Hepatobiliary disease

Question 1

nausea and vomiting, anorexia
myalgia
lethargy
right upper quadrant (RUQ) pain

may have Hx of travel/ IVDU

Answer 1

Viral Hepatitis (Hep ABCDE)

Question 2

Intermittent RUQ pain, often after eating.

Normally “female, forties, fat and fair”

Answer 2

Biliary Colic

Question 3

Pain similar to biliary colic but more severe and persistent. May radiate to the back or right shoulder.

Pyrexial and Murphy’s sign positive.

Answer 3

Acute cholecystitis

Question 4

fever (rigors are common)
RUQ pain
jaundice

Answer 4

Cholangitis

Question 5

Small bowel obstruction secondary to an impacted gallstone.

May develop if a fistula forms between a gangrenous gallbladder and the duodenum.

Answer 5

Gallstone ileus

Question 6

RUQ pain, anorexia, jaundice and weight loss.

Palpable RUQ mass (Courvoisier sign)

periumbilical lymphadenopathy (Sister Mary Joseph nodes)

left supraclavicular adenopathy (Virchow node) may be seen

Answer 6

Cholangiocarcinoma

Question 7

Severe epigastric pain + vomiting

Usually due to alcohol or gallstones
Periumbilical discolouration (Cullen’s sign) and flank discolouration (Grey-Turner’s sign) is described but rare

Answer 7

Acute pancreatitis

Question 8

Painless jaundice
Anorexia and weight loss
(sometimes may present with pain)

Answer 8

Pancreatic cancer