Clinical Findings (Liver, Gallbladder & The Bile Ducts)

Question 1

Asymptomatic, alcohol abuse, chemotherapy, diabetes mellitus, elevated LFT’s (AST and ALT), hyperlipidemia, obesity, and pregnancy

Answer 1

Fatty liver disease

Question 2

Chills, dark urine, elevated LFT’s (ALP, ALT, AST, LDH, total bilirubin, PT), fatigue, fever, hepatosplenomegaly, jaundice, nausea, and vomiting

Answer 2

Hepatitis

Question 3

Ascites, diarrhea, abnormal LFT’s (ALP, ALT, AST, bilirubin, PT, PTT, total protein, and decreased albumin), fatigue, hepatosplenomegaly (initial), jaundice, splenomegaly, and weight loss

Answer 3

Cirrhosis

Question 4

Abnormal LFT’s, ascites, diarrhea, fatigue, hepatosplenomegaly (initially), hepatic encephalopathy, caput medusa, tremors, and GI bleeding

Answer 4

Portal hypertension

Question 5

Abdominal pain, elevated LFT’s, hypovolemia, leukocytosis, low-grade fever, nausea, and vomiting

Answer 5

Portal vein thrombosis

Question 6

Recent bout of diverticulitis, appendicitis, inflammatory bowel disease, bowel obstruction, ulcers within the bowel, GI cancer, and invasive procedures that involved stent placement (TIPS) or endoscopic analysis of the bowel

Answer 6

Portal venous gas

Question 7

Ascites, elevated LFT’s, hepatomegaly, splenomegaly, and upper abdominal pain

Answer 7

Budd-Chiari syndrome

Question 8

Asymptomatic, possible normal LFT’s, ADPKD, and hemorrhagic or large cysts may cause right upper quadrant pain

Answer 8

Hepatic cysts

Question 9

Leukocytosis, low-grade fever, nausea, obstructive jaundice, right upper quadrant tenderness, and possible recent travel abroad

Answer 9

Hydatid liver cyst

Question 10

Hepatomegaly, right upper quadrant or general abdominal pain, general malaise, diarrhea (possibly bloody), fever, leukocytosis, elevated LFT’s, mild anemia, and possible recent travel abroad

Answer 10

Amebic hepatic abscess

Question 11

Fever, hepatomegaly, leukocytosis, possible abnormal LFT’s, and right upper quadrant pain

Answer 11

Pyogenic hepatic abscess

Question 12

Immunocompromised patients including cancer patients, recent organ transplant patients, and patients with immunodeficiency virus, right upper quadrant pain, fever, and hepatomegaly

Answer 12

Hepatic candidiasis

Question 13

Cavernous hemangioma

Answer 13

Asymptomatic

Question 14

Focal nodular hyperplasia

Answer 14

Asymptomatic

Question 15

Asymptomatic, oral contraceptive use, and pain occurs with hemorrhage

Answer 15

Hepatocellular adenoma

Question 16

Hepatic lipoma

Answer 16

Asymptomatic

Question 17

Trauma, recent surgery, pain, and decreased hematocrit

Answer 17

Hepatic hematoma

Question 18

Elevated AFP, abnormal LFT’s (possibly), cirrhosis, chronic hepatitis, unexplained weight loss, hepatomegaly, fever, palpable mass, and abdominal swelling with ascites

Answer 18

Hepatocellular carcinoma

Question 19

Abnormal LFT’s (possibly), weight loss, jaundice, right upper quadrant pain, hepatomegaly, and abdominal swelling with ascites

Answer 19

Hepatic metastasis

Question 20

Pediatric patient, may cause hepatomegaly, and may be accompanied by hemangiomas of the skin

Answer 20

Infantile hemangioendothelioma

Question 21

Pediatric patient, may be asymptomatic, palpable abdominal mass, hepatomegaly, abdominal pain, weight loss, anorexia, elevated AFP, and jaundice

Answer 21

Hepatoblastoma

Question 22

Asymptomatic, biliary colic, abdominal pain after fatty meals, epigastric pain, nausea and vomiting, pain that radiates to the shoulders

Answer 22

Cholelithiasis

Question 23

Asymptomatic, any reason for biliary stasis (total parenteral nutrition, extended period of fasting)

Answer 23

Gallbladder sludge

Question 24

Polyps

Answer 24

Asymptomatic

Question 25

Adenomyomatosis

Answer 25

Asymptomatic

Question 26

Right upper quadrant tenderness, epigastric or abdominal pain, leukocytosis, possible elevation in ALP, ALT, GGT, and bilirubin (with obstruction), fever, pain that radiates to the shoulders, nausea and vomiting

Answer 26

Acute cholecystitis

Gangrenous cholecystitis and gallbladder perforation

Question 27

Diabetic patient, right upper quadrant pain possibly without Murphy sign, fever, can progress to sepsis

Answer 27

Emphysematous cholecystitis

Question 28

Intolerance to fatty foods because of subsequent to abdominal pain, nontender gallbladder

Answer 28

Chronic cholecystitis

Question 29

Right upper quadrant tenderness, epigastric or abdominal pain, leukocytosis

Answer 29

Acalculous cholecystitis

Question 30

Palpable gallbladder, could suffer from painless jaundice (Courvoisier gallbladder), possible elevation in ALP, ALT, GGT, and bilirubin (with obstruction)

Answer 30

Gallbladder enlargement

Question 31

Porcelain Gallbladder

Answer 31

Asymptomatic

Question 32

Weight loss, right upper quadrant pain, jaundice, nausea and vomiting, hepatomegaly, possible elevation in ALP, ALT, GGT, and bilirubin (with obstruction)

Answer 32

Gallbladder carcinoma

Question 33

Jaundice, elevated ALP, ALT, GGT, and bilirubin (with obstruction), right upper quadrant pain

Answer 33

Choledocholithiasis

Question 34

Charcot triad (fever, right upper quadrant pain, and jaundice), leukocytosis, elevated ALP, ALT, GGT, and bilirubin (with obstruction)

Answer 34

Cholangitis

Question 35

Recent biliary or gastric surgery, emphysematous or acute cholecystitis, or fistula formation, symptoms of acute cholecystitis

Answer 35

Pneumobilia

Question 36

Asymptomatic, may have symptoms of inflammation of the biliary tree, gallbladder, or pancreas

Answer 36

Ascariasis

Question 37

Jaundice, pruritus, unexplained weight loss, abdominal pain, elevated bilirubin and ALP

Answer 37

Cholangiocarcinoma

Question 38

Neonatal jaundice, elevated AST, ALT, and bilirubin

Answer 38

Biliary atresia

Question 39

Jaundice, pain, fever

Answer 39

Choledochal cyst

Question 40

Pain, fever, jaundice, signs of portal hypertension

Answer 40

Caroli disease