GI - Hepatobiliary Disease And Related Disorders - Characteristic Features

Question 1

What set of symptoms would prompt a viral hepatitis diagnosis?

Answer 1

Common symptoms:

• Nausea, vomiting, anorexia
• myalgia
• lethargy
• RUQ pain

Questions may point towards risk factors: foreign travel (E) or IDVU (B/C/D)

Question 2

What set of symptoms would prompt a congestive hepatomegaly diagnosis?

Answer 2

-Liver tenderness: liver only causes pain if stretched - t/f can happen as a consequence of congestive heart failure

Question 3

What set of symptoms/features would prompt a cholangiocarcinoma diagnosis?

Answer 3

• Persistent biliary colic symptoms
• anorexia, jaundice and wt loss
• palpable mass in RUQ (Courvoisier’s sign)
• Peri-umbilical lymphadenopathy - Sister Mary Joseph nodes
• left supraclavicular lymphadenopathy - Virchow node

Question 4

What set of symptoms/features would prompt a acute pancreatitis diagnosis?

Answer 4

Usually due to alcohol/gallstones

• severe epigastric pain
• vomiting is common
• examination may reveal tenderness, ileus, low grade fever
• Periumbellical discolouration: Cullen’s sign
• flank discolouration: Grey-Turner’s sign (rare)

Question 5

What set of symptoms/features would prompt a pancreatic cancer diagnosis?

Answer 5

• Painless jaundice: classical presentation (actually pain is relatively common symptom)
• Anorexia
• Wt loss

Question 6

What set of symptoms/features would prompt a amoebic liver abscess diagnosis?

Answer 6

• Typical symptoms: malaise, anorexia and wt loss
• Associated TUQ pain tend to be mild
• Jaundice uncommon
• fever can be present

Question 7

What set of symptoms/features would prompt a biliary colic diagnosis?

Answer 7

• RUQ pain, intermittent, usually begins abruptly and subsides gradually
• Attacks often after eating
• nausea common
• ‘Fat, female, fair, forties’ - bit of a generalisation

Question 8

What set of symptoms/features would prompt a acute cholecystitis diagnosis?

Answer 8

Pain similar to biliary colic but more severe and persistent, may radiate to back or right shoulder
-pt may be pyrexial and Murphy’s sign positive (arrest of inspiration on palpation of RUQ)

Question 9

What set of symptoms/features would prompt a ascending cholangitis diagnosis?

Answer 9

Infection of bile ducts, commonly secondary to gallstones - classic triad

• Fever (rigors common)
• RUQ pain
• Jaundice

Question 10

What set of symptoms/features would prompt a gallstone ileus diagnosis?

Answer 10

Describes small bowel obstruction secondary to impacted gallstone

• May develop if fistula forms between gangrenous gallbladder and duodenum
• Will have pneumobilia