Hepatobiliary Disease And Related Disorders

Question 1

Common symptoms include:

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

Questions may point to risk factors such as foreign travel or intravenous drug use.

Answer 1

Viral Hepatitis

Question 2

The liver only usually causes pain if stretched. One common way this can occur is as a consequence of congestive heart failure. In severe cases cirrhosis may occur.

Answer 2

Congestive Hepatomegaly

Question 3

RUQ pain, intermittent, usually begins abruptly and subsides gradually. Attacks often occur after eating. Nausea is common.

It is sometimes taught that patients are female, forties, fat and fair although this is obviously a generalisation.

Answer 3

Biliary Colic

Question 4

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

The patient may be pyrexial and Murphy’s sign positive (arrest of inspiration on palpation of the RUQ)

Answer 4

Acute cholecystitis

Question 5

An infection of the bile ducts commonly secondary to gallstones. Classically presents with a triad of:

• Fever (rigors are common)
• RUQ pain
• jaundice

Answer 5

Ascending Cholangitis

Question 6

This describes small bowel obstruction secondary to an impacted gallstone. It may develop if a fistula forms between a gangrenous gallbladder and the duodenum.

Abdominal pain, distension and vomiting are seen.

Answer 6

Gallstone ileus

Question 7

Persistent biliary colic symptoms, associated with anorexia, jaundice and weight loss. A palpable mass in the right upper quadrant (Courvoisier sign), periumbilical lymphadenopathy (Sister Mary Joseph nodes) and left supraclavicular adenopathy (Virchow node) may be seen

Answer 7

Cholangiocarcinoma

Question 8

Usually due to alcohol or gallstones
Severe epigastric pain
Vomiting is common
Examination may reveal tenderness, ileus and low-grade fever
Periumbilical discolouration (Cullen’s sign) and flank discolouration (Grey-Turner’s sign) is described but rare

Answer 8

Acute Pancreatitis

Question 9

Painless jaundice is the classical presentation of pancreatic cancer. However pain is actually a relatively common presenting symptom of pancreatic cancer. Anorexia and weight loss are common

Answer 9

Pancreatic cancer

Question 10

Typical symptoms are malaise, anorexia and weight loss. The associated RUQ pain tends to be mild and jaundice is uncommon.

Answer 10

Amoebic liver abscess