Hepatic and Biliary

Question 1

What are the primary pain patterns for hepatic and biliary conditions?

Answer 1

Hepatic:

• pain in the right upper quadrant (RUQ)
• pain mid-epigastrium, innervation from T5-T11.

Biliary:

• RUQ pain, typically after eating a fatty meal, may affect the 10th rib.

Question 2

What are the secondary (referred) pain patterns for hepatic and biliary conditions?

Answer 2

Hepatic:

• Back pain between T7 and T10 to the right of the midline, and right upper trapezius/shoulder pain.

Biliary:

• Right upper trapezius and shoulder pain, interscapular pain between T4 and T8, and right subscapular pain.

Question 3

What are the signs and symptoms of jaundice?

Answer 3

• Yellowing of the eyes (bilirubin > 2-3 mg/dL) and skin (> 5-6 mg/dL)
• Skin changes = pruritus, bruising, spider angiomas, and palmar erythema.

Question 4

What are the risk factors for jaundice?

Answer 4

Liver disease, cirrhosis, alcohol abuse, and hepatitis.

Question 5

Ascites

• signs and symptoms = ?
• risk factors = ?

Answer 5

• Signs and Symptoms: Abdominal swelling due to fluid accumulation, discomfort, and weight gain.
• Risk Factors: Liver cirrhosis, CHF, cancer, pericarditis, and infection.

Question 6

What is asterixis and what causes it?

Answer 6

Asterixis: A flapping tremor caused by the accumulation of ammonia in the blood, seen in liver disease patients.

Question 7

acute hepatitis

• signs and symptoms = ?
• risk factors = ?

Answer 7

• Signs and Symptoms: Fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, and jaundice.
• Risk Factors: Injection drug use, unsafe sexual practices, alcohol abuse, and exposure to contaminated blood.

Question 8

chronic hepatitis

• signs and symptoms = ?
• risk factors = ?
• metabolic diseases causing chronic hepatitis = ?

Answer 8

• Signs and Symptoms: Fatigue, joint pain, jaundice, muscle weakness, abdominal pain, and easy bruising.
• Risk Factors: Long-term alcohol use, viral hepatitis, and autoimmune diseases.
• Metabolic diseases causing = Wilson’s Disease, Hemochromatosis

• Considered chronic if lasting > 6 months

Question 9

What are the signs and symptoms of cholelithiasis (gallstones)?

Answer 9

RUQ pain, especially after eating, nausea, vomiting, fever, and muscle guarding.

Question 10

The “5 F’s” mnemonic = ?

Answer 10

The “5 F’s” mnemonic:

• fair:more prevalent in Caucasianpopulation
• fat:BMI > 30
• female
• fertile:one or more children
• forty:age > 40

Question 11

cholecystitis

• signs and symptoms = ?
• risk factors = ?

Answer 11

• Signs and Symptoms: Severe RUQ pain, nausea, vomiting, fever, and muscle guarding.
• Risk Factors: Gallstones, fatty diet, obesity, and family history of gallbladder disease.

Question 12

cirrhosis of the liver

• signs and symptoms = ?
• risk factors = ?

Answer 12

• Signs and Symptoms: Fatigue, jaundice, weakness, easy bruising, and ascites.
• Risk Factors: Chronic alcohol use, viral hepatitis, fatty liver disease, and obesity.

Question 13

liver cancer

• signs and symptoms = ?
• risk factors = ?

Answer 13

• Signs and Symptoms: Jaundice, weight loss, muscular weakness, constant ache in the epigastrium or mid-back.
• Risk Factors: Chronic liver disease, cirrhosis, long-term alcohol use, and viral hepatitis.

Question 14

gallbladder cancer

• signs and symptoms = ?
• risk factors = ?

Answer 14

• Signs and Symptoms: RUQ pain, jaundice, unexplained weight loss, nausea, vomiting, and abdominal swelling.
• Risk Factors: Chronic gallbladder inflammation, obesity, and untreated symptomatic gallstones.

Question 15

What is the clinical significance of Murphy’s sign?

Answer 15

Pain upon palpation of the RUQ during inspiration, indicates gallbladder inflammation (cholecystitis).

Question 16

What is the clinical significance of McBurney’s point?

Answer 16

Tenderness 1/3 the distance between ASIS and umbilicus, indicates appendicitis.

Question 17

What are the rheumatic manifestations of hepatitis?

Answer 17

Joint pain, typically asymmetric and oligoarticular, with larger joints affected; may precede GI symptoms by weeks.

Question 18

What are the different types of viral hepatitis and their primary transmission methods?

Answer 18

• Hepatitis A: fecal-oral
• Hepatitis B: blood, sexual contact;
• Hepatitis C: blood, body fluids.

Question 19

What are the four stages of hepatitis?

Answer 19

• incubation/preclinical (asymptomatic)
• initial/pre-icteric (arthralgias)
• icteric (jaundice)
• recovery (fatigue)

Question 20

What are the skin and nail bed changes associated with hepatic disease?

Answer 20

• Spider angiomas
• palmar erythema
• white nails (Nails of Terry)
• jaundice

Question 21

What are the signs and symptoms of metabolic bone disease in patients with cirrhosis?

Answer 21

Bone pain, weakness, and an increased risk of fractures due to impaired bone metabolism.

Question 22

What are the most common causes of liver cirrhosis in the United States?

Answer 22

Alcohol abuse, nonalcoholic fatty liver disease (NAFLD), and viral hepatitis.

Question 23

What are the most common complications of untreated gallstones?

Answer 23

• cholangitis (infection)
• cholecystitis (inflammation)
• pancreatitis

Question 24

What are the neurologic symptoms associated with hepatic disease?

Answer 24

• Asterixis (flapping tremor)
• CTS-like symptoms
• numbness and tingling in hands and feet.

Question 25

What are the signs and symptoms of cholangitis (infection of the bile ducts)?

Answer 25

RUQ pain, fever, chills, jaundice, and signs of systemic infection.

Question 26

What is the relationship between hepatic disorders and shoulder pain?

Answer 26

Hepatic or biliary disorders can refer pain to the right shoulder, typically with upper trapezius and subscapular pain.

Question 27

Cirrhosis of the Gallbladder

• signs and symptoms = ?

Answer 27

• Signs and Symptoms: Fatigue, pruritis, dry eyes and/or mouth, RUQ or shoulder pain, jaundice

• Metabolic bone disease: impaired osteoblasts, accelerated osteoclasts.