Hepatobiliary

Question 1

Classical triad of Hepatitis

Answer 1

1. Fever
2. Jaundice
3. Tender hepatomegaly

Question 2

25 year old single man comes to the clinic with general malaise, anorexia, nausea and fever for 10 days. Yesterday he noted dark urine and pale stools. On examination, you found high temperature, icterus and tender enlarged liver.

• Take further relevant history
• Arrange appropriate investigation
• Diagnosis and immediate management

Answer 2

1. Further history : - SADMA COT FP
   -Travel history
   - Sexual history
   - Immunisation against Hepatitis A or B
   - Blood donor or recipient
2. Investigations : - FBE with ESR & CRP
   - LFT
   - Serology for Hepatitis A, B, C and EBV
   - INR
3. Diagnosis : Hepatitis A (because travel history + long incubation period + no risk factors of Hepatitis B or C)
4. Immediate Management :
   - Complete bed rest, only up for toilet and shower
   - Fat free diet and extra fluids
   - No alcohol
   - No paracetamol
   - Extra care for hygiene to reduce the transmission by feco-oral route
   - Test girlfriend and other household members and treat them with immunoglobulin if positive

Question 3

25 year old single man comes to the clinic with general malaise, anorexia, nausea and fever for 10 days. Yesterday he noted dark urine and pale stools. On examination, you found high temperature, icterus and tender enlarged liver.

• Explain the Diagnosis.

Answer 3

• Condition - Hepatitis (infection of the liver)
• Cause - Hepatitis A, B, C virus or EBV
• Commonality - Not so uncommon
• Clinical features -
  Symptoms: travel history after whichever he has fever, general malasie, loss of appetite, nausea/vomitting, dark urine and pale stools with diarrhoea and skin becoming yellow.
  Signs: High temperature, jaundice and tender hepatomegaly.
• Course: Hepatitis A is usually Transmitted by feco oral route or Contaminated food and drinks.
• Prognosis: Complete recovery is expected which can be easily treated at home.
• Complications: if left untreated

Question 4

Causes of dark urine (hyperbilirubinuria)

Answer 4

1. Viral hepatitis- Hepatitis. A, B or C
2. Drug induced hepatitis - Antibiotics
3. Alcoholic liver disease
4. Hemochromatosis
5. Wilsons disease
6. Choledocolithiasis
7. Cholangiocarcinoma
8. Pancreatic carcinoma