Hepatic and Biliary

Question 1

What are the primary pain patterns for hepatic conditions?

Answer 1

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

Question 2

What are the primary pain patterns for biliary conditions?

Answer 2

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

Question 3

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

Answer 3

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

Question 4

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

Answer 4

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

Question 5

What are the signs and symptoms of jaundice?

Answer 5

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

Question 6

What are the risk factors for jaundice?

Answer 6

Liver disease, cirrhosis, alcohol abuse, and hepatitis.

Question 7

What are the signs and symptoms of ascites?

Answer 7

Abdominal swelling due to fluid accumulation, discomfort, and weight gain.

Question 8

What are the risk factors for ascites?

Answer 8

Liver cirrhosis, CHF, cancer, pericarditis, and infection.

Question 9

What is asterixis and what causes it?

Answer 9

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

Question 10

What are the signs and symptoms of acute hepatitis?

Answer 10

Fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, and jaundice.

Question 11

What are the risk factors for acute hepatitis?

Answer 11

Injection drug use, unsafe sexual practices, alcohol abuse, and exposure to contaminated blood.

Question 12

What are the signs and symptoms of chronic hepatitis?

Answer 12

Fatigue, joint pain, jaundice, muscle weakness, abdominal pain, and easy bruising.

Question 13

What are the risk factors for chronic hepatitis?

Answer 13

Long-term alcohol use, viral hepatitis, and autoimmune diseases.

Question 14

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

Answer 14

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

Question 15

What are the risk factors for cholelithiasis?

Answer 15

The “5 F’s” mnemonic: fair, fat, female, fertile, and forty (Caucasian, BMI > 30, women, > 40 years old).

Question 16

What are the signs and symptoms of cholecystitis?

Answer 16

Severe RUQ pain, nausea, vomiting, fever, and muscle guarding.

Question 17

What are the risk factors for cholecystitis?

Answer 17

Gallstones, fatty diet, obesity, and family history of gallbladder disease.

Question 18

What are the signs and symptoms of cirrhosis of the liver?

Answer 18

Fatigue, jaundice, weakness, easy bruising, and ascites.

Question 19

What are the risk factors for cirrhosis of the liver?

Answer 19

Chronic alcohol use, viral hepatitis, fatty liver disease, and obesity.

Question 20

What are the signs and symptoms of liver cancer?

Answer 20

Jaundice, weight loss, muscular weakness, constant ache in the epigastrium or mid-back.

Question 21

What are the risk factors for liver cancer?

Answer 21

Chronic liver disease, cirrhosis, long-term alcohol use, and viral hepatitis.

Question 22

What are the signs and symptoms of gallbladder cancer?

Answer 22

RUQ pain, jaundice, unexplained weight loss, nausea, vomiting, and abdominal swelling.

Question 23

What are the risk factors for gallbladder cancer?

Answer 23

Chronic gallbladder inflammation, obesity, and untreated symptomatic gallstones.

Question 24

What is the clinical significance of Murphy’s sign?

Answer 24

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

Question 25

What is the clinical significance of McBurney’s point?

Answer 25

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

Question 26

What are the “5 F’s” mnemonic for gallbladder disease?

Answer 26

Fair, fat, female, fertile, and forty (common risk factors for gallbladder disease).

Question 27

What are the rheumatic manifestations of hepatitis?

Answer 27

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

Question 28

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

Answer 28

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

Question 29

What are the four stages of hepatitis?

Answer 29

Incubation/preclinical (asymptomatic), initial/pre-icteric (arthralgias), icteric (jaundice), recovery (fatigue).

Question 30

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

Answer 30

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

Question 31

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

Answer 31

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

Question 32

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

Answer 32

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

Question 33

What are the most common complications of untreated gallstones?

Answer 33

Cholangitis (infection), cholecystitis (inflammation), and pancreatitis.

Question 34

What are the neurologic symptoms associated with hepatic disease?

Answer 34

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

Question 35

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

Answer 35

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

Question 36

What is the relationship between hepatic disorders and shoulder pain?

Answer 36

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