion, disorientation, and inability to focus.

E. Mild lethargy: Mild lethargy involves drowsiness and reduced energy but does not typically impair orientation or the ability to focus as severely as seen in this patient.